ASSESS THE KNOWLEDGE AND PRACTICES OF NURSES REGARDING THE PREVENTION OF INFECTION IN BURN PATIENT IN TERTIARY CARE HOSPITAL LAHORE

Introduction: Burn wound infection are one of the most significant and possibly genuine complications that happen in the intense period following injury. Roughly 180,000 expiries happen due to burn each year evaluated by world health organization in 2018. Reducing the spread of disease and human care services related burn infection in the burn unit of public hospital. WHO has revealed a lot higher occurrence in Pakistan roughly 1388/100000 yearly when contrasted with worldwide frequency of 110/100000 for every annum Implementation of rules will lessen the rate pace of burn wound contamination in the burn unit. Methodology: quantitative observational descriptive study design was used to assess the nurses’ knowledge and practices regarding prevention of infection in burn patient. In order to assess nurses practiced, data was collected through the standardized checklist and questionnaire regarding prevention of infection in burn patient. The checklist and questionnaire consist of 55 items. Results: The findings of this study revealed that there are poor knowledge and practices of nurses regarding prevention of infection in burn patient. Conclusion: Based on the findings of the study, it is concluded that nurses working in burn units of hospital of Lahore, Punjab region have low knowledge and practices regarding prevention of Infections among burn patients. Therefore, hospitals are required to organize adequate trainings and to develop unit specific clinical infection control guidelines and protocols Key words: Infection, Practice, Knowledge, Burn, Patient. DOI: 10.7176/JHMN/74-11 Publication date: May 31 st 2020

focused results are misty. Right now, we analyzed the impact of chlorhexidine gluconate bathing on counteraction of clinic procured circulatory system diseases and surveyed constancy to execution of this conduct mediation (Musuuza et al., 2019).
There is expanding enthusiasm for the job of cleaning for overseeing hospital obtained contaminations. Pathogens, for example, vancomycin-safe enterococci, methicillin safe Staphylococcus aureus, multi safe Gram-negative bacilli, norovirus, and Clostridium difficile persevere in the health care services condition for a considerable length of time. Both cleanser and disinfectant-based cleaning can help control these pathogens, in spite of the fact that challenges with estimating neatness have undermined the nature of distributed proof. Conventional cleaning techniques are famously wasteful for sterilization, and new methodologies have been proposed, including disinfectants, steam, mechanized dispersal frameworks, and antimicrobial surfaces (Dancer, 2014).
Medical attendants share obligation with other health care services work force for infection chance decrease in patients across whole continuum of care and assume imperative job in diminishing dangers for disease through an assortment of direct consideration exercises (Abukhelaif, 2019). Use and proper disposal of personal protective equipment, solid hospital waste management, environmental sanitation and properly cleanliness of equipment, surfaces play an important role in infection control among burnt patients. So, it is need to assess the nurse's knowledge and practices regarding the prevention of infection among burnt patients.

Problem statement:
Burn wounds are possibly hazardous conditions and burn patients request excellent consideration. Infection management during care of burnt patients at burnt units are essential for the wellbeing of patients and health care worker. Nurses are play as an important role during care of burnt patient. This care should be given by knowledgeable and competent nurses following specific guideline or protocols that will reduce the occurrence of infection and complications.
Thus, there is proof that administration and care of patient with burn injury need a one of a unique information and abilities from a mindful multidisciplinary colleague particularly the medical health worker such as nurse, and explicit contamination control rules ought to be produced for decreasing diseases particularly clinic procured disease. The actual need to do the study is to assess the knowledge and practice of nurses regarding prevention of infection among burnt patient. In the context of above mention research problem, the answer will give for bellow mentioned questions through this study.
Purpose of the study: the purpose of the study is to assess the nurses' knowledge and practice for prevention of infection in burn patients in tertiary care hospital Lahore

Research questions:
• What is the knowledge of nurses regarding Prevention of Infection in Burn Patients?
• What are the practices of nurses regarding Prevention of Infection in Burn Patients?

Hypothesis
Alternative hypothesis: • Nurses knowledge may have positive effect in control of infection among burnt patient.
• Nurses practices may have positive effect in control of infection among burnt patient.

Infection:
The intrusion and duplication of microorganisms, for example, microscopic organisms, viruses, and parasites in consume quiet conceded in burn unit that are not regularly present inside the body.

Independent variable;
• Knowledge

Limitation/ Scope of the study
• Investigation discoveries will be restricted and can't be summed up on the generalized that the little example and chose from one land region in Pakistan. • The extent of the examination will be additionally restricted not utilized control group • The scope of the study will be also limited not used control group.

Review of Literature
Roughly 180,000 deaths happen by burn each year assessed by world health organization in 2018 (Jennifer . WHO has revealed a lot higher occurrence in Pakistan roughly 1388/100000 yearly when contrasted with worldwide frequency of 110/100000 for each annum Implementation of rules will decrease the rate pace of consume twisted disease in the consume unit (Othman & Kendrick, 2010). Different studies show that the how patient related items, nurse knowledge and practices have importance in prevention of infection in burnt patients.
A study recently conducted in Pakistan regarding the assessment of Knowledge regarding infection control was received by 89% of nurses but their source of information was practice not in-service educational programs.
Subsequently, they had inadmissible degree of information and practices showed by information and practice score under 75%. The discoveries of the present examination uncovered medical attendants' low degree of information and practices. Thus, health care settings are required to compose propelled instructional courses and to create unit explicit clinical rules and conventions (Buksh, Ghani, Amir, Asmat, & Ashraf, 2019).
Another study conducted in 2018 to assess the knowledge of nurses regarding prevention of infection among burn patients and results revealed that that the majority 69.8% of nurses had passed score of knowledge regarding nosocomial infection in burns' units at middle Euphrates teaching hospitals.in addition, the present study pointed out there was a significant relationship between nurse knowledge and number of training courses about nosocomial infection (AL-Salih et al., 2018).
In 2017 authors proposes in their investigations with respect to nurse's information about contamination and a large portion of the nurses 87% had a reasonable degree of information, while just 4% of them had a decent degree Journal of Health, Medicine andNursing www.iiste.org ISSN 2422-8419 An International Peer-reviewed Journal Vol.74, 2020 184 of information on preventive proportions of nosocomial diseases among burnt patients. The outcomes additionally uncovered that most of the nurses71% had reasonable practices about nosocomial diseases while 26% of them had great practices and just 3% of them had poor practices. The holes in information and works on with respect to disease control measures show the need to build up a related medicinal services arrangement in regards to contamination (Alrubaiee, Baharom, Shahar, Daud, & Basaleem, 2017).
In Nigeria a study conducted to assess the knowledge and practices of nurses regarding infection control and results revealed that the sixty nine out of the 80 respondents had great information that a hand is the most widely recognized vehicle of transmission of contamination. Be that as it may, 53.8% and 32.5% of the respondents knew about development of hand cleanliness and rehearsed six stages of the hand washing procedure separately (Adegboye et al., 2018).

Hand washing:
In 2016 a study conducted regarding aseptic technique such as hand washing in association with infection spread among burn patient and results revealed that the 42.9% 42.9% of the members didn't wash their hands appropriately previously, during and after the dressing methodology while 88.1% had great information on aseptic system; anyway 14.6% of the members kept up the aseptic system practice all through the technique while 85.4% didn't. Measurable criticalness was found between hindrances to aseptic system and satisfactory water supply in the taps and cleanser at P=0.038. 70.7% of the rooms needed standard working methods on disease counteraction (JEROTICH, 2016).

Gloves:
A study conducted in 2019 regarding gloves as a powerful hindrance for contamination control and results uncovered that there is solid proof of positive connection between familiarity with the respondents with gloves as a viable boundary for disease control, hand interceded transmission and catheter care rehearses with a large portion of the attendant's segment qualities anyway there was no relationship between the age and wearing of gloves (Abukhelaif, 2019).
Aseptic technique: Prevention of burn wound contamination includes evaluation of the injury at each dressing change for changes in the character, scent or measure of twisted seepage, with prompt warning of the doctor if any crumbling happens. Exacting aseptic procedure ought to be utilized when taking care of the open injury and dressing materials just as recurrence of dressing ought to be founded on the appraisal of the injury condition. In the event that the injury has necrotic material present, a debriding dressing ought to be picked while a defensive dressing is best for perfect, mending wounds (Norbury et al., 2016).

Needle stick injury:
Injections with tainted needles and syringes in low-and center pay nations have diminished significantly as of late, incompletely because of endeavors to decrease reuse of infusion gadgets. Regardless of this advancement, in 2010, hazardous infusions were as yet liable for upwards of 33 800 new HIV contaminations, 1.7 million hepatitis B diseases and 315 000 hepatitis C diseases .An individual who encounters one needle stick injury from a needle utilized on a tainted source quiet has dangers of 30%, 1.8%, and 0.3% separately of getting contaminated with HBV, HCV and HIV (Pepin, Chakra, Pepin, Nault, & Valiquette, 2014). Journal of Health, Medicine andNursing www.iiste.org ISSN 2422-8419 An International Peer-reviewed Journal Vol.74, 2020 Solid waste and PPE: the aggregate sum of waste created by human services exercises, about 85% is general, non-dangerous waste. The staying 15% is viewed as perilous material that might be irresistible, dangerous or radioactive. Measures to guarantee the safe and ecologically stable administration of social insurance squanders can keep unfriendly wellbeing and natural effects from such waste including the unintended arrival of substance or organic risks, including drug-safe microorganisms, into the earth subsequently ensuring the strength of patients, wellbeing laborers, and the overall population (Tarvadi, 2018).

Venous catheter insertion:
An examination analyzed the impact of purging versus no purifying, and results uncovered that the Chlorhexidine arrangement may diminish blood diseases related with the catheter contrasted and povidone-iodine arrangement (lessening the contamination rate from 64 cases for each 1000 patients with povidone iodine to 41 instances of disease for every 1000 with chlorhexidine. This makes an interpretation of into the need to get 44 individuals maintain a strategic distance from one extra circulatory system contamination. Chlorhexidine arrangement may (contrasted and povidone iodine arrangement) additionally decrease the nearness of irresistible life forms inside the catheter diminished from 240 tainted catheters for every 1000 individuals to 189 contaminated catheters for every 1000 individuals (Lai et al., 2016).
Chlorhexidine bath: Patient bathing with chlorhexidine gluconate essentially decreased the rate of clinic gained circulation system diseases. Numerous examinations didn't report constancy to the intercession or patient-focused results. For maintainability and replicability fundamental for compelling execution, loyalty appraisal that goes past whether a patient got a mediation or not ought to be standard practice especially for complex social intercessions, for example, chlorhexidine gluconate bathing (Musuuza et al., 2019).
Environmental cleaning: Environmental cleaning is a piece of standard Precautions, which ought to be applied to all patients in all health care services setup. It is significant that ecological cleaning programs be executed inside the structure of office level projects. Where conceivable during staff preparing and instruction, for instance consider producing collaborations and featuring the connection between ecological cleaning and hand cleanliness exercises in forestalling natural transmission of emergency clinic procured disease (Ling, Apisarnthanarak, Villanueva, Pandjaitan, & Yusof, 2015).

Objectives
General objective: • To assess the Nurses' knowledge and practices for prevention of infection in burn patients in tertiary care hospital Lahore.

Specific objectives
• To assess the Nurses' knowledge for prevention of infection in burn patients in tertiary care hospital Lahore.
• To assess the Nurses' practices for prevention of infection in burn patients in tertiary care hospital Lahore.
Journal of Health, Medicine and Nursing www.iiste.org ISSN 2422-8419 An International Peer-reviewed Journal Vol.74, 2020 Significance of the study Patient: who conceded burn unit for the most part is profoundly helpless to disease. Along these lines, the use of widespread precautionary measures secured staff, patients and condition from contamination it is limited uses in burn unit to advance patient wellbeing and reduction chance.
Nurse: in this manner, evaluation level of attendants' information and practice about disease control procedure is crucial activity to control contamination in the burn unit. In this way nurses will comprehend their weakness and attempted to receive standard rule in results their insight and abilities will be improved.

Organization:
The Finding of the examination may be useful for the association to build up the methodologies to control superfluous infection through instructional meeting, workshop, and class in result at last this will improve the workplace and nature of care. It will be appropriate for the administration to find a way to locate the powerless components. In results the quality of care will be improved.
Policy maker: This mindfulness will help the strategy creator to plan methodologies and set in motion to improve the workplace.

Future researcher:
The aftereffect of this investigation will provide guidance to the future analyst to use this examination as a writing and direction. Moreover, study will assist them with identifying the investigation hole.
The discoveries of the examination can be utilized as optional information for future research researchers.

Study Design:
Observational quantitative cross-sectional investigation study design was use

Study site:
The study was conducted in Jinnah hospital located at Lahore, Pakistan.

Study Setting:
The study was conducted in burn-unit of Jinnah hospital.

Study duration:
The Study duration was 4 months from February, 2020 to May, 2010.

Study population:
The study population was all charge nurses working in burn units of Jinnah hospital.

Inclusion Criteria:
• All charge nurses working in burn units working at least for six months before the start of data collection.
• Willing to participate Exclusion Criteria: • Nurses working in burn care units, who were not involved in direct patient care e.g. Head nurses, Clinical Instructors and Nurse Managers and nurses who have worked for less than six months in the Burns Unit.

•
Not willing to participate Sampling Technique: 187 Data was collected by convenient sampling technique from selected sample.

Sample Size:
Sample size was calculated by using "Selvin's formula".
The total population is 300. The sample size for this study will be 171.

Ethical Consideration;
Composed consent was taken from the Ethical board of University of Lahore. Authorization was taken from the Nursing manager of, Jinnah hospital, to lead investigate study. All members were educated about the motivation behind the examination. All data and gathered information were kept secret by head examiner printed copy in lock.
Secrecy of delicate duplicate was kept up by a coding. The subject was educated that there are no hindrances or hazard on the strategies of the investigation.

Data collection procedure:
After endorsement poll was circulated the nurses to survey the information and watch the nurse's practices over a time of 02 months beginning from walk 2020 to April 2020. The chose burn units were visited on consistent schedule and nurses were drawn closer during morning, night and night shifts.

Data Collection Instrument and Tools:
A well-adapted questionnaire was to measure the knowledge in this study from nurses' point of view it consists of two sections.
Section A: section A consists of demographic data such as age, educational status, experience, information received regarding infection control and protocol availability regarding infection control.
Section B: section "B" consists of 27 items. It was used in 2018 to assess the knowledge of nurses regarding prevention of infection among burnt patient. It was calculated as with internal consistency of 0.685 which indicated that the instrument was reliable for data collection. The nurses will require indicating their opinions.
Section C: section "C" is a checklist including, use of personal protective equipment's and its disposal, fumigation, disinfectant of medical equipment, appropriate waste management of burn unit waste, aseptic techniques, hand Journal of Health, Medicine and Nursing www.iiste.org ISSN 2422-8419 An International Peer-reviewed Journal Vol.74, 2020 washing techniques, Chlorhexidine bath, aseptic techniques of skin preparation. Check list will use to assess the practices of nurses working in burn units.

Data Analysis Method:
The study was analyzing the data by SPSS version 16. Statistical analysis of the study was descriptive. The study sample will be characterized by using a measure of central tendency (mean, median, and mode).

Results
This study is conducted at Jinnah hospital to assess the knowledge and practices of nurses regarding the prevention of infection in burn patient. The result of this study distributed into two sections, first section is statistics of demographic factors of nurse working in hospital regarding the prevention of infection in burn patient and second is frequency and statistics of 27 items regarding nursing knowledge assessment and Checklist regarding prevention of infection in burn patients.
Section A: Table 1 shows that the frequency of demographics includes age, qualification experience, Protocol availability regarding infection control and Information received regarding infection control of the 171 participants and the results revealed that the age of participants was found minimum 21 to highest 52, participant's age group 21-28 years frequency was 31 (18.1%), majority 64 (37.4%) participants were belong to age group 37-44 years and moderately 53 (31%) were fall in age group 29-36 years and only 23 (13.5%) were 45-52 year old. Only 32 (18.3%) participants have experience 10-12 years, majority of nurses 62 (36.7%) have 7-9 years job experience, 38 (22.2%) have 4-6 years' experience and 39 (22.8%) nurses have 1-3 years' experience. Participants' response regarding Protocol availability regarding infection control as only 56 (32.7%) go with there is no proper availability of protocol and majority 115 (67.3%) respond as yes there is availability of protocols as needed. The Information received regarding infection control was found as majority106 (62%) were not received information and only 65 (38%) were Information received regarding infection control. The qualification of the participants was 16 (9.4%) having diploma in midwifery, majority 109 (63.7%) have diploma in general nursing, 36 (21.1%) have bachelor of science in nursing (Post RN) and only 10 (5.8%) were hold a degree of Bachelor of science in nursing (Generic).  Table 2 Figure 1 shows that the age of participants was found minimum 21 to highest 52, participant's age group 21-28 years frequency was 31 (18.1%), majority 64 (37.4%) participants were belong to age group 37-44 years and moderately 53 (31%) were fall in age group 29-36 years and only 23 (13.5%) were 45-52 year old.

Figure 1
Journal of Health, Medicine and Nursing www.iiste.org ISSN 2422-8419 An International Peer-reviewed Journal Vol.74, 2020 Figure 2 shows that the only 32 (18.3%) participants have experience 10-12 years, majority of nurses 62 (36.7%) have 7-9 years job experience, 38 (22.2%) have 4-6 years' experience and 39 (22.8%) nurses have 1-3 years' experience.     Section B: Section 2 consist of questionnaire and checklist regarding the prevention of infection in burn patient consisting 54 items further divided into 2 parts, and each part consists 27 items. Table 3 shows the frequency percentage of 27 items of questionnaire regarding knowledge assessment of nurses for the prevention of infection in burn patient. and results revealed that mostly above 50 % nurses have good knowledge. Item one is "Burn patients are unique due to propensity to disperse microbes" and results revealed that the majority 108 (63.2%) respond as yes and only 63 (36%) respond as "No". The participant responds as 95 (55.4%) know and 76 (44.6%) did not know the referral criteria of American Burn Association. Item three is "Zone Journal of Health, Medicine and Nursing www.iiste.org ISSN 2422-8419 An International Peer-reviewed Journal Vol.74, 2020 is located in the center of burn wound" and participants respond as majority 101 (69.1%) were go with "Yes" and 70 (40.9%) were responds as "No". The participants response regarding item four which is "Treat it with a skin care product like antibiotic ointment" and results revealed that the only 80 (46.2%) were do this and majority 91 (53.8) did not do this. The participants response regarding item five and results revealed that majority 103 (60.2%) know that and 68 (39.8%) did not know that the major burn infection is burn wound cellulitis. Item six is "Common cause of fever in burn patients is systemic inflammatory" and majority 119 (69.4%) go with yes and 52 (30.6%) respond as "No". Item seven is "Burn wound cellulitis is most common infection in burn patients" and results revealed that the majority 110 (64.7%) respond as yes and only 61 (35.3%) respond as "No". The participant responds as 104 (60.2%) know and 67 (39.8%) did not know the Burn wounds initially colonized with grampositive organisms. Item nine is "Sepsis syndrome manifested by, bloodstream infection, Fluid loss" and participants respond as majority 91 (53.2%) were go with "Yes" and 80 (46.8%) were responds as "No". The participants response regarding item ten which is "Exogenous microorganisms resistant as compared to endogenous" and results revealed that the only 120 (70.2%) were do this and 51 (29.8) did not do this. The participants response regarding item eleven and results revealed that majority 114 (66.8%) know that and 57 (33.3%) did not know that the principle causative agent of cellulitis gram positive organisms. Item twelve is "Routine surveillance cultures should be taken after 3 months" and majority 108 (63.2%) go with yes and 63 (36.8%) respond as "No". Item thirteen is "Quantitative swab culture provide information about the presence of microorganisms on the external catheter surface" and results revealed that the only 71 (41.5%) respond as yes and 100 (58.5%) respond as "No". The participant responds as 99 (57.1%) know and 72 (42.9%) did not know the contact precautions are most effective than other precautions. Item fifteen is "plants and flowers harbor resistant organisms that's why these are not allowed in burn unit" and participants respond as majority 100 (58.5%) were go with "Yes" and 71 (41.5%) were responds as "No". The participants response regarding item sixteen which is "According to Spaulding classification of medical devices, which come in contact with mucous membranes or nonintact skin require high level of disinfection as semi critical item" and results revealed that the only 100 (58.5%) were go with "Yes" and 71 (41.5%) were responds as "No". The participants response regarding item seventeen and results revealed that majority 103 (60.2%) know that and 68 (39.8%) did not know that the CDC guidelines of disinfection, Immersion time of equipment for high level disinfection (HLD) with 2.4% glutaraldehyde. Item eighteen is "high touch surface areas must be clean and disinfect" and majority 105 (61.4%) go with yes and 66 (38.6%) respond as "No". Item nineteen is "chlorhexidine bath and its suggested frequency in burn patients for prevention of infection in burn patients" and results revealed that the only 96 (55.4%) respond as yes and 76 (44.6%) respond as "No". The participant responds as 93 (54.7%) know and 78 (45.3%) did not know the factor including high antibiotic pressures, high colonization pressures, need for intensive medical and surgical therapy, and a vulnerable, immunocompromised patient leads to acquisition of antibiotic resistant organism in burn patients.

Figure 2
Item twenty-one is "preparation of the isolation room or area, ensure that appropriate handwashing facilities and hand-hygiene supplies are available" and participants respond as majority 105 (61.4%) were go with "Yes" and 66 (38.2%) were responds as "No". The participants response regarding item twenty two which is "precautions such as hand washing and barrier nursing, efficient cleaning and decontamination of hospital equipment, are most important for prevention of MRSA in burn patients" and results revealed that the only 99 (57.2%) were go with "Yes" and 71 (41.5%) were responds as "No". The participants response regarding item twenty-three and results revealed that majority 105 (61.4%) know that and 66 (38.6%) did not know that the burn Patients require additional infection control precautions. Item twenty-four is "nasal decolonization of MRSA patients done by mupirocin" and majority 99 (57.9%) go with yes and 72 (42.1%) respond as "No". The participants response regarding item twenty-five which is "Aquatic environment of hydrotherapy room is difficult to decontaminate" and results revealed that the only 126 (73.5%) were go with "Yes" and 45 (26.7%) were responds as "No". The participants response regarding item twenty-six and results revealed that majority 81 (47.4%) know that and 90 (52.6%) did not know that the specific antiseptic such as Chlorhexidine gluconate recommended for hand washing. Item twenty-seven is "Did you that the Important step during removal of personal protective equipment" and majority 90 (52.6%) go with yes and 81 (47.4%) respond as "No".  Table 3  Table 4 shows that the statistics (mean, median, mode and standard deviation) of 27 items of checklist regarding knowledge assessment of nurses for the prevention of infection in burn patient and results revealed that the highest mean value is 1.58 of item thirteen which is "Semi Quantitative swab culture provide information about the presence of microorganisms on the external catheter surface" and comparatively lowest mean value is 1.26 for item twenty five which is "Aquatic environment of hydrotherapy room is difficult to decontaminate". The mean value for others item is between 1.26-1.58 respectively. Median and mode value of most of items is 1 and highest is 2. Standard deviation value .501 is highest and comparatively .442 is low.  Figure 6 shows that the results regarding item one is "Burn patients are unique due to propensity to disperse microbes" and results revealed that the majority 108 (63.2%) respond as yes and only 63 (36%) respond as "No".

Figure 7
Figure 8 shows that the results regarding item three is "Zone is located in the center of burn wound" and participants respond as majority 101 (69.1%) were go with "Yes" and 70 (40.9%) were responds as "No".

Figure 8
Journal of Health, Medicine and Nursing www.iiste.org ISSN 2422-8419 An International Peer-reviewed Journal Vol.74, 2020 Figure 9 shows that the results regarding item and the participants response regarding item four which is "Treat it with a skin care product like antibiotic ointment" and results revealed that the only 80 (46.2%) were do this and majority 91 (53.8) did not do this. Figure 10 shows that the results regarding item and the participants response regarding item five and results revealed that majority 103 (60.2%) know that and 68 (39.8%) did not know that the major burn infection is burn wound cellulitis.               Figure 20 shows that the results regarding item fifteen is "plants and flowers harbor resistant organisms that's why these are not allowed in burn unit" and participants respond as majority 100 (58.5%) were go with "Yes" and 71 (41.5%) were responds as "No".

Figure 20
Figure 21 shows that the results regarding item and the participants response regarding item sixteen which is "According to Spaulding classification of medical devices, which come in contact with mucous membranes or nonintact skin require high level of disinfection as semi critical item" and results revealed that the only 100 (58.5%) were go with "Yes" and 71 (41.5%) were responds as "No".              shows that the results regarding item and the participants response regarding item twenty-five which is "Aquatic environment of hydrotherapy room is difficult to decontaminate" and results revealed that the only 126 (73.5%) were go with "Yes" and 45 (26.7%) were responds as "No". Figure 31 shows that the results regarding item and the participants response regarding item twenty-six and results revealed that majority 81 (47.4%) know that and 90 (52.6%) did not know that the specific antiseptic such as Chlorhexidine gluconate recommended for hand washing.  Figure 32 shows that the results regarding item twenty-seven is "Did you that the Important step during removal of personal protective equipment" and majority 90 (52.6%) go with yes and 81 (47.4%) respond as "No". Table 5  chlorhexidine bath, 85 (49.7%) did not give chlorhexidine bath and only 0 (0%) were not applicable at the time of patient care. Observation regarding item twenty-seven was show that 85 (49.7%) participants were prefer to fumigation. 71 (41.5%) did not prefer to fumigation and only 15 (8.7%) were not applicable at the time of patient care.

Checklist items
Observed F  Table 5 Table 6 shows that the statistics (mean, median, mode and standard deviation) of 27 items of checklist regarding knowledge assessment of nurses for the prevention of infection in burn patient and results revealed that the highest mean value is 1.70 of item three and comparatively lowest mean value is 1.26 for item eleven which is "Handling Soiled linen". The mean value for others item is between 1.26-1.70 respectively. Median and mode value of most of items is 1 and highest is 2. Standard deviation value .771 is highest and comparatively .501 is low.  Table 6 Figure 33 shows that the majority of participants 110 (64.3%) observed as wash their hand 56 (32.7%) did not wash their hand and only 5 (2.9%) were not applicable at the time of patient care.

Discussion
The findings emerged from the data are that nurses in study areas have insufficient knowledge and practice about infection control in burn patients. However, they received information through practice but in-service education programs need to develop to prepare nurses for prevention of infection.
Nurses' knowledge of infection control has fundamental role in preventing hospital acquired infections among burn patients. As majority of study participants received information regarding prevention of infection, the finding of current study showed low level of knowledge among nurses as indicated by the low percentages of accurate responses. The finding showed that about 60% (n=171) has satisfactory level of knowledge indicated by unsatisfactory knowledge score 40%. These findings are comparable to Atalla et al. work on compliance of nurses with infection control polices concluded that participants had low-level regarding infection control guidelines (Greenfield, 2010).
Likewise, twice a day chlorhexidine bath protocol is most effective method recommended for burn patients for decreasing hospital acquired infections even up to zero (Popp, Layon, Nappo, Richards, & Mozingo, 2014).
Findings of current study showed very low knowledge regarding this protocol because of unavailability of inservice education regarding prevention of HAI in burn patients. The present study revealed that majority 95 (55.4%) of nurses have knowledge about these procedures but the 76 (44.6%) have known knowledge about this.
The findings are in agreement with Mohammad Zadeh et al. revealed poor knowledge of health care workers regarding infection control precautions (Mohammadzadeh, Behnaz, & Parsa, 2013). The findings are contrary to Sorte, who reported that nurses have good (76%) knowledge regarding prevention of hospital acquired infection (Joshi et al., 2015).
Burn patients with resistant organisms (for example MRSA) may serve as reservoir for transmission of infection to other patients, so these patients require various precautions specially contact precautions (Emaneini et al., 2018).
The present study revealed low knowledge for such precautions especially contact precautions which are more essential for MRSA patients. The fining is consistent with Askarian et al. demonstrated low knowledge of health care workers for standard precautions and also reported that 90% of participants need extra infection control education (Askarian, Memish, & Khan, 2007) Nurses' practices complying with evidence-based guidelines about burn care have a crucial impact on preventing Infections among burn patients. The present study illustrates that not a single nurse has satisfactory level of practice as indicated by total performance scores 65%. These findings may involve many factors such as low nurse to patient ratio, few burn centers, less experience in burn centre, unavailability of in-service training courses, diminished institutional resources and absence of specific protocol etc. Nurses' practices complying with evidencebased guidelines about burn care has crucial impact on preventing Infections among burn patients. All of the nurses showed unsatisfactory level of practice as indicated by total performance scores <75%. This finding is supported by study conducted by El-Sayed et al. in burn centre of Egypt who reported very low percentage of study sample had satisfactory level of practice for preventing infection in burn patients (El-Sayed et al., 2015).
As nurses' practices for infection control in burn patients mainly involve standard precautions but findings of present study showed very low performance. This may be due to overburden of nurses and unavailability of resources. These consequences are also shared by Abdulraheem et al. who observed poor compliance of health care workers regarding standard precautions during care of patients (Abdulraheem, Amodu, Saka, Bolarinwa, & Uthman, 2012). Journal of Health, Medicine andNursing www.iiste.org ISSN 2422-8419 An International Peer-reviewed Journal Vol.74, 2020 Hand hygiene is the first initial step towards successful infection control in any healthcare setup including burn Centre. Although the results found that all of nurses had unsatisfactory level of practice but regarding hand washing 110 (64.3%) nurses shows positivity to hand hygiene and 56 (32.7%) did not wash hand or not follow the hand washing steps. Many research studies investigating the compliance to hand hygiene such as Karaaslan et al. also observed only 41% compliance similar to findings of present study (Karaaslan et al., 2014).
Use of Personal protective equipment (PPE) includes the use of mask, sterile gown and sterile gloves during care of patient. Carrer et al. found reduction in the risk of skin colonization when PPE were implemented (Verbeek et al., 2019). In present study nurses shows unsatisfactory compliance as 81 (75%) use masks, 92 (53.8%) use masks but very poor compliance for use of gowns (45 %) because they thought that gowns are not necessary during care of patient. Consequently, an overall low performance for PPE was noted because even not wearing gowns can lead to cross contamination between the patients. Findings are agreement with Ganczak and Szych, who reported only low (5%) compliance to PPE by nurses (Ganczak & Szych, 2007).
Cleaning and disinfection of medical devices is so important to prevent buildup of various microorganisms onto medical devices, it is highly likely that bacteria will grow if left unchecked or without disinfection properly.
Findings of present study showed very low compliance with it. In consistent with Quinn et al. who concluded with that equipment cleaning was observed on approximately one-fourth of the person days for registered nurses (Quinn et al., 2015).

Conclusion:
Based on the findings of the study, it is concluded that nurses working in burn units of hospital of Lahore, Punjab region have low knowledge and practices regarding prevention of Infections among burn patients.
Therefore, hospitals are required to organize adequate trainings and to develop unit specific clinical infection control guidelines and protocols.
Limitations: There are many limitations found for this study; ➢ Investigation discoveries will be restricted and can't be summed up on the generalized that the little example and chose from one land region in Pakistan.
➢ The extent of the examination will be additionally restricted not utilized control group ➢ The scope of the study will be also limited not used control group.
➢ The duration for this study was too short.
➢ Data collection faced lot of issues.
➢ The participants of the study were careless and non-cooperative regarding to fill the questionnaire.
➢ Investigation discoveries will be restricted and can't be summed up generally that the little example and chose from one topographical zone in Pakistan.
➢ The extent of the investigation will be likewise restricted not utilized benchmark group.
I would like to thanks authorities of university who gave me permission to collect data from the community. I am also thankful to the participants who actively participated, and gave me their precious time and information in this research. I would also thanks to my Parents, husband, sisters and my cute children who stood by me and bear my not attending to them in busy days of my research study.
Last but not least, I am very thankful to Mr. Muhammad Sabir who being teacher of English subject supports me and correction without any benefit.