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Exploring the influence of hospital staff education on fire safety preparedness
Correspondence to NAVNEET DHALIWAL; drnavneet2008@gmail.com
[To cite: Sethi S, Thimmaiah G, Dhaliwal N, Kumar A. Exploring the influence of hospital staff education on fire safety preparedness. Natl Med J India. DOI: 10.25259/NMJI_669_2024]
Abstract
Background
India is among countries with high mortality and morbidity rates from fire-related incidents. Fires at healthcare facilities can be more devastating than any other place at any time as they house more vulnerable people. Knowledge and experience of hospital workers and managers largely determine hospital preparedness.
Methods
A questionnaire-based interventional study was conducted in the advanced cardiac centre of a tertiary care institute. Ninety healthcare workers from different areas were included. We assessed the knowledge of hospital staff about fire safety practices and the effect of fire safety education on knowledge and practice.
Results
We observed that most participants reported appropriate practices, which increased significantly after the education. Among 90 participants, baseline awareness of immediate fire response and exit routes was high (100%). Fire safety education led to a significant improvement in knowledge, with correct responses for type B fire increasing from 7.8% to 48.9%, and correct identification of foam extinguisher use rising from 28.9% to 43.3% (p<0.05), alongside a marked reduction in ‘don’t know’ responses (22.2% to 4.4%). Practice-related responses also improved significantly post-intervention, with a higher proportion of participants reporting appropriate fire safety practices across domains.
Discussion
We found a statistically significant positive moderate correlation between knowledge and practice scores, indicating that knowledge and practice are related to each other affected by significant randomness.
INTRODUCTION
Burn injury results in substantial mortality and morbidity across the world1 and India is among the countries with a high rate of fire-related deaths.2 Fires can erupt at any place, including healthcare facilities. Fires at healthcare facilities can be more devastating than any other place at any given time, as they house many vulnerable people, including the sick, disabled, elderly, children, pregnant, immunocompromised, and those on life support and immobile patients. Fire-related disasters in hospitals are due to external or internal threats. External or internal threats may be human-made or sequel to natural disasters.3 Hospitals have a complex structure, which mandates the need to be adequately prepared to respond to various predictable or unpredictable incidents, such as fire accidents.4 Knowledge and experience of hospital workers and managers determine hospital preparedness to a great extent.4 Thus, we assessed the knowledge of hospital staff on fire safety practice, and the effect of fire safety education on knowledge and practice.
METHODS
We did a study at the advanced cardiac centre (ACC) of a tertiary care institute with over 2200 beds in northern India, over 6 months (November 2023 to April 2024). The ACC is a state-ofthe-art 210-bedded independent hospital with a total area of 13 355 m2, with four floors. The centre has four fully equipped cardiac catheterization laboratories and four modular operating theatres designed for advanced cardiac and thoracic surgeries with 56 intensive care beds. Other areas include outpatient departments, wards, laboratories, faculty offices, and support areas. The average footfall in the outpatient department of ACC is approximately 700 per day.
Sample size and sampling technique
We included 90 of 425 healthcare workers using convenience sampling. Staff working in different patient care areas of the hospital were included to be representative of the study population—163 nursing officers, 240 hospital and sanitary attendants, and 22 other staff, like ward attendants, technicians, etc. The sample size was 76 with a 95% CI and a 10% margin of error; however, 90 participants were included.
All participants were informed about the steps, and only those willing to participate were included.
Questionnaire development
All participants were assessed for their knowledge and preparedness regarding fire accidents with a pre-designed self-administered questionnaire in Hindi, which is spoken, read, and understood by the staff of all working classes of the hospital; it was also disseminated in English. The questionnaire comprised two sections. The first section aimed to collect the demographic profile of the participants, including age, designation, area of work, and years of service in this hospital.
The second part of the questionnaire comprised 15 items for assessing the knowledge (7 questions) and practices (8 questions) of the participants. The questionnaire was developed with the help of a team of experts, and care was taken to include all domains related to fire safety. Vocabulary was modified to maintain comprehensibility and to incorporate familiar words rather than jargon. The Cronbach’s alpha value of 0.82 indicated that the questionnaire had acceptable internal consistency. It was a closed-ended questionnaire with 3 options (viz., yes/no/don’t know) for each question. A correct response was assigned a score of ‘1,’ and an incorrect response or don’t know was assigned a score of ‘0.’ Though the questionnaire was self-administered, the principal investigator was available to address any doubts.
Education regarding fire safety
After assessing knowledge and practice, participants were educated about fire safety in healthcare settings. The lecture focused on fire prevention, preparedness, evacuation plans, smoke alarms, and the use of fire extinguishers. A lecture series was planned for the healthcare workers over a month, with almost four classes per week. A batch comprising 25-27 participants was made for the said lectures. Hands-on training was given to operate the fire extinguishers in case of any kind of fire. The same questionnaire was used 2 months after the lecture for a reassessment of knowledge and practice.
Statistical analysis
The data were analyzed using SPSS (Statistical Package for Social Sciences) 25.0 version, IBM, Chicago. Data were analysed for the probability distribution using the Shapiro-Wilk test, and it was found that it was not normally distributed. Descriptive statistics were performed. The chi-square test was used to analyse the responses. A comparison between the scores before and after education was done using the Wilcoxon signed-rank test. The correlation between variables was assessed using Spearman’s correlation coefficient. p<0.05 was considered statistically significant.
Ethical considerations
The study was initiated after obtaining approval from the institutional ethics committee (registration number—INT/IEC/2024/SPL 583). Only those willing to participate were included in the study, and written informed consent was obtained from them.
RESULTS
We included 90 healthcare workers. Most participants were aged >45 years (41; 45.6%; Table 1) and were nursing officers (40; 44.4%). Forty-seven (52.2%) participants were posted in the wards, and a major proportion of participants had experience of >10 years (54; 60%).
| Items | n(%) | |
|---|---|---|
| Age (in years) | <30 | 12 (13.3) |
| 30–45 | 37 (41.1) | |
| >45 | 41 (45.6) | |
| Designation | Nursing officer | 40 (44.4) |
| Hospital attendants | 18 (20.0) | |
| Sanitary attendants | 22 (24.4) | |
| Others | 10 (11.1) | |
| Area of posting | Wards | 47 (52.2) |
| Operation theatre | 17 (18.9) | |
| Intensive care unit | 5 (5.6) | |
| Outpatient department | 21 (23.3) | |
| Number of years in service | <3 | 10 (11.1) |
| 3–10 | 26 (28.9) | |
| >10 | 54 (60.0) |
All participants were aware of activating the fire alarm and dialling the emergency fire service number after spotting a fire. Many participants did not understand the 5 types of fire extinguishers, whereas, after education, this number decreased significantly (26; 28.9% v. 9; 10.0%). However, there was a significant increase in the number of participants who answered this question incorrectly even after education (Table 2). In response to the question related to foam-containing fire extinguishers, a significant decrease in participants responding ‘don’t know’ (20; 22.2% v. 4; 4.4%) and a substantial increase in the number of participants giving correct responses was seen (26; 28.9% v. 39; 43.3%; p<0.05). After education, there was a significant increase in the participants correctly answering the question related to type B fire (7; 7.8% v. 44; 48.9%; Table 2).
| Question | Before/after fire safety education | Yes n(%) | No n(%) | Don’t know n(%) | p value |
|---|---|---|---|---|---|
| Activating the fire alarm and dialling the emergency fire service number is the first thing to do in case of a fire emergency. (Yes)* | Before | 90 (100.0) | 0 (0.0) | 0 (0.0) | – |
| After | 90 (100.0) | 0 (0.0) | 0 (0.0) | ||
| Smoke and suffocation are the most important causes of death in fire accidents. Yes)* | Before | 87 (96.7) | 0 (0.0) | 3 (3.3) | 0.081 |
| After | 90 (100.0) | 0 (0.0) | 0 (0.0) | ||
| Stairs are better than lifts to escape a building in case of a fire accident. (Yes)* | Before | 89 (98.9) | 1 (1.1) | 0 (0.0) | 1.000 |
| After | 89 (98.9) | 1 (1.1) | 0 (0.0) | ||
| According to the National Fire Protection Association, there are five types of fire extinguishers. (Yes)* | Before | 50 (55.6) | 14 (15.6) | 26 (28.9) | 0.001 |
| After | 32 (35.6) | 49 (54.4) | 9 (10.0) | ||
| Foam-containing fire extinguishers are useful in case of electric fire. (No)* | Before | 44 (48.9) | 26 (28.9) | 20 (22.2) | 0.001 |
| After | 47 (52.2) | 39 (43.3) | 4 (4.4) | ||
| Awareness of exit routes in the workplace is important for every employee to escape from fire. (Yes)* | Before | 90 (100.0) | 0 (0.0) | 0 (0.0) | 0.129 |
| After | 86 (95.6) | 3 (3.3) | 1 (1.1) | ||
| Electric equipment results in a B-class of fire. (No)* | Before | 57 (63.3) | 7 (7.8) | 26 (28.9) | 0.001 |
| After | 39 (43.3) | 44 (48.9) | 7 (7.8) |
ª Correct answer
Table 3 compares the responses pertaining to practice before and after education. Most participants reported appropriate practices, which increased significantly after education.
| Question | Before/after fire safety education | Yes n (%) | No n (%) | Don’t know n (%) | p value |
|---|---|---|---|---|---|
| Has the evacuation map been displayed in your organization? | Before | 76 (84.4) | 4 (4.4) | 10 (11.1) | 0.001 |
| After | 69 (76.7) | 20 (22.2) | 1 (1.1) | ||
| Have you received fire safety training in your workplace? | Before | 69 (76.7) | 20 (22.2) | 1 (1.1) | 0.007 |
| After | 84 (93.3) | 6 (6.7) | 0 (0.0) | ||
| Do you know how to use a fire extinguisher in case of a fire outbreak? | Before | 65 (72.2) | 12 (13.3) | 13 (14.4) | 0.001 |
| After | 90 (100.0) | 0 (0.0) | 0 (0.0) | ||
| Are you aware of the fire emergency procedure of your institution? | Before | 86 (95.6) | 1 (1.1) | 3 (3.3) | 0.359 |
| After | 89 (98.9) | 0 (0.0) | 1 (1.1) | ||
| Does your workplace have a fire alarm? | Before | 82 (91.1) | 4 (4.4) | 4 (4.4) | 0.05 |
| After | 89 (98.9) | 0 (0.0) | 1 (1.1) | ||
| Does your workplace have a fire hose? | Before | 87 (96.7) | 0 (0.0) | 3 (3.3) | 0.003 |
| After | 75 (83.3) | 10 (11.1) | 5 (5.6) | ||
| Does your workplace have a fire/smoke detector(s)? | Before | 86 (95.6) | 4 (4.4) | 0 (0.0) | 0.004 |
| After | 72 (80.0) | 12 (13.3) | 6 (6.7) | ||
| Is there a fire emergency number for you to call in case of a fire accident? | Before | 76 (84.4) | 2 (2.2) | 12 (13.3) | 0.001 |
| After | 90 (100.0) | 0 (0.0) | 0 (0.0) |
No significant differences were seen when comparing the median knowledge and practice scores before and after education (Table 4). We also found a statistically significant positive correlation between knowledge and practice score (Spearman’s correlation coefficient=0.432, p=0.001).
| Pre-education | Post-education | Z value | p value | |
|---|---|---|---|---|
| Knowledge score | 5.0 | 5.0 | –1.897 | 0.058 |
| (5.0–5.0) | (5.0–6.0) | |||
| Practice score | 8.0 | 8.0 | –1.799 | 0.072 |
| (5.75–8.0) | (7.0–8.0) |
Wilcoxon signed-rank tests
DISCUSSION
In this study in a hospital setting, we found that all participants had correct knowledge about the first action in case of a fire accident. Similar to our findings, Kulkarni et al. reported that in their study, 96.4% of participants had correct knowledge about the first action in case of a fire accident.5 Similar findings were also reported by Chiom and Ify.6
Smoke inhalation during a fire is of critical concern.7 All participants knew that smoke was an important cause of death in a fire accident. Previously, various hospitals lacked automatic fire systems, fire sprinklers, detectors, and alarms, resulting in high casualty rates.8 Most of our participants knew that our hospital is equipped with an evacuation map, fire extinguishers, fire emergency procedures, smoke alarms, fire hoses, fire smoke detectors, and a fire emergency number.
A significant improvement in the response to questions about practice showed that our educational intervention was effective in improving fire safety practices. This finding was similar to that findings of Lee and Dahinten who also suggested that continuous and systematic education at the hospital level is essential to improve patient safety awareness, including fire safety.9 Before fire safety education, 69 (76.7%) participants reported that they had previously received fire safety training (education) at their workplace. The number increased substantially to 84 (93.3%) after the education. This suggests that the interventions aimed at increasing fire safety training were effective. The high rate of training indicates that the organization successfully prioritized and implemented comprehensive fire safety training programs.
We found that the difference in knowledge and practice scores before and after education was not statistically significant. A plausible explanation could be that the participants had sufficient knowledge before the lecture.
However, on assessing the difference in response to individual questions, we found that after education, there was a significant increase in the number of individuals who received fire safety education, individuals who practised using fire extinguishers, and individuals who had information about fire emergencies (Table 2). However, for some questions there was a significant increase in the number of participants who answered the question incorrectly. The possible reasons for this unexpected outcome could be the educational content was inappropriate or the participants made mistakes under pressure. These findings also suggest the importance of repetition and reinforcement in education.10 Cho et al. also found that frequent education about fire safety preparedness effectively maintained high patient safety awareness, risk knowledge, and risk-attitude scores among nurses.11
Knowledge is known to be futile if not applied in our daily lives.12 Many studies from different fields have demonstrated that imparting knowledge may not necessarily bring the desired changes in practice.12 However, the role of knowledge in bringing about change cannot be denied. Thus, conforming to the above, we found a statistically significant positive correlation between knowledge and practice scores, indicating that knowledge and practice are related to each other but have significant randomness affecting them. Colletto et al. also reported a primary association between a higher level of risk knowledge and a more positive risk attitude.13
Conclusion
Our study showed that the employees of our hospital have adequate knowledge about fire safety. Education regarding fire safety is efficacious in improving the workers’ knowledge and fire safety practices.
Conflicts of interest
None declared
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