|Year : 2018 | Volume
| Issue : 2 | Page : 223-227
Are standard precautions for hospital-acquired infection among nurses in public sector satisfactory?
Ahmad Batran1, Ahmad Ayed1, Basma Salameh1, Mohammad Ayoub2, Ahmad Fasfous3
1 Department of Nursing, Arab American University of Jenin, Jenin, Palestine
2 Dr. Sulaiman Al Habib Medical Group, King Saudi Arabia
3 Department of Social Sciences, Bethlehem University, Jenin, Palestine
|Date of Web Publication||27-Dec-2018|
Dr. Ahmad Ayed
Department of Nursing, Arab American University of Jenin, Jenin
Source of Support: None, Conflict of Interest: None
Background and Aim: Standard precautions are permitted in delivering the care to all patients in clinical settings to avoid the spread of infection. However, their interventions are grounded on the knowledge of the nurses and the other healthcare workers. The nurses should have satisfactory standard precautions' knowledge and practice level for hospital acquired infection. The study aimed to evaluate the standard precautions' knowledge and practice levels among the nurses in the Saudi Arabia private hospitals. Materials and Methods: A cross-sectional study was performed between March and May 2017 in four hospitals (King Khalid Hospital, Najran General Hospital, Maternal and Child Hospital, and New Najran General Hospital). Data were collected using a validated tool from a convenience sample of 198 nurses. Results: The study showed that 88 (44.4%) had good knowledge while 109 (55.1%) had a fair knowledge of standard precautions. According to their practice, the majority 184 (92.9%) of the participants had good level while 13 (6.6%) had a fair level. Conclusion: The nurses have a good level of knowledge and practice with standard precautions. There is a moderate relationship between knowledge and practice of standard precaution. Nurses should practice standard precautions in their daily routine regardless of the patient diagnosis, updating knowledge, improved specific operational guidelines/policies on the practice of standard precaution, regular supply of infection prevention materials, and routine immunization and screening for the staff against Hepatitis B.
Keywords: Knowledge, nurse, practice, standard precautions
|How to cite this article:|
Batran A, Ayed A, Salameh B, Ayoub M, Fasfous A. Are standard precautions for hospital-acquired infection among nurses in public sector satisfactory?. Arch Med Health Sci 2018;6:223-7
|How to cite this URL:|
Batran A, Ayed A, Salameh B, Ayoub M, Fasfous A. Are standard precautions for hospital-acquired infection among nurses in public sector satisfactory?. Arch Med Health Sci [serial online] 2018 [cited 2022 Jun 28];6:223-7. Available from: https://www.amhsjournal.org/text.asp?2018/6/2/223/248671
| Introduction|| |
Healthcare-associated infection (HCAI) defined by the World Health Organization as infection occurs in a patient during the process of care which was not evident at the time of admission to a healthcare facility. The prevalence of HCAI in developed and developing countries is 7.6% and 10.1%, respectively., Standard precautions are practices for infection control that apply to all patients, presumed, assumed of infection status, or confirmed diagnosis. Hand hygiene, personal protective equipment, environmental cleanliness, injection safety, waste management, and respiratory hygiene and cough management are considered the components of standard precautions., However, proper hand hygiene and basic precautions practices are simple and cheap cost infection control measures during invasive procedures, but requires more responsibility from staff and change their practice, in addition, to raise their awareness. Human plays an important role in HCAI, therefore, the adequate nursing staff is necessary., Compliance of healthcare workers with standard precautions is the best method to prevent and control HCAI in patients and health workers. Improving compliance with standard precautions among health workers associated with their awareness, standard precautions training, and experience. Standard precautions are confirmed when providing care to the patients, despite their presumed infection status. It is also evident when dealing with equipment that is assumed or contaminated of contamination, and in contact risk with body fluids, blood, secretions, and excretions except sweat. They include microorganisms spread by contact, airborne, and droplet routes.,
Standard precautions aim to prevent and/or reduce of transmission of HCAI and protect of nurses and healthcare profession from sharp injuries. Approximately (54%) of the nurses had a fair level knowledge and 91% had a good practice of standard precautions., Tai et al. described that 60% of the nurses and 46% of the physicians believed that hand hygiene prevents more than 75% of HCAI. Whereas, Talaat and Shamia showed that only satisfactory knowledge among 5% of physicians and 10% of nurses toward standard precautions. At the same time, 30% of physicians and only 4% of nurses had an adequate level of performance. The compliance with hand hygiene improved after hand hygiene promotion program. Eskander et al. reported that approximately (64%) of the nurses' knowledge level was unsatisfactory and (57%) had satisfactory performance level. At the same time, positive relationships were found between knowledge and practice while the standard precautions practice still poor by nurses in surgical wards.
The quality of healthcare and patient safety influenced by Nosocomial infection. Negative outcomes include hospital stay days increasing, healthcare costs, economic problems to patients and their families and yet deaths. In the southeastern region of U.S, over a 1-year period, the annual cost of nosocomial infections exceeded $26 million among 28 community hospitals. These results indicate the huge economic load linked with nosocomial infections.
Nurses, as well as other healthcare workers, are involved in nosocomial infections' transmission. It has also been described that spread frequently occurs during the implementation of therapeutic procedures and in noncompliance with aseptic techniques by health professions. Thus, this will expose patients to numerous pathogens., Therefore, the study aimed to evaluate the standard precautions' knowledge and practice levels among the nurses in the Saudi Arabia private hospitals.
| Materials and Methods|| |
A cross-sectional study was carried out among nurses.
Sample and setting
A convenience sample which composed of 198 nurses, who work in the Intensive Care Units, emergency department, medical wards, surgical wards, operational wards, pediatric, neonatal, labor, and postpartum wards of four hospitals (King Khalid Hospital, Najran General Hospital, Maternal and Child Hospital, and New Najran General Hospital), in Saudi Arabia in the period from March to May 2017 were sampled.
Permission was approved from the hospitals' administrators. Informed consent of the nurses was obtained before the administration of the questionnaire. The purpose of the study was discussed with the participants and assured of their right to confidentiality and anonymity. The participation was voluntary. Data were collected using a questionnaire developed by researchers and reviewed by five experienced nurses from the clinical settings, who have infection control certification. They provided the researchers with comments; thus, changes were made to the questionnaire before they were disseminated to the participants.
The first part composed of nurses' demographic characteristics such as age, gender, marital status, Hospital, Qualification, working department, experience, a vaccine of hepatitis B, and infection control training course. The second part assessed knowledge with 32 items; each item had coded with an answer point, one point for correct answer and incorrect or answer with I don't know coded zero. The correct responses were computed to get total knowledge scores for each participant. Total scores for all variables reached 32 points and then transformed to 100%. The knowledge scores were considered poor knowledge (≤50%), fair knowledge (51%–80%), and (>80) good knowledge. The third part assessed the practice with 23 items using a Likert scale (every time coded (3), sometimes coded (2), and never coded (1). The total scores transformed to 100%. Good level above 80%, fair level between 51% and 80%, and poor level of 50% or less).
The pilot study was done with 20 nurses from the private hospitals and they were excluded from the actual study and their feedbacks suggested that the questionnaire was acceptable and filled in 20–25 min.
| Results|| |
[Table 1] represents that around two-thirds of the nurses 130 (65.7%) were in 20–30 years age group. Majority of the studies sample had bachelor degree147 (74.2%). At the same time, the majority was female 184 (92.9%), only 14 (7.1%) were males. This supports the observation that the nursing profession is predominantly made up of females. However, half of them 100 (50.5%) were married, and who had <5 years of experience were 118 (59.6%). Most of the participants assured that they have sharp box 191 (96.5%). Around 187 (94.4%) were received an infection control training course. The majority of the nurses 181 (91.4) had vaccinated against hepatitis B.
[Table 2] revealed that approximately half of the participants 88 (44.4%) had good knowledge level, 109 (55.1%) had fair knowledge, while 1 (0.5%) had poor knowledge level. At the same time, it indicated 184 (92.9%) of the studied sample had good practice, 13 (6.6%) had fair practice, while only 1 (0.5%) had poor practice.
|Table 2: Assessment of the standard precautions nurses' knowledge and practice level (n=198)|
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[Table 3] revealed that high knowledge scores mean found in the age group of 31–40 years, females, diploma degree, had above 15 years' experience and had not attended courses (80.68, 78.58, 80.23, 80.08, and 80.68), respectively. An ANOVA test was performed, and there were no significant statistical differences found between knowledge scores mean toward age, gender, and experience (F = 0.458, 0.052, 1.419, 0.321, and 0.458), respectively, at P (0.499, 0.821, 0. 244, 0.726, and 0.499), respectively.
|Table 3: The differences between the nurses' demographic characteristics and the standard precautions knowledge (n=198)|
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[Table 4] showed that high practices scores mean found in the age group of 31–40 years old, females, master degree, had years of experience above 15 years and attended training courses (79.42, 80.47, 82.43, 81.22, and 79.84), respectively. An ANOVA test was performed, and no significant statistical differences were found between practice scores mean according to age, gender, education, years of experience, and training course (F = 1.68, 0.50, 0.13, 0.13, and 0.21), respectively at P (0.190, 0.480, 0.882, 0.879, and 0.651), respectively.
|Table 4: The differences between the nurses' demographic characteristics and the practice of the standard precautions (n=198)|
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[Table 5] revealed that Pearson correlation test was performed and that there is moderate relationship between knowledge and practice of standard precautions of the sample (r = 044, at P < 0.001).
|Table 5: The relationship between the nurses' knowledge score mean and practice scores mean of the standard precautions (n=198)|
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| Discussion|| |
Hospital-acquired infection is the main problem in worldwide. Therefore, up to date the nursing knowledge and practice play an important role in standard precautions. Standard precautions aim to prevent the spread of infectious agents through blood and body fluids. The nurses should implement standard precautions continuously as an essential part of patients' care. That is agree with why the current study was conducted. The study showed that two-thirds of the study participants between 20 and 30 years old. This result is in agreement with that of Johnson et al. emphasizing the need to keep this group of health workers free from hospital infections in their early life. The majority of the participants had previous training courses of standard precaution in the clinical settings, but these courses not well-organized. Therefore, the nursing curriculum must be emphasized the issues of standard precautions and infection control measures. In addition, the findings from this study revealed that the majority of the participants had received hepatitis B vaccine, highlighting the hospitals' policies and guidelines that new nurses must be vaccinated when employed to deal with exposure to blood-borne pathogens and needle stick.
In addition, the study indicated that the nurses were knowledgeable related to standard precautions. These findings supported by Vaz et al. study which had reported that 90.0% of nurses had a knowledgeable level of standard precautions. On the other hand, this is inconsistent with the previous studies,,,, where the knowledge level was found to be lower than what was reported in this current study.
Concerning the practice level, the majority of the studied sample had good practice level of standard precautions. This is consistent with Fashafsheh study, and more than what was documented by Agaral and Thomas.
This may due that they believe that practice is more critical than standard precaution knowledge level.
The study showed that there were no significant differences between standard precautions knowledge level with the age, gender, experience, education, and training courses. These findings are inconsistent with the previous studies., This may indicate that the knowledge of standard precaution is important and the infection control policies of hospitals stressed the nurses to attain lectures and workshops that offered.
The main finding of the current study showed a moderate relationship between standard precautions knowledge and practice level. This clarifies that knowledge according to standard precautions affects practice and application. This result consistent with the findings of other studies that firmly propose that standard precautions knowledge level was positively correlated with practice level, confirming that greater standard precautions knowledge level the better activity practice level.,
| Conclusion|| |
The overall knowledge and practice toward the standard precautions of infection control among nurses in the targeted hospitals were good and a moderate relationship between knowledge and practice of standard precaution.
- Nurses should always implement standard precautions regardless of the patient diagnosis
- Updating knowledge of nurses through continuing mandatory lectures/workshops on standard precautions
- Specific policies/operational guidelines on the practice of standard precaution should be developed.
Implications of the study
The current data highlight the importance of both knowledge and practice of standard precautions among nurses and other healthcare professionals and updating the courses of infection control for the nurses recurrently.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Organization. Report on the Burden of Endemic Health Care-Associated Infection Worldwide. Geneva: WHO; 2011.
Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L. Burden of endemic health-care-associated infection in developing countries: Systematic review and meta-analysis. Lancet 2011;377:228-41.
Center of Disease Prevention and Control (CDC). Glossary of Terms. Atlanta, USA: Center of Disease Prevention and Control; 2012.
World Health Organization. Guidelines on Prevention and Control of Hospital Associated Infections. Geneva: WHO; 2002.
World Health Organization. Practical Guidelines for Infection Control in Health Care Facilities. Geneva: WHO; 2004.
Bouallègue O, Naija W, Said H, Nouria A, Jaidane N, Dhidah L. Incidence of ICU acquired nososcomial infections in University Hospital of Sahloul (Sousse-Tunisia). Antimicrob Resist Infect Control 2013;2:P233.
Hugonnet S, Chevrolet JC, Pittet D. The effect of workload on infection risk in critically ill patients. Crit Care Med 2007;35:76-81.
Cole M. Infection control: Worlds apart primary and secondary care. Br J Community Nurs 2007;12:301, 303-6.
Siegel JD, Rhinehart E, Jackson M, Chiarello L; Health Care Infection Control Practices Advisory Committee 2007 guideline for isolation precautions: Preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35:S65-164.
Luo Y, He GP, Zhou JW, Luo Y. Factors impacting compliance with standard precautions in nursing, China. Int J Infect Dis 2010;14:e1106-14.
Siegel JD, Rhinehart E, Jackson M, Chiarello L. Health Care Infection Control Practices Advisory Committee. Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. US; 2007. Am J Infect Control 2007;35 Suppl 2:S65-164. Available from: https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines.pdf
. [Last accessed on 2018 Jun 24].
Vaz K, McGrowder D, Crawford T, Alexander-Lindo RL, Irving R. Prevalence of injuries and reporting of accidents among health care workers at the University Hospital of the West Indies. Int J Occup Med Environ Health 2010;23:133-43.
Ayed A, Eqtait M, Fashafsheh I, Ali G. Knowledge & compliance of nursing staff towards standard precautions in the Palestinian hospitals. Adv Life Sci Technol 2015;36:21-30.
Fashafsheh I, Ayed A, Eqtait F, Harazneh L. Knowledge and practice of nursing staff towards infection control measures in the Palestinian hospitals. J Educ Pract 2015;6:79-90.
Tai JW, Mok ES, Ching PT, Seto WH, Pittet D. Nurses and physicians' perceptions of the importance and impact of healthcare-associated infections and hand hygiene: A multi-center exploratory study in Hong Kong. Infection 2009;37:320-33.
Talaat E, Shamia E. Developing a control action plan for infection prevention at the endoscopy unit. J Int Acad Res 2010;2:412-20.
Picheansathian W, Pearson A, Suchaxaya P. The effectiveness of a promotion programme on hand hygiene compliance and nosocomial infections in a neonatal intensive care unit. Int J Nurs Pract 2008;14:315-21.
Eskander H, Morsy W, Elfeky H. Intensive care nurses' knowledge & practices regarding infection control standard precautions at a selected Egyptian cancer hospital. J Educ Pract 2013;4:160-74.
Mahmud N, Abdul Sahib S. Assessment of nurses' practices toward infection control standardized precautions in Azady teaching hospital in the City of Kirkuk. Iraqi Natl J Nurs Spec 2011;24: 52-8.
Kaye KS, Anderson DJ, Sloane R, Chen LF, Choi Y, Link K, et al.
The effect of surgical site infection on older operative patients. J Am Geriatr Soc 2009;57:46-54.
Anderson DJ, Kaye KS, Chen LF, Schmader KE, Choi Y, Sloane R, et al.
Clinical and financial outcomes due to methicillin resistant Staphylococcus aureus
surgical site infection: A multi-center matched outcomes study. PLoS One 2009;4:e8305.
Costello JM, Graham DA, Morrow DF, Morrow J, Potter-Bynoe G, Sandora TJ, et al.
Risk factors for surgical site infection after cardiac surgery in children. Ann Thorac Surg 2010;89:1833-41.
Racco M, Horn K. Central catheter infections: Use of a multidisciplinary team to find simple solutions. Crit Care Nurse 2007;27:80, 78-9.
Johnson E, Asuzu C, Adebiyi D. Knowledge and practice of universal precautions among professionals in public and private health facilities in Uyo, Southern Nigeria – A comparative study. Ibom Med J 2013;6:9-19.
Abdulraheem S, Amodu O, Saka J, Bolarinwa A, Uthman B. Knowledge, Awareness and compliance with standard precautions among health workers in North Eastearn Nigeria. J Community Med Health Educ 2012;2:131.
Isara AR, Ofili AN. Knowledge and practice of standard precautions among health care workers in the federal medical centre, Asaba, Delta State, Nigeria. Niger Postgrad Med J 2010;17:204-9. [Full text]
Agaral M, Thomas P. Prevalence of postoperative nosocomial infection in neuro surgical patients and associated risk factors-a prospective study. NJI 2003;107:620-5.
Hamid MZ, Aziz NA, Anita AR, Norlijah O. Knowledge of blood-borne infectious diseases and the practice of universal precautions amongst health-care workers in a tertiary hospital in Malaysia. Southeast Asian J Trop Med Public Health 2010;41:1192-9.
Chan MF, Ho A, Day MC. Investigating the knowledge, attitudes and practice patterns of operating room staff towards standard and transmission-based precautions: Results of a cluster analysis. J Clin Nurs 2008;17:1051-62.
Taneja J, BibhaBati M, Aradhana B, Poonam L, Vinita D, Archana T, et al.
Evaluation of knowledge and practice amongst nursing staff toward infection control measures in a tertiary care hospital in India. Can J Infect Control 2009;24:104-7.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]