Compliance of Cypriot nurses with Standard Precautions to avoid exposure to pathogens

Factors influencing nursing professionals' adherence to facial protective equipment usage: A comprehensive review

BACKGROUND

Facial protective equipment (FPE) adherence is necessary for the health and safety of nursing professionals. This review was conducted to synthesize predisposing, enabling, and reinforcing factors that influence FPE adherence, and thus inform efforts to promote adherence.

METHODS

Articles were collected using Cumulated Index to Nursing and Allied Health Literature and MEDLINE and screened for inclusion. Included articles were original studies focused on FPE adherence by nurses to prevent respiratory infection which contained occupation-specific data from at least 10 individuals and were published in English between January 2005 and February 2022.

RESULTS

Thirty articles were included, 21 of which reported adherence rates. Adherence ranged from 33% to 100% for respiratory protection and 22% to 100% for eye protection. Predisposing demographic factors influencing adherence included tenure and occupation, while modifiable predisposing factors included knowledge and perception of FPE, infection transmission, and risk. Enabling factors included geography, care settings, and FPE availability. Reinforcing factors included organizational support for health and safety, clear policies, and training.

CONCLUSIONS

The identified demographic factors suggest populations that may benefit from targeted interventions, while modifiable factors suggest opportunities to enhance education as well as operational processes and supports. Interventions that target these areas have the potential to promote adherence and thereby improve the occupational safety of nurses.

Compliance of healthcare workers in a psychiatric inpatient ward to infection control practices during the COVID-19 pandemic: a participant observation study supplemented with a self-reported survey

BACKGROUND

As an emerging infectious disease with a heterogenous and uncertain transmission pattern, coronavirus disease 2019 (COVID-19) has created a catastrophe in healthcare-associated infections (HAIs) and posed a significant challenge to infection control practices (ICPs) in healthcare settings. While the unique characteristics of psychiatric patients and clinical settings may make the implementation of ICPs difficult, evidence is lacking for compliance with ICPs among healthcare workers (HCWs) in a psychiatric setting during the COVID-19 pandemic.

METHODS

A cross-sectional multi-method study based on participant unobtrusive observation coupled with the completion of a self-administered ICP survey was conducted to assess compliance with ICPs among HCWs in a psychiatric inpatient ward in a regional hospital. An online checklist, called eRub, was used to record the performance of HCWs in hand hygiene (HH) and other essential ICPs. Furthermore, a well-validated questionnaire (i.e., Compliance with Standard Precautions Scale, CSPS) was used to collect the participants' self-reported ICP compliance for later comparison.

RESULTS

A total of 2,670 ICP opportunities were observed from January to April 2020. The overall compliance rate was 42.6%. HCWs exhibited satisfactory compliance to the wearing of mask (91.2%) and the handling of clinical waste (87.5%); suboptimal compliance to the handling of sharp objects (67.7%) and linen (72.7%); and poor compliance to HH (3.3%), use of gloves (40.9%), use of personal protective equipment (20%), and disinfection of used surface/area (0.4%). The compliance rates of the nurses and support staff to HH were significantly different (χ2 = 123.25, p < 0.001). In the self-reported survey, the overall compliance rate for ICPs was 64.6%.

CONCLUSION

The compliance of HCWs in a psychiatric inpatient ward to ICPs during the COVID-19 pandemic ranged from poor to suboptimal. This result was alarming. Revisions of current ICP guidelines and policies that specifically target barriers in psychiatric settings will be necessary.

Compliance among Registered Nurses and Doctors in Critical Care Units: Challenges Affecting Their Adherence to Standard Precautions

(1) Background: Awareness and compliance with standard precautions (SPs) are essential health issues for both healthcare staff and patients. Hence, more research is urgently needed in the health sector worldwide, particularly in Arab countries. The purpose of this study was to investigate compliance with SPs among nurses and doctors, as well as challenges affecting their adherence to these SPs. (2) Methods: A cross-sectional descriptive study was conducted. The researchers administered the compliance with the Standard Precautions Scale (CAPS) to staff nurses and doctors from critical care units at a university-affiliated hospital in Jeddah, Kingdom of Saudi Arabia (KSA). A total of 112 nurses and 59 doctors were enrolled in the study to determine their compliance with SPs as well as the challenges affecting their adherence to these SPs. (3) Results: The overall mean percentage scores of nurses' and doctors' compliance with SPs were 36.43 ± 15.85% and 33.27 ± 15.76%, respectively. In addition, the current study identified associated challenges affecting these healthcare workers' adherence to these SPs, including the effect of sociodemographic factors, such as age and experience. (4) Conclusions: The study found that both nurses and doctors had poor compliance with all SPs except for disposal of sharps, which scored with suboptimal compliance. Nurses' compliance with recommended precautions varied significantly according to age, clinical experience, and attendance at training courses. Healthcare organizations should consider a holistic approach to promote adherence to SPs to enhance outcomes associated with optimized care delivery and stakeholder safety.

Impact of patient safety climate on infection prevention practices and healthcare worker and patient outcomes

BACKGROUND

Standard precautions may prevent patient health care associated infections and provider occupational exposures but are not often used by health care workers. A positive patient safety climate might contribute to improved adherence. The aim of this study was to determine the relationships among patient safety climate, standard precaution adherence, and health care worker exposures and HAIs.

METHODS

This multi-site, cross-sectional study included survey data from nurses on patient safety climate, observational data on adherence, and existing health care worker exposure and health care associated infections data. Data were aggregated to hospital unit level for correlational and multivariable regression analyses.

RESULTS

A total of 5,285 standard precaution observations and 452 surveys were collected across 43 hospital units. Observed adherence to all categories of standard precautions was 64.4%; there were significant differences by provider role. Multivariable models identified key predictors explaining sizeable variance in methicillin-resistant Staphylococcus aureus (41%), catheter associated urinary tract infections (23%), mucotaneous exposures (43%) and needlestick and sharps injuries (38%).

DISCUSSION

This study produced findings not previously published thus advancing the state of the science in patient and occupational health safety. These include identifying modifiable features of the safety climate and key organizational characteristics associated better outcomes.

CONCLUSIONS

In this novel study we identified that a positive patient safety climate and adherence to standard precautions predict key HAI and occupational health outcomes.

Stigma towards health care providers taking care of COVID-19 patients: A multi-country study

Background

Health care providers (HCPs) have always been a common target of stigmatization during widespread infections and COVID-19 is not an exception.

Aim

This study aims to investigate the prevalence of stigmatization during the COVID-19 pandemic among HCPs in seven different countries using the Stigma COVID-19 Healthcare Providers tool (S19-HCPs).

Design

Cross-sectional.

Methods

The S19-HCPs is a self-administered online survey (16-item) developed and validated by the research team. The participants were invited to complete an online survey. Data collection started from June–July 2020 using a convenience sample of HCPs from Iraq, Jordan, Egypt, Saudi Arabia, Indonesia, Philippines, and Kuwait.

Results

A total number of 1726 participants were included in the final analysis. The majority of the study participants were Jordanians (22%), followed by Kuwaitis (19%), Filipinos (18%) and the lowest participants were Indonesians (6%). Other nationalities were Iraqis, Saudis, and Egyptians with 15%, 11% and 9% respectively. Among the respondents, 57% have worked either in a COVID-19 designated facility or in a quarantine center and 78% claimed that they had received training for COVID-19. Statistical significance between COVID-19 stigma and demographic variables were found in all aspect of the S19-HCPs.

Conclusion

The findings of this study demonstrated high levels of stigmatization against HCPs in all the included seven countries. On the other hand, they are still perceived positively by their communities and in their utmost, highly motivated to care for COVID-19 patients. Educational and awareness programs could have a crucial role in the solution of stigmatization problems over the world.

Factors influencing self-reported adherence to standard precautions among Thai nursing students: A cross sectional study

AIM

This study explored nursing students' compliance with standard precautions (SPs) and attitudes to SPs in Thailand, to identify factors that may increase adherence to SPs and infection prevention and control best practice.

BACKGROUND

In the context of high rates of healthcare associated infections as in Thailand, effective strategies to promote high levels of clinician adherence to SPs is a priority. Nursing students are one group of healthcare workers who play a vital role in caring for patients and constitute the future nursing workforce.

DESIGN

A cross-sectional survey design was used.

METHODS

A self-reported survey comprising the Compliance with Standard Precautions Scale and the Factors Influencing Adherence to Standard Precautions Scale were distributed to nursing students as a Thai paper-based survey.

RESULTS

A total of '533 second' to fourth year nursing students from a tertiary nursing school in Bangkok, Thailand completed the survey. The average nursing student compliance to SPs was 68.5%. Most (91.2%) reported only using water for handwashing and 57.2% reported reuse of surgical masks. The fourth-year students had higher compliance (M=3.90, SD=1.12) on the 'prevention of cross infection from person-to-person' dimension while second-year students reported higher compliance on the 'disposal of sharps' (M=2.67, SD=0.57) dimension. 'Contextual Cues' was identified as the factor (M=3.41, SD=0.40) that had the greatest influence on adherence and 'Practice Culture' (M=1.84, SD=0.66) and 'Justification' (M = 1.35, SD.68 had the lowest influence. Fourth year students identified 'Leadership' (M=2.90, SD=0.49) as an important influence on adherence to SPs.

CONCLUSIONS

To increase nursing students' adherence there needs to be greater emphasis on the importance of SPs in theoretical sessions and regular monitoring and feedback on hand hygiene performance and personal protective equipment use while students are on placements. More visible organizational leadership and promotion of high levels of adherence to SPs may assist students to translate their theoretical knowledge into practice.

Knowledge and compliance with standard precautions among registered nurses: A cross-sectional study

Background

Nurses and patients are often exposed to various types of infections during their clinical practice. Knowledge and compliance with standard precautions are essential to prevent hospitals associated infections and protect patients as well as medical workers from exposure to infectious agents.

Aims

This study aimed to assess the level of knowledge, level of compliance, and associated factors toward compliance with standard precautions among registered nurses in the North of Jordan.

Methods

A cross-sectional study was conducted at three hospitals in the North of Jordan. Two were public hospitals and one was a university-affiliated hospital. A questionnaire concerning the knowledge and compliance with the standard precaution guidelines was distributed among 300 registered nurses of whom 266 completed the questionnaire (response rate 88.7%).

Results

53% of the participants were from governmental hospitals and 57.1% were females. The age median of them was 30 years (IQR = 28–32). The majority of the participants were medical/surgical RNs (33.1%) while only 8.3% of them were from the pediatric/gynecology departments. The overall knowledge score was 16.27 (SD = 3.15), and the total compliance score was 49.15 (SD = 12.36). Besides, the study showed a moderate positive correlation between the level of knowledge, experience in years, and the standard precautions compliance (r = 0.387, p = 0.01), (r = 0.341, p = 0.01), respectively.

Conclusions

standard precautions are the basic level of the infection control process. The participants may possess satisfactory knowledge and compliance levels. However, more training programs and more focusing on the standard precautions by educational institutes are needed for nurses to improve their knowledge and compliance with infection-control standard precautions.

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Knowledge and compliance with standard precaution guidelines are essential during the era of the COVID-19 pandemic.

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Nurses from Jordan may possess satisfactory knowledge and compliance levels.

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More training programs and more focusing on the standard precautions by nurses' educational institutes is needed.

Compliance with standard precautions in inpatient healthcare settings in the Czech Republic: a cross-sectional survey

OBJECTIVE

The study evaluates compliance with declared hygienic standards carried out by healthcare professionals in clinical practice within their scope of direct patient care and the maintenance of medical tools and devices in healthcare facilities in the Czech Republic.

METHODS

Cross-sectional questionnaire study focused on the standards of safe health care. All 80 addressed healthcare providers were also involved in the 2018 Adverse Event Reporting System (AERS) pilot project. Responses were scored on a 6-level scale, from "always" (100 points) to "never" (0 points). The evaluation was performed according to the frequency of responses and the average index (max. 100 points). Data analysis was performed using IBM SPSS Statistics version 22 (level of significance 1% and 5%).

RESULTS

There were statistically processed 2,016 questionnaires (100%). Most respondents stated their job classification as non-medical healthcare professionals (NHP) working at a patient's bedside (73%), physicians (16%), or other NHP (11%). As per their medical specialty, 43% of the respondents practice internal medicine, 28% surgery, 14% psychiatry, 9% long-term inpatient care, and 6% stated other fields of medicine. The lowest declared compliance was registered in the statement "I use a face mask when exposure to air-transmitted pathogens is anticipated" (rating index 80 points). The highest compliance (99.4 points) was registered in the statement: "I discard used sharp materials into sharps containers."

CONCLUSION

In the surveyed healthcare facilities within the Czech Republic, overall compliance with hygiene standards is at a good level. Declared differences in compliance with hygiene standards in the selected items of the questionnaire are influenced by multiple factors. Generally, a higher level of compliance is linked to increasing age, years of practice, and a higher level of education. When comparing professional groups, a higher level of compliance with hygiene standards was registered in the NHP group.

Effectiveness of implementing link nurses and audits and feedback to improve nurses' compliance with standard precautions: A cluster randomized controlled trial

BACKGROUND

To prevent health care-associated infections, health organizations recommend that health care workers stringently observe standard precautions (SPs). Nevertheless, compliance with SPs is still suboptimal, emphasizing the need for improvement interventions.

METHODS

A cluster randomized controlled trial with a pretest-post-test design was conducted with 121 clinical nurses who worked in different wards of a university hospital. The intervention group (n = 61) had 3 infection control link nurses nominated and attended systematic audits and feedback. The control group (n = 60) received only the standard multimodal approach used in the hospital. Pre- and post-test assessment of SPs compliance was performed via the World Health Organization observational hand hygiene form and Compliance with Standard Precaution Scale Italian version.

RESULTS

At the post-test, nurses in the intervention group reported significantly increased compliance with hand hygiene, whereas no significant improvement was found in the control group. Nurses in both groups reported significantly increased Compliance with Standard Precaution Scale Italian version scores; however, a higher increase and practical significance was observed in the intervention group. Participants who improved their scores were also compared between groups, showing a significantly greater increase of individual scores in intervention group compared to the control group.

CONCLUSIONS

The findings of this study provide significant practical implications for hospitals seeking to improve compliance with SPs among nurses, showing the effectiveness of using infection control link nurses combined with systematic audits and feedback.

Survey of isolation room equipment and resources in an academic hospital

PURPOSE

The purpose of this paper, a point prevalence study, is to quantify the incidence of isolation and identify the type of communicable diseases in isolation. The paper evaluates isolation precaution communication, availability of personal protective equipment (PPE) as well as other equipment necessary for maintaining isolation precautions.

DESIGN/METHODOLOGY/APPROACH

A standardised audit tool was developed in accordance with the National Standards for the Prevention and Control of Healthcare Associated Infections (May 2009). Data were collected from 14 March 2017 to 16 March 2017, through observation of occupied isolation rooms in an academic hospital in Dublin, Ireland. The data were subsequently used for additional analysis and discussion.

FINDINGS

In total, 14 per cent (125/869) of the total inpatient population was isolated at the time of the study. The most common isolation precaution was contact precautions (96.0 per cent). In all, 88 per cent of known contact precautions were due to multi-drug resistant organisms. Furthermore, 96 per cent of patients requiring isolation were isolated, 92.0 per cent of rooms had signage, 90.8 per cent had appropriate signs and 93.0 per cent of rooms had PPE available. Finally, 31 per cent of rooms had patient-dedicated and single-use equipment and 2.4 per cent had alcohol wipes available.

PRACTICAL IMPLICATIONS

The audit tool can be used to identify key areas of noncompliance associated with isolation and inform continuous improvement and education.

ORIGINALITY/VALUE

Currently, the rate of isolation is unknown in Ireland and standard guidelines are not established for the evaluation of isolation rooms. This audit tool can be used as an assessment for isolation room compliance.

Factors contributing to clinical nurse compliance with infection prevention and control practices: A cross-sectional study

Although healthcare-associated infection is preventable, low compliance with infection prevention and control practices has been a significant issue for hospitals. This study aimed to evaluate the knowledge, attitudes, perceived safe environment, and compliance of clinical nurses and to identify the factors contributing to compliance with infection prevention and control practices. A cross-sectional study was conducted with 197 nurses who worked in university hospitals in Korea. Data were collected using a self-administrated questionnaire. Nurses correctly answered 67.4% of the questions regarding infection prevention and control knowledge, with the lowest correct scores (55%) related to multidrug-resistant organisms. Nurses demonstrated favorable attitudes toward infection prevention and control (6.5 of 8) and favorable perceptions regarding safe environment (7.75 of 9). The overall compliance score was 87.41 of 100. Nurses' attitudes, perceived safe environment, and period of clinical experience had significant positive contributions to compliance. Among employment departments, the intensive care unit was associated with higher compliance. Our findings indicate that institutional support for safe environments should be combined with ongoing education for improving knowledge and attitudes of nurses, especially in general wards.

Factors Influencing Adherence to Standard Precautions Scale: A psychometric validation

Despite the mandated use of standard precaution guidelines to limit infection transmission in health-care settings, adherence by health-care professionals is suboptimal. There is currently no psychometrically-validated scale to assess influences on workers' adherence. After the data collection was conducted, Michinov et al. (2016) published a questionnaire to determine sociocognitive determinants of adherence to Standard Precautions. The aim of the present study was to develop and test the psychometric properties of such a scale. Forty nine items were derived from interviews with 29 nurses and tested across two studies. Study 1 was a repeated-measures survey using principal components analysis with data from 363 participants; a 29 item, five factor solution was extracted with good to acceptable internal reliabilities (α = .61-.85). Data from 122 of the original participants retested at 4 weeks showed intraclass correlations of .69-.84. Study 2, which was 6 months later, used confirmatory factor analysis with data from a second sample of 384 participants, and supported the five factor structure of leadership, justification, culture/practice, contextual cues, and judgement. The Factors Influencing Adherence to Standard Precautions Scale has good psychometric properties and stability across time and samples. The scale is suitable for use with nurses, and its validation with other health-care professionals and trainees is important in order to tailor effective interventions to promote adherence.

Missed Opportunities: The Development and Testing of Standard Precaution Case Vignettes

Standard precautions are a recommended set of actions health care workers should take to prevent health care-associated infections and potentially infectious exposures. However, they are not reliably practiced, many opportunities are missed, and a substantial discrepancy between workers' stated performance and actual performance exists. This article presents findings from developing and testing standard precaution case scenarios to enhance nursing knowledge. Infusion nursing is high risk and entails highly complex care in dynamic settings. Challenges may exist when integrating this advanced care with fundamental standard precaution requirements. For this reason, findings from this study have implications for infusion nursing practice.

Compliance with Standard Precautions among Clinical Nurses: Validity and Reliability of the Italian Version of the Compliance with Standard Precautions Scale (CSPS-It)

Background: The compliance with Standard Precautions (SPs) guidelines, as a primary strategy for the prevention of healthcare associated infections, is still suboptimal among healthcare providers. However, no instrument measuring nurses’ compliance with SPs is available in Italian. This study aims to assess the validity and reliability of the Compliance with Standard Precaution Scale–Italian version (CSPS-It) among clinical nurses. Methods: The study consisted of two phases: (1) translation and cross-cultural adaptation of the CSPS; (2) validity and reliability evaluation of the CSPS-It. Confirmatory factor analysis (CFA) and hypothesis testing were performed to evaluate the construct validity. Cronbach’s alpha, intra-class correlation coefficient of test-retest scores, and item-total correlations were computed to establish reliability. Results: The CSPS-It showed a sound validity and reliability. The unidimensional model tested at CFA yielded acceptable fit indices. The hypothesis testing supported better nurses’ compliance based on participation in at least one training course on SPs. Conclusions: The CSPS-It is a valid and reliable instrument for measuring the compliance with SPs among clinical nurses. This version will allow for the conduction of further studies in favor of progress in this specific field of research. Managers should pay greater attention in monitoring compliance with SPs among clinical nurses.

Knowledge of standard precautions and barriers to compliance among healthcare workers in the Lower Manya Krobo District, Ghana

BACKGROUND

Implementing standard precautions (SP) has been a major challenge for health care workers (HCWs) especially those in developing countries thereby compromising their safety and increasing their exposure to blood-related pathogens. Compliance with safety precautions and occupational accidents among health workers are often unreported. The literature on knowledge and compliance to SP in Ghana is scanty. We report findings of a study that examined knowledge of SP, compliance and barriers to compliance with SP among HCWs in two health facilities in Ghana.

METHODS

This is a facility-based cross-sectional study involving 100 HCWs from two health facilities in the Lower Manya Krobo District of the Eastern region. Statistical analysis summarised data on socio-demographic characteristics of respondents, knowledge of SP and compliance and barriers to SP in frequencies and percentages.

RESULTS

Most respondents had been working as health staff for 0-5 years (65.0%). Generally, knowledge of the basic concepts of SP was low; only 37.0% of HCWs knew that SP includes hand washing before and after any direct contact with the patient, 39.0% knew about cough etiquettes and 40.0% knew about aseptic techniques which involve infection prevention strategies to minimise the risks of infection. Fifty percent of respondents always protect themselves against BBFs of patients. About a quarter of the respondents do not recap needles after use and 28.0% of respondents sometimes promptly wipe all blood spills. HCWs were of the opinion that wearing PPEs-such as gloves, aprons, gowns and goggles-might cause patients to panic sometimes (63.0%) and complying with SP sometimes interferes with the ability to provide care (38.0%). Sometimes, because of the demands of patient care, HCWs do not have enough time to comply with the rigours of SP (44.0%) and sometimes PPEs are not available.

CONCLUSION

Education programmes on the benefits of SP should be organised frequently. The OHS national policy together with the application of the IPC training manual in all health care facilities must be enforced. Communities of practice should be established and sanctions and rewards should be introduced to limit negative behavior and reinforce positive attitudes as regards SP.

Factors Affecting The Compliance Of Myanmar Nurses In Performing Standard Precaution

Introduction: Exposure to pathogens is a serious issue for nurses. The literature explains that standard precaution have not consistently done in nursing. The purpose of this study was to analyze the factors affecting the compliance of nurses in Myanmar in performing standard precautions.Methods: This study used a cross-sectional design. Samples included 34 nurses in Waibagi Specialist Hospital (SHW), Myanmar. The independent variables were the characteristics of nurses, knowledge of standard precaution, and exposure to blood / body fluids and needle puncture wounds. The dependent variable was the performance of standard prevention. Data analyzed using descriptive analysis and logistic regression.Results: The result showed that almost respondents (91.18%) had a good knowledge about prevention standards and 73.5% of respondents had good adherence in performing standard precaution. However, in practice nurses have not been consistent in closing the needles that have been used correctly. The results showed that nurse characteristics did not significantly affect adherence to standard precaution with statistical test results as follows: age (p = 0.97), gender (p = 1.00), religion (p = 0.72), education (p = 0.85), work experience at SHW (p = 0, 84), education training program (p = 0.71), knowledge (p = 0.76), and needle stick injury (p = 0,17). But, there was a significant influence between adherence to standard precaution on the incidence of injury due to puncture needle with p value = 0.01.Discussion: The barriers to applying standard precautions by Myanmar nurses can be reduced by providing basic training, supervision and improvement of operational standard procedures.

Effects of a mixed media education intervention program on increasing knowledge, attitude, and compliance with standard precautions among nursing students: A randomized controlled trial

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Performance of SPs knowledge improved significantly after mixed media education.

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Performance of SPs attitude improved significantly after mixed media education.

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Performance of SPs compliance improved significantly after mixed media education.

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Hands cleaning rate was significantly improved after mixed media education.

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The mixed media education intervention was efficient.

Background

Standard precautions (SPs) are considered fundamental protective measures to manage health care-associated infections and to reduce occupational health hazards. This study intended to assess the effectiveness of a mixed media education intervention to enhance nursing students' knowledge, attitude, and compliance with SPs.

Method

A randomized controlled trial with 84 nursing students was conducted in a teaching hospital in Hubei, China. The intervention group (n = 42) attended 3 biweekly mixed media education sessions, consisting of lectures, videos, role-play, and feedback with 15-20 minutes of individual online supervision and feedback sessions following each class. The control group learned the same material through self-directed readings. Pre- and posttest assessments of knowledge, attitudes, and compliance were assessed with the Knowledge with Standard Precautions Questionnaire, Attitude with Standard Precautions Scale, and the Compliance with Standard Precautions Scale, respectively. The Standard Bacterial Colony Index was used to assess handwashing effectiveness.

Results

At 6-week follow-up, performance on the Knowledge with Standard Precautions Questionnaire, Attitude with Standard Precautions Scale, and Compliance with Standard Precautions Scale were significantly improved in the intervention group compared with the control group (P < .01). The hand hygiene standard in the intervention group (38 passed) outperformed the control group (23 passed) (P < .01).

Conclusions

A mixed media education intervention is effective in improving knowledge, attitude, and compliance with SPs.

Relationship between patient safety climate and adherence to standard precautions

BACKGROUND

Standard precautions (SPs) are designed to limit bloodborne pathogen exposures among health care workers (HCWs) and health care-associated infections. SP adherence is globally suboptimal; however, reasons are underexplored. This study aim was to explore the relationships among safety climate factors and SP adherence by HCWs in hospitals using newly developed survey and observational tools.

METHODS

Cross-sectional data from 11 units in 5 hospitals were collected between March and September 2015. A patient safety and standard precaution survey was administered to nurses and pooled with data from observations of HCW-patient interactions using defined SP indications. Descriptive statistics of distributions, frequencies, and Pearson correlation coefficients were calculated to determine the unit-level relationships among dimensions of the patient safety climate and unit percentages of SP adherence (P < .05).

RESULTS

There were 540 HCW-patient encounters with 1,713 SP indications and 140 surveys collected. Although most nurses (94%) reported always or often adhering to SPs and generally reported positive scores on unit safety climate, observed SP adherence was 62% (unit range, 31%-80%). Only 30% of nurses rated staffing positively, and this was inversely related to observed SP adherence.

CONCLUSIONS

Adherence to the full complement of observed SP behaviors by HCWs of all types was suboptimal. The relationship between safety climate, particularly staffing, and adherence to SPs warrants further testing.

Reasons and consequences of low adherence to standard precautions by the nursing team

Standard precautions (SP) are recommendations to prevent infection and protect health care workers during the provision of care, however, still exists low adherence to these recommendations. Objective To analyze the reasons and consequences of low adherence to standard precautions by the nursing staff. Method integrative literature review, search in seven databases, from 2005 to 2014. Results 30 articles were selected for analysis. The reasons for low adherence evidenced relate to deficient practices of lifelong learning, risk behaviors of workers, inadequate provision of equipment and protective equipment and inadequate working conditions. The consequences are accidents and occupational diseases. There are few intervention studies, which merely provide guidance to professionals. Conclusions The low adhesion to standard precautions is linked to individual aspects of workers, employers and educational institutions. Intervention strategies carried out have shown little efficient by only focusing on the worker.

Relationship between patient safety climate and standard precaution adherence: a systematic review of the literature

Standard precaution (SP) adherence is universally suboptimal, despite being a core component of healthcare-associated infection (HCAI) prevention and healthcare worker (HCW) safety. Emerging evidence suggests that patient safety climate (PSC) factors may improve HCW behaviours. Our aim was to examine the relationship between PSC and SP adherence by HCWs in acute care hospitals. A systematic review was conducted as guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Three electronic databases were comprehensively searched for literature published or available in English between 2000 and 2014. Seven of 888 articles identified were eligible for final inclusion in the review. Two reviewers independently assessed study quality using a validated quality tool. The seven articles were assigned quality scores ranging from 7 to 10 of 10 possible points. Five measured all aspects of SP and two solely measured needlestick and sharps handling. Three included a secondary outcome of HCW exposure; none included HCAIs. All reported a statistically significant relationship between better PSC and greater SP adherence and used data from self-report surveys including validated PSC measures or measures of management support and leadership. Although limited in number, studies were of high quality and confirmed that PSC and SP adherence were correlated, suggesting that efforts to improve PSC may enhance adherence to a core component of HCAI prevention and HCW safety. More clearly evident is the need for additional high-quality research.

Predictors for compliance of standard precautions among nursing students

BACKGROUND

We aimed to investigate the frequency of standard precautions (SPs) compliance and the factors affecting the compliance among nursing students (NSs).

METHODS

A cross-sectional survey study guided by the health belief model was conducted in 2009. The study questionnaire is valid (content validity index, 0.81) and reliable (Cronbach α range, 0.65-0.94).

RESULTS

There were 678 questionnaires analyzed, with a response rate of 68.9%. The mean frequency score of SPs compliance was 4.38 ± 0.40 out of 5. Tukey honest significant difference post hoc test indicated that year 2 and year 4 students had better SPs compliance than year 3 students. Further analysis using a univariate general linear model identified an interaction effect of perceived influence of nursing staff and year of study (F1,593 = 3.72; P < .05). The 5 following predictors for SPs compliance were identified: knowledge of SPs, perceived barriers, adequacy of training, management support, and influence of nursing staff.

CONCLUSION

Although the SPs compliance among NSs was high, the compliance varied by year of study and was affected by the nursing staff. Furthermore, SPs compliance among NSs can be enhanced by increasing SPs knowledge, providing more SPs training, promoting management support, reducing identified SPs barriers, and improving nursing staff compliance to SPs.

Good Practices For Infection Prevention and Control at a Psychiatric Hospital in Brazil

This exploratory cross-sectional study aims to investigate good practice for preventing and controlling infections in a psychiatric hospital and for limiting potential exposure to biohazards for nursing professionals at this hospital located in the State of São Paulo, Brazil. The researchers directly and systematically observed 830 nursing procedures, 40.6% of which presented a moderate to high risk of biohazard exposure. Results indicate very low adherence to hand hygiene (1.2% before procedures, 2.9% after procedures), inappropriate use of gloves, and other instances of noncompliance to the standards of good practice for preventing and controlling infection, such as a lack of concurrent/terminal cleaning of dirty beds (132 instances) and careless manipulation of sharp devices (34 instances).

[Factors influencing adherence to standard precautions among nursing professionals in psychiatric hospitals]

OBJECTIVE

Evaluate and correlate individual, work-related and organizational factors that influence adherence to standard precautions among nursing professionals of psychiatric hospitals in São Paulo.

METHOD

An exploratory cross-sectional study conducted with 35 nursing professionals, using the assessment tool for adherence to standard precautions through the Likert scale, ranging from 1 to 5.

RESULTS

Knowledge of the precautions received a high score (4.69); adherence received (3.86) and obstacles (3.78), while intermediaries and the scales of organizational factors received low scores (2.61). There was a strong correlation between the magnitude adherence scale and the personal protective equipment availability (r = 0.643; p = 0.000). The training scale for prevention of HIV exposure (p = 0.007) was statistically different between the nurses and nursing assistants.

CONCLUSION

The organizational factors negatively contributed to adherence to standard precautions, indicating that psychiatric institutions lack safe working conditions, ongoing training and management actions to control infections.

Nursing students' perceptions of patient dignity

BACKGROUND

Respecting patients' dignity has been described as a fundamental part of nursing care. Many studies have focused on exploring the concept of patients' dignity from the patient and nurse perspective, but knowledge is limited regarding students' nursing perceptions and experiences.

OBJECTIVE

To explore the issue of patients' dignity from the perspective of nursing students.

RESEARCH DESIGN

A qualitative study was employed with the formation of four focus groups and the participation of nursing students. Data were analysed via a thematic content analysis of the discussions.

PARTICIPANTS AND RESEARCH CONTEXT

Thirty-four nursing students of a Cyprus University participated in the four focus groups. Each group was homogenous in terms of the year of study and heterogeneous in terms of clinical practice in various wards.

ETHICAL CONSIDERATION

The study's protocol was reviewed and approved by the Cyprus National Bioethics Committee. Ethical standards were followed throughout the study.

FINDINGS

Several factors that maintain or compromise patients' dignity emerged. These factors were grouped into five themes: (a) patients' preferences, verbal abuse and regarding a patient as a unique person; (b) privacy and confidentiality; (c) loss of autonomy and need for help; (d) discrimination and (e) attribution and reciprocity.

DISCUSSION

Different understandings of the perceived concept of dignity and the factors that maintain or compromise patient's dignity were expressed through the eyes and the feelings of nursing students. Students highlighted the importance of promoting patient dignity as an important component of nursing care.

CONCLUSION

Nurse educators can use the findings of this study in order to tailor nursing programmes to emphasise the importance of respecting patients' dignity. In addition, nurse ward managers can use the findings as means for persuading nurses to change current behaviour.

Ocorrência de acidentes de trabalho com material biológico potencialmente contaminado em enfermeiros

Objetivo Investigar ocorrência e características dos acidentes com material biológico potencialmente contaminado em enfermeiros.Métodos Estudo transversal que incluiu 121 enfermeiros. O instrumento de pesquisa foi um questionário autoaplicável com variáveis sociodemográficas e relacionadas a acidentes de trabalho.Resultados Em relação à ocorrência de acidente do trabalho com exposição a material biológico potencialmente contaminado entre enfermeiros, 65 (53,8%) foram vítimas. Destes, 63(52,1%) por perfurocortantes e 22 (18,2%) por exposição à mucosa e/ou pele não íntegra. Não houve diferença estatisticamente significativa entre os grupos quanto à ocorrência e notificação do acidente (p=0,791 e p=0,427); conhecimento da resposta vacinal (p=0,379); troca de recipiente de perfurocortantes (p=0,372) e treinamento sobre precauções padrão (p=0,158). Com relação ao treinamento foi verificada diferença estatisticamente significativa (p=0,014) uma vez que enfermeiros nos estabelecimentos menores relataram maior desejo de participação.Conclusão Os acidentes são frequentes entre os enfermeiros e o treinamento relaciona-se positivamente à adesão às precauções-padrão.

Validation and cross-cultural pilot testing of compliance with standard precautions scale: self-administered instrument for clinical nurses

OBJECTIVE

To perform detailed psychometric testing of the compliance with standard precautions scale (CSPS) in measuring compliance with standard precautions of clinical nurses and to conduct cross-cultural pilot testing and assess the relevance of the CSPS on an international platform.

DESIGN

A cross-sectional and correlational design with repeated measures.

SETTING

Nursing students from a local registered nurse training university, nurses from different hospitals in Hong Kong, and experts in an international conference.

METHODS

The psychometric properties of the CSPS were evaluated via internal consistency, 2-week and 3-month test-retest reliability, concurrent validation, and construct validation. The cross-cultural pilot testing and relevance check was examined by experts on infection control from various developed and developing regions.

RESULTS

Among 453 participants, 193 were nursing students, 165 were enrolled nurses, and 95 were registered nurses. The results showed that the CSPS had satisfactory reliability (Cronbach α = 0.73; intraclass correlation coefficient, 0.79 for 2-week test-retest and 0.74 for 3-month test-retest) and validity (optimum correlation with criterion measure; r = 0.76, P < .001; satisfactory results on known-group method and hypothesis testing). A total of 19 experts from 16 countries assured that most of the CSPS findings were relevant and globally applicable.

CONCLUSIONS

The CSPS demonstrated satisfactory results on the basis of the standard international criteria on psychometric testing, which ascertained the reliability and validity of this instrument in measuring the compliance of clinical nurses with standard precautions. The cross-cultural pilot testing further reinforced the instrument's relevance and applicability in most developed and developing regions.