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.

Nursing students' knowledge, attitude and practices of infection prevention and control guidelines at a tertiary institution in the Western Cape: A cross sectional study

BACKGROUND

Nurses in sub-Saharan Africa are particularly at a higher risk of acquiring nosocomial infections, considering the increased prevalence of infectious diseases. It is therefore imperative that these nurses have a sound knowledge and understanding of infection prevention procedures.

OBJECTIVE

The main objective of this study was to describe the knowledge, attitudes and practices concerning infection prevention and control precautions among nursing students in a resource limited setting.

METHOD

A cross sectional study design was employed. A self-administered questionnaire concerning infection prevention and control guidelines were made available to students enrolled in a mainstream programme for completion of an undergraduate nursing degree.

SETTING AND PARTICIPANTS

A total of 301 students at second, third and final years of study from a tertiary institution in the Western Cape were invited to participate.

RESULTS

The final cohort comprised of 301 students with the majority between the ages of 17-26 (88.2%), with a mean age of 23 ± 4.7 (SD) years and the dominant gender being female (83.4%). According to the classification system used in this study, the majority of the students were overall evaluated as having good level of knowledge (47.4%) and poor attitude (41.7%) scores, with little difference in practice scores observed between different years of study. There was a positive correlation found between students' total attitude and total practice scores (r = 0.48 p < 0.01). Results showed that significant associations between gender and knowledge (p < 0.05), attitudes (p < 0.05) and practice (p < 0.05) exists. There was also a significant association between province and those who repeated a year with total knowledge scores (p < 0.05).

CONCLUSION

Based on the results of this study, it is recommended that interactive infection control courses that promote critical thinking are implemented at undergraduate level along with more stringent forms of assessments focusing on infection prevention and control, during clinical training.

Infection prevention and control: Who is the judge, you or the guidelines?

OBJECTIVES

The aim of this study was to explore the attitudes and behaviours of registered nurses and their colleagues around the adoption of standard precautions in order to determine strategies to promote adherence.

DESIGN

A qualitative exploratory descriptive design used interviews and focus group to collect data.

SETTING

Registered nurses and registered midwifes from a tertiary metropolitan hospital took part in the study.

PARTICIPANTS

A voluntary sample of 29 adults was recruited from the Australian nursing (n = 25) and midwifery (n = 4) workforce. There were six men (mean age = 36.83 years; SD = 8.93) and 23 women (mean age = 41.36 years; SD = 10.25). Participants were recruited through advertisement on notice boards and emails from unit managers.

RESULTS

Thematic analysis revealed five themes but the focus here is on staff judgements which are against the guidelines. Participants indicated that where in their judgement the patient posed no risk and they judged themselves skilled in the procedure, they were justified in deviating from the guidelines. Some staff judgements appeared to be self-protecting, while others were irrational and inconsistent.

CONCLUSIONS

Despite use of standard precautions being mandated, staff often deviated from them based on their own assessment of the situation or the patient. Any deviance from the guidelines is of concern but especially so when staff take it upon themselves to apply their own criteria or judgements. These results also suggest there may be some organisational inadequacies with regards to training and supervision of staff.

Universal precautions

The purpose of this literature review is to consider key themes from empirical research relating to the knowledge and compliance of universal precautions amongst healthcare practitioners. Utilising international studies, strategies to improve universal precautions are analysed. The review identifies areas of limited knowledge, synthesises existing research and suggests aspects of universal precautions that need to be studied further.

A literature search of studies listed in the Cumulative Index of Nursing and Allied Health Literature (CINAHL) database was conducted from 1990–2003, using a number of key words. Review, analysis and synthesis of selected studies were performed.

The findings of this review showed that universal precautions are considered an effective means of protecting patients and staff and controlling infection. The consensus from this body of evidence is that, globally, knowledge of universal precautions is inadequate and compliance low. Studies from many countries have shown that specific intervention strategies, such as education, are influential in improving knowledge and compliance.

This review concludes that it is imperative that future research examines how the attitudes and beliefs of practitioners can be influenced and changed to reenforce adherence to universal precautions within the clinical practice setting. There remains a lack of evidence on the long-term benefits of practice interventions to improve compliance, and what specific barriers are influential in affecting how healthcare practitioners adopt universal precautions more effectively in their practice.

Factors influencing nurses' compliance with Standard Precautions in order to avoid occupational exposure to microorganisms: A focus group study

BACKGROUND

Nurses may acquire an infection during the provision of nursing care because of occupational exposure to microorganisms. Relevant literature reports that, compliance with Standard Precautions (a set of guidelines that can protect health care professionals from being exposed to microorganisms) is low among nurses. Additionally, high rates of exposure to microorganisms among nurses via several modes (needlesticks, hand contamination with blood, exposure to air-transmitted microorganisms) occur. The aim of the study was to study the factors that influence nurses' compliance with Standard Precaution in order to avoid occupational exposure to pathogens, by employing a qualitative research design.

METHOD

A focus group approach was used to explore the issue under study. Four focus groups (N = 30) were organised to elicit nurses' perception of the factors that influence their compliance with Standard Precautions. The Health Belief Model (HBM) was used as the theoretical framework and the data were analysed according to predetermined criteria.

RESULTS

Following content analysis, factors that influence nurses' compliance emerged. Most factors could be applied to one of the main domains of the HBM: benefits, barriers, severity, susceptibility, cues to action, and self-efficacy.

CONCLUSIONS

Changing current behavior requires knowledge of the factors that may influence nurses' compliance with Standard Precautions. This knowledge will facilitate in the implementation of programs and preventive actions that contribute in avoiding of occupational exposure.

A review of the evidence for suboptimal compliance of healthcare practitioners to standard/universal infection control precautions

AIMS

The review examines from international research: the extent to which practitioners comply with infection control precautions; the pertinent issues that are considered influential in compliance; what strategies have been evaluated to instigate positive behaviour changes amongst practitioners and the effect of these interventions.

BACKGROUND

Internationally, standard/universal precautions (UP) are regarded as fundamental in the prevention and control of infection, and effective in protecting practitioners and patients. However, adherence has been problematic and the practice of standard/UPs is globally suboptimal.

DESIGN AND METHODS

Literature review where relevant evidence was identified using several electronic databases, from 1994 to 2006, with number of key terms utilized. Data were extracted by using key headings, which facilitated analysis.

RESULTS

Thirty-seven studies were appraised. Twenty-four related to measuring practitioner compliance and 13 studies that evaluated the effect of a research intervention on compliance. In addition, other studies were included which examined the specific reasons for suboptimal compliance, or discussed infection control precautions generally.

CONCLUSIONS

Compliance to infection control precautions is internationally suboptimal. The evidence confirms that compliance to specific aspects of standard/UPs varies, and practitioners are selective in their application of recommended practice. Compliance does improve following a structured intervention; however, research fails to indicate for how long the intervention affects practitioner compliance, or whether compliance after a period of time returns to the norm. Several reasons for non-compliance are discussed, and recommendations for future research are suggested. Relevance to clinical practice. Suboptimal compliance has significant implications for staff safety, patient protection and the care environment. Infection control teams and researchers need to consider the reasons for non-compliance and provide a supportive environment that is conducive to the routine, long-term application of standard precautions.

Self-reported infection control practices and perceptions of HIV/AIDS risk amongst emergency department nurses in Botswana

This descriptive exploratory study investigated the reported practices and perceptions of emergency nurses related to infection control in the context of the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) pandemic in Botswana. Quantitative and qualitative data were collected using a self-administered questionnaire. Forty questionnaires were distributed to nurses with emergency department experience in Botswana, with a response rate of 55% (n = 22). Quantitative data were analysed using descriptive statistics while qualitative data were subjected to thematic and content analysis. The majority of respondents reported compliance with universal precautions at the hospital emergency department. However, qualitative data highlighted resource constraints that may hinder compliance with universal precautions such as a lack of appropriate facilities, a shortage of equipment and materials, inadequate staffing and absence of sustainable in-service education programs. Further, the reported compliance with Universal Precautions had not removed the fear of exposure to HIV/AIDS and perceived risk of transmission to family. The authors recommend in-service education and practice initiatives to promote sustainable compliance with universal precautions and realistic risk perception among nurses. Further research is required to evaluate nurses' compliance with universal precautions in developing countries using observational methods or in-depth interviews. This would enable exploration of nurses' actions regarding compliance with universal precautions.

Work-related asthma among health care workers: surveillance data from California, Massachusetts, Michigan, and New Jersey, 1993-1997

BACKGROUND

Asthma morbidity has increased, posing a public health burden. Work-related asthma (WRA) accounts for a significant proportion of adult asthma that causes serious personal and economic consequences.

METHODS

Cases were identified using physician reports and hospital discharge data, as part of four state-based surveillance systems. We used structured interviews to confirm cases and identify occupations and exposures associated with WRA.

RESULTS

Health care workers (HCWs) accounted for 16% (n = 305) of the 1,879 confirmed WRA cases, but only 8% of the states' workforce. Cases primarily were employed in hospitals and were nurses. The most commonly reported exposures were cleaning products, latex, and poor air quality.

CONCLUSIONS

Health care workers are at risk for work-related asthma. Health care providers need to recognize this risk of WRA, as early diagnosis will decrease the morbidity associated with WRA. Careful product purchasing and facility maintenance by health care institutions will decrease the risk.

Central venous catheters: a survey of ICU practices

AIM

This paper describes the current infection control practices for CVC care and compares these to evidence-based practice guidelines.

BACKGROUND

Intensive care patients with central venous catheters (CVCs) are at risk of catheter-related infection, which increases morbidity, mortality and health care costs. Infection control practices, including care of intravenous administration sets and catheter sites, are undertaken by nurses in an attempt to avoid infection. Although practice guidelines are available, infection control practices may vary between practitioners and institutions; however, current practice has not been formally surveyed.

METHOD

A prospective, cross-sectional descriptive survey was carried out. Intensive care units (n = 14) in Australia were surveyed about their infection control policies for CVC care. Results were tabulated and compared with evidence-based practice guidelines.

RESULTS

A wide variety of responses was received about duration of administration set use for standard, parenteral nutrition and propofol (lipid-based anaesthetic) infusions; ad hoc administration set connection technique; dressing frequency, materials and solutions; and barrier precautions used during procedures. There was inconsistent adherence to the guidelines.

CONCLUSION

There is variation in the infection control approach to CVC care. Greater adherence to existing Centers for Disease Control Guidelines would assist in the standardization of best practice and facilitate evidence-based care.

Perceptions that influence occupational exposure reporting

Statistics on health care workers' occupational exposures to bloodborne pathogens underestimate the true extent of the problem because of a tendency for underreporting. A descriptive correlational design was used to investigate compliance with standard precautions and occupational exposure reporting practices among perioperative nurses in Australia. The study found that although intention to report both percutaneous and mucocutaneous exposures was relatively high, mean compliance rates for actually reporting exposures incurred were considerably lower. The perception of barriers to reporting significantly influenced compliance.

Profiles of rural nurses' use of personal protective equipment: a cluster analysis

This study examined the relationship between profiles of rural registered nurses' levels of compliance with the use of personal protective equipment and HIV-related attitudes. Survey data were collected from 395 practicing registered nurses in nine rural counties in New York and Pennsylvania. Cluster analysis grouped respondents according to their use of protective equipment by patient HIV status. Seven profiles were identified from the resulting 13 clusters. Profiles were named according to the characteristics of the protective equipment usage that were most evident in each profile. Usage levels included minimal users, appropriate users, anticipatory users, glove users, discriminate users, maximal users, and optimal users. Of these, three were classified as compliant, one as undercompliant, and three as overcompliant. Selective compliance (changing usage in response to patients' HIV status) was characteristic of five profiles. Knowledge that patients were HIV-positive accounted for overcompliance and selective compliance and was related to nurses' HIV attitudes. Undercompliance was related to care of patients who were HIV-negative or unknown. Rural nurses' use of personal protective equipment is not homogenous but discrete and idiosyncratic. This analysis expands current knowledge and redefines nursing practice of standard precautions.