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190]

Original Article

Are Standard Precautions for Hospital-Acquired Infection

among Nurses in Public Sector Satisfactory?
Ahmad Batran, Ahmad Ayed, Basma Salameh, Mohammad Ayoub1, Ahmad Fasfous2
Department of Nursing, Arab American University of Jenin, 2Department of Social Sciences, Bethlehem University, Jenin, Palestine, 1Dr. Sulaiman Al Habib Medical
Group, King Saudi Arabia

Abstract
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

Introduction Compliance of healthcare workers with standard precautions

is the best method to prevent and control HCAI in patients
Healthcare‑associated infection (HCAI) defined by the
and health workers.[9] Improving compliance with standard
World Health Organization as infection occurs in a patient
precautions among health workers associated with their
during the process of care which was not evident at the time
awareness, standard precautions training, and experience.[10]
of admission to a healthcare facility.[1] The prevalence of
Standard precautions are confirmed when providing care
HCAI in developed and developing countries is 7.6% and
to the patients, despite their presumed infection status. It is
10.1%, respectively.[1,2] Standard precautions are practices for
also evident when dealing with equipment that is assumed
infection control that apply to all patients, presumed, assumed
or contaminated of contamination, and in contact risk with
of infection status, or confirmed diagnosis.[3] Hand hygiene,
body fluids, blood, secretions, and excretions except sweat.
personal protective equipment, environmental cleanliness,
They include microorganisms spread by contact, airborne,
injection safety, waste management, and respiratory hygiene
and droplet routes.[11,12]
and cough management are considered the components of
standard precautions.[4,5] However, proper hand hygiene and Standard precautions aim to prevent and/or reduce of
basic precautions practices are simple and cheap cost infection transmission of HCAI and protect of nurses and healthcare
control measures during invasive procedures, but requires more
responsibility from staff and change their practice, in addition, Address for correspondence: Dr. Ahmad Ayed,
to raise their awareness.[6] Human plays an important role in Department of Nursing, Arab American University of Jenin, Jenin, Palestine.
E‑mail: [email protected]
HCAI, therefore, the adequate nursing staff is necessary.[7,8]

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DOI: How to cite this article: Batran A, Ayed A, Salameh B, Ayoub M, Fasfous A.
10.4103/amhs.amhs_84_18 Are standard precautions for hospital-acquired infection among nurses in
public sector satisfactory?. Arch Med Health Sci 2018;6:223-7.

© 2018 Archives of Medicine and Health Sciences | Published by Wolters Kluwer ‑ Medknow 223

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Batran, et al.: Standard precautions level among nurses

profession from sharp injuries.[11] Approximately (54%) of the were made to the questionnaire before they were disseminated
nurses had a fair level knowledge and 91% had a good practice to the participants.
of standard precautions.[13,14] Tai et al. described that 60% of the
The first part composed of nurses’ demographic characteristics
nurses and 46% of the physicians believed that hand hygiene
such as age, gender, marital status, Hospital, Qualification,
prevents more than 75% of HCAI.[15] Whereas, Talaat and
working department, experience, a vaccine of hepatitis B, and
Shamia showed that only satisfactory knowledge among 5% of
infection control training course. The second part assessed
physicians and 10% of nurses toward standard precautions. At
knowledge with 32 items; each item had coded with an answer
the same time, 30% of physicians and only 4% of nurses had
point, one point for correct answer and incorrect or answer with
an adequate level of performance.[16] The compliance with hand I don’t know coded zero. The correct responses were computed
hygiene improved after hand hygiene promotion program.[17] to get total knowledge scores for each participant. Total scores
Eskander et al. reported that approximately (64%) of the for all variables reached 32 points and then transformed
nurses’ knowledge level was unsatisfactory and (57%) had to 100%. The knowledge scores were considered poor
satisfactory performance level.[18] At the same time, positive knowledge (≤50%), fair knowledge (51%–80%), and (>80)
relationships were found between knowledge and practice good knowledge. The third part assessed the practice with
while the standard precautions practice still poor by nurses in 23 items using a Likert scale (every time coded (3), sometimes
surgical wards.[19] coded (2), and never coded (1). The total scores transformed
The quality of healthcare and patient safety influenced by to 100%. Good level above 80%, fair level between 51% and
Nosocomial infection. Negative outcomes include hospital 80%, and poor level of 50% or less).
stay days increasing, healthcare costs, economic problems The pilot study was done with 20 nurses from the private
to patients and their families and yet deaths.[20] In the hospitals and they were excluded from the actual study and
southeastern region of U.S, over a 1‑year period, the annual their feedbacks suggested that the questionnaire was acceptable
cost of nosocomial infections exceeded $26 million among 28 and filled in 20–25 min.
community hospitals. These results indicate the huge economic
load linked with nosocomial infections.[21]
Results
Nurses, as well as other healthcare workers, are involved in Table 1 represents that around two‑thirds of the nurses
nosocomial infections’ transmission. It has also been described 130 (65.7%) were in 20–30 years age group. Majority of the
that spread frequently occurs during the implementation of studies sample had bachelor degree147 (74.2%). At the same
therapeutic procedures and in noncompliance with aseptic time, the majority was female 184 (92.9%), only 14 (7.1%)
techniques by health professions. Thus, this will expose were males. This supports the observation that the nursing
patients to numerous pathogens.[22,23] Therefore, the study profession is predominantly made up of females. However, half
aimed to evaluate the standard precautions’ knowledge and of them 100 (50.5%) were married, and who had <5 years of
practice levels among the nurses in the Saudi Arabia private experience were 118 (59.6%). Most of the participants assured
hospitals. that they have sharp box 191 (96.5%). Around 187 (94.4%)
were received an infection control training course. The majority
Materials and Methods of the nurses 181 (91.4) had vaccinated against hepatitis B.
A cross‑sectional study was carried out among nurses. Table 2 revealed that approximately half of the participants
Sample and setting 88 (44.4%) had good knowledge level, 109 (55.1%) had fair
A convenience sample which composed of 198 nurses, who knowledge, while 1 (0.5%) had poor knowledge level. At the
work in the Intensive Care Units, emergency department, same time, it indicated 184 (92.9%) of the studied sample had
medical wards, surgical wards, operational wards, pediatric, good practice, 13 (6.6%) had fair practice, while only 1 (0.5%)
neonatal, labor, and postpartum wards of four hospitals had poor practice.
(King Khalid Hospital, Najran General Hospital, Maternal and Table 3 revealed that high knowledge scores mean found
Child Hospital, and New Najran General Hospital), in Saudi in the age group of 31–40 years, females, diploma degree,
Arabia in the period from March to May 2017 were sampled. had above 15 years’ experience and had not attended
Permission was approved from the hospitals’ administrators. courses (80.68, 78.58, 80.23, 80.08, and 80.68), respectively.
An ANOVA test was performed, and there were no significant
Informed consent of the nurses was obtained before the
statistical differences found between knowledge scores mean
administration of the questionnaire. The purpose of the study
toward age, gender, and experience (F = 0.458, 0.052, 1.419,
was discussed with the participants and assured of their
0.321, and 0.458), respectively, at P (0.499, 0.821, 0. 244,
right to confidentiality and anonymity. The participation was
0.726, and 0.499), respectively.
voluntary. Data were collected using a questionnaire developed
by researchers and reviewed by five experienced nurses from Table 4 showed that high practices scores mean found in the
the clinical settings, who have infection control certification. age group of 31–40 years old, females, master degree, had
They provided the researchers with comments; thus, changes years of experience above 15 years and attended training

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Batran, et al.: Standard precautions level among nurses

an important role in standard precautions. Standard precautions

Table 1: Assessment of the demographic data of the
aim to prevent the spread of infectious agents through blood
sample (n=198)
and body fluids. The nurses should implement standard
Items n (%) precautions continuously as an essential part of patients’ care.
Age That is agree with why the current study was conducted. The
20-30 years old 130 (65.7) study showed that two‑thirds of the study participants between
31-40 years old 43 (21.7) 20 and 30 years old. This result is in agreement with that of
>40 25 (12.6) Johnson et al.[24] emphasizing the need to keep this group of
Education health workers free from hospital infections in their early life.
Nursing diploma 40 (20.2) The majority of the participants had previous training courses
Bachelor 147 (74.2)
of standard precaution in the clinical settings, but these courses
Master 11 (5.6)
not well‑organized. Therefore, the nursing curriculum must be
Gender
emphasized the issues of standard precautions and infection
Male 14 (7.1)
control measures. In addition, the findings from this study
Female 184 (92.9)
Marital status
revealed that the majority of the participants had received
Single 100 (50.5)
hepatitis B vaccine, highlighting the hospitals’ policies and
Married 91 (46.0) guidelines that new nurses must be vaccinated when employed
Other 7 (3.5) to deal with exposure to blood‑borne pathogens and needle
Experience stick.
5 years or less 118 (59.6) In addition, the study indicated that the nurses were
6–15 years 72 (36.4)
knowledgeable related to standard precautions. These findings
>15 years 8 (4.0)
supported by Vaz et al.[12] study which had reported that 90.0%
Sharp box
of nurses had a knowledgeable level of standard precautions.
Yes 191 (96.5)
On the other hand, this is inconsistent with the previous
No 7 (3.5)
studies,[14,16,25,26] where the knowledge level was found to be
Training course
Yes 187 (94.4)
lower than what was reported in this current study.
No 11 (5.6) Concerning the practice level, the majority of the studied
Hepatitis B vaccine sample had good practice level of standard precautions. This
Yes 181 (91.4) is consistent with Fashafsheh study,[14] and more than what
No 17 (8.6) was documented by Agaral and Thomas.[27]
This may due that they believe that practice is more critical
Table 2: Assessment of the standard precautions nurses’ than standard precaution knowledge level.
knowledge and practice level (n=198) The study showed that there were no significant differences
Level Standard precautions levels between standard precautions knowledge level with the age,
Poor (%) Fair (%) Good (%) Total (%) gender, experience, education, and training courses. These
Knowledge 1 (0.5) 109 (55.1) 88 (44.4) 198 (100.0) findings are inconsistent with the previous studies.[14,28] This
Practice 1 (0.5) 13 (6.6) 184 (92.9) 198 (100.0) 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
courses (79.42, 80.47, 82.43, 81.22, and 79.84), respectively. offered.
An ANOVA test was performed, and no significant statistical
differences were found between practice scores mean according The main finding of the current study showed a moderate
to age, gender, education, years of experience, and training relationship between standard precautions knowledge and
course (F = 1.68, 0.50, 0.13, 0.13, and 0.21), respectively at practice level. This clarifies that knowledge according to
P (0.190, 0.480, 0.882, 0.879, and 0.651), respectively. standard precautions affects practice and application. This
result consistent with the findings of other studies that firmly
Table 5 revealed that Pearson correlation test was performed propose that standard precautions knowledge level was
and that there is moderate relationship between knowledge positively correlated with practice level, confirming that
and practice of standard precautions of the sample greater standard precautions knowledge level the better activity
(r = 044, at P < 0.001). practice level.[29,30]

Discussion Conclusion
Hospital‑acquired infection is the main problem in worldwide. The overall knowledge and practice toward the standard
Therefore, up to date the nursing knowledge and practice play precautions of infection control among nurses in the targeted

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Batran, et al.: Standard precautions level among nurses

hospitals were good and a moderate relationship between

Table 3: The differences between the nurses’
knowledge and practice of standard precaution.
demographic characteristics and the standard precautions
knowledge (n=198) Recommendations
Items n Mean±SD F P 1. Nurses should always implement standard precautions
Age regardless of the patient diagnosis
20-30 years’ old 187 78.41±10.49 0.458 0.499 2. Updating knowledge of nurses through continuing
31-40 years’ old 11 80.68±15.74 mandatory lectures/workshops on standard precautions
>40 187 78.41±10.49 3. Specific policies/operational guidelines on the practice of
Gender standard precaution should be developed.
Male 14 77.90±25.31 0.052 0.821
Female 184 78.58±8.95 Implications of the study
Education The current data highlight the importance of both knowledge
Diploma 40 80.23±11.99 1.419 0.244 and practice of standard precautions among nurses and other
Bachelor 147 78.40±8.98 healthcare professionals and updating the courses of infection
Master 11 74.15±22.97 control for the nurses recurrently.
Experience
5 years or less 118 78.89±9.82 0.321 0.726 Financial support and sponsorship
6-15 years 72 77.79±12.35 Nil.
Above 15 years 8 80.08±10.69
Conflicts of interest
Training course
Yes 187 78.41±10.49 0.458 0.499
There are no conflicts of interest.
No 11 80.68±15.74
P value significant at the 0.05 level. SD: Standard deviation References
1. World Health Organization. Report on the Burden of Endemic Health
Care‑Associated Infection Worldwide. Geneva: WHO; 2011.
Table 4: The differences between the nurses’ 2. Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H,
Donaldson L. Burden of endemic health‑care‑associated infection in
demographic characteristics and the practice of the developing countries: Systematic review and meta‑analysis. Lancet
standard precautions (n=198) 2011;377:228‑41.
3. Center of Disease Prevention and Control (CDC). Glossary of Terms.
Items n Mean±SD F P
Atlanta, USA: Center of Disease Prevention and Control; 2012.
Age 4. World Health Organization. Guidelines on Prevention and Control of
20-30 years old 130 88.31±7.26139 1.676 0.190 Hospital Associated Infections. Geneva: WHO; 2002.
31-40 years old 43 90.12±7.43 5. World Health Organization. Practical Guidelines for Infection Control
>40 25 87.13±4.39 in Health Care Facilities. Geneva: WHO; 2004.
Gender 6. Bouallègue O, Naija W, Said H, Nouria A, Jaidane N, Dhidah L.
Incidence of ICU acquired nososcomial infections in University
Male 14 87.27±10.45 0.501 0.480
Hospital of Sahloul (Sousse‑Tunisia). Antimicrob Resist Infect Control
Female 184 88.65±6.74 2013;2:P233.
Education 7. Hugonnet S, Chevrolet JC, Pittet D. The effect of workload on infection
Diploma 40 88.48±7.75 0.126 0.882 risk in critically ill patients. Crit Care Med 2007;35:76‑81.
Bachelor 147 88.49±6.57 8. Cole M. Infection control: Worlds apart primary and secondary care. Br
Master 11 89.59±10.45 J Community Nurs 2007;12:301, 303‑6.
9. Siegel JD, Rhinehart E, Jackson M, Chiarello L; Health Care Infection
Experience
Control Practices Advisory Committee 2007 guideline for isolation
5 years or less 118 88.42±6.66 0.129 0.879 precautions: Preventing transmission of infectious agents in health care
6-15 years 72 88.65±7.84 settings. Am J Infect Control 2007;35:S65‑164.
Above 15 years 8 89.67±5.11 10. Luo Y, He GP, Zhou JW, Luo Y. Factors impacting compliance with
Training course standard precautions in nursing, China. Int J Infect Dis 2010;14:e1106‑14.
Yes 187 88.61±6.96 0.206 0.651 11. Siegel JD, Rhinehart E, Jackson M, Chiarello L. Health Care Infection
No 11 87.62±8.53 Control Practices Advisory Committee. Guideline for Isolation
Precautions: Preventing Transmission of Infectious Agents in Healthcare
P value significant at the 0.05 level. SD: Standard deviation
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].
Table 5: The relationship between the nurses’ knowledge 12. Vaz K, McGrowder D, Crawford T, Alexander‑Lindo RL, Irving R.
Prevalence of injuries and reporting of accidents among health care
score mean and practice scores mean of the standard
workers at the University Hospital of the West Indies. Int J Occup Med
precautions (n=198) Environ Health 2010;23:133‑43.
Item n Mean±SD r P 13. Ayed A, Eqtait M, Fashafsheh I, Ali G. Knowledge & compliance of
nursing staff towards standard precautions in the Palestinian hospitals.
Knowledge 198 78.53±10.80 0.44 0.001 Adv Life Sci Technol 2015;36:21‑30.
Practice 198 88.55±7.04 14. Fashafsheh I, Ayed A, Eqtait F, Harazneh L. Knowledge and practice
P value significant at the 0.05 level. SD: Standard deviation of nursing staff towards infection control measures in the Palestinian

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[Downloaded free from http://www.amhsjournal.org on Friday, February 8, 2019, IP: 199.250.146.190]

Batran, et al.: Standard precautions level among nurses

hospitals. J Educ Pract 2015;6:79‑90. team to find simple solutions. Crit Care Nurse 2007;27:80, 78‑9.
15. Tai JW, Mok ES, Ching PT, Seto WH, Pittet D. Nurses and physicians’ 24. Johnson E, Asuzu C, Adebiyi D. Knowledge and practice of universal
perceptions of the importance and impact of healthcare‑associated precautions among professionals in public and private health facilities
infections and hand hygiene: A multi‑center exploratory study in Hong in Uyo, Southern Nigeria – A comparative study. Ibom Med J
Kong. Infection 2009;37:320‑33. 2013;6:9‑19.
16. Talaat E, Shamia E. Developing a control action plan for infection 25. Abdulraheem S, Amodu O, Saka J, Bolarinwa A, Uthman B. Knowledge,
prevention at the endoscopy unit. J Int Acad Res 2010;2:412‑20. Awareness and compliance with standard precautions among health
17. Picheansathian W, Pearson A, Suchaxaya P. The effectiveness of a workers in North Eastearn Nigeria. J Community Med Health Educ
promotion programme on hand hygiene compliance and nosocomial 2012;2:131.
infections in a neonatal intensive care unit. Int J Nurs Pract 26. Isara AR, Ofili AN. Knowledge and practice of standard precautions
2008;14:315‑21. among health care workers in the federal medical centre, Asaba, Delta
18. Eskander H, Morsy W, Elfeky H. Intensive care nurses’ knowledge &
State, Nigeria. Niger Postgrad Med J 2010;17:204‑9.
practices regarding infection control standard precautions at a selected
27. Agaral M, Thomas P. Prevalence of postoperative nosocomial infection
Egyptian cancer hospital. J Educ Pract 2013;4:160‑74.
in neuro surgical patients and associated risk factors‑a prospective
19. Mahmud N, Abdul Sahib S. Assessment of nurses’ practices toward
study. NJI 2003;107:620‑5.
infection control standardized precautions in Azady teaching hospital in
28. Hamid MZ, Aziz NA, Anita AR, Norlijah O. Knowledge of blood‑borne
the City of Kirkuk. Iraqi Natl J Nurs Spec 2011;24: 52‑8.
20. Kaye KS, Anderson DJ, Sloane R, Chen LF, Choi Y, Link K, et al. The infectious diseases and the practice of universal precautions amongst
effect of surgical site infection on older operative patients. J Am Geriatr health‑care workers in a tertiary hospital in Malaysia. Southeast Asian J
Soc 2009;57:46‑54. Trop Med Public Health 2010;41:1192‑9.
21. Anderson DJ, Kaye KS, Chen LF, Schmader KE, Choi Y, Sloane R, 29. Chan MF, Ho A, Day MC. Investigating the knowledge, attitudes
et al. Clinical and financial outcomes due to methicillin resistant and practice patterns of operating room staff towards standard and
Staphylococcus aureus surgical site infection: A multi‑center matched transmission‑based precautions: Results of a cluster analysis. J Clin
outcomes study. PLoS One 2009;4:e8305. Nurs 2008;17:1051‑62.
22. Costello JM, Graham DA, Morrow DF, Morrow J, Potter‑Bynoe G, 30. Taneja J, BibhaBati M, Aradhana B, Poonam L, Vinita D, Archana T,
Sandora TJ, et al. Risk factors for surgical site infection after cardiac et al. Evaluation of knowledge and practice amongst nursing staff
surgery in children. Ann Thorac Surg 2010;89:1833‑41. toward infection control measures in a tertiary care hospital in India.
23. Racco M, Horn K. Central catheter infections: Use of a multidisciplinary Can J Infect Control 2009;24:104‑7.

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