Nurses' Current performance and Barriers to Use Infection Control

Standard Precautions in Family Health Centers in Mansoura City

Manar Magdy Ahmed(1)& Eman Shokry Abd Allah (2)&Fatma Mohamed Ahmed (3)
(1)
B.SC. Faculty of Nursing, Mansoura University,(2) Professor of community health
(3)
nursing and Head of Geriatric Department- Faculty of Nursing -Zagazig University,
Lecturer of community health nursing- Faculty of Nursing-Zagazig University.

Abstract
Background: Health care associated infection is a worldwide problem. Standard Precautions are
the minimum infection prevention practices that apply to all patient care regardless of suspected or
confirmed infection status of the patient in any setting where healthcare is delivered. Aim of the
study: to explore nurses' current performance and barriers to use infection control standard
precautions in family health centers in Mansoura city. Research design: cross sectional descriptive
design. Setting: This study was conductedatfamily health centers in Mansoura city, Dakahlia
governorate. Subjects: included160 nurses working in all family health centers participated in the
study. Tools of data collection: Two tools were used in data collection; ToolI: consisted of three
parts;demographic and professional data, nurses' knowledge regarding infection control standard
precaution and nurses' barriers to apply infection control standard precaution), Tool II: included two
observational checklists; nurses' practices of infection control standard precaution checklist and
Inventory checklist. Results of the present study revealed that58.8% of nurses had satisfactory
total knowledge score, while 61.3% had adequate total practice score. The highly perceived barriers
were nursing related (91.3%).A statistically significant positive correlation was found between family
health center environment and nurses' knowledge, practice and perceived
barriers.Conclusion:nurses' current performance to use infection control standard precautions lacks
to knowledge than practice, and nursing related and facility related barriers were the highly
perceived barriers to hinder nurses' use of infection control standard precautions in family health
centers. Recommendations: Activate the role of infection control committee in family health
centers, advocate perceived barriers that can affect nurses' compliance to infection control
standard precautions to authority figure in charge in order to establish strategies to improve
performance of nurses toward infection control standard precaution at family health centers.

Key Words: Infection control standard precautions, Nurses' performance, Barriers, Family
health centers.

Introduction
microbiology capacity in some public Health care acquired infections
sector facilities, in addition the complexity are worldwide problem. Infection
of applying the routine system of acquired during health care delivery is
reporting infections and the complexity of estimated between 5%and 10% in
case definitions hinders the availability of developed countries on the other hand,
such data. Some studies indicate that in developing countries the risk of
health care acquired infections are infection is 2 to 20 times higher and the
emerging as an important public health proportion of patients infected can
problem. (3) exceed 25% as declared by World
Health Organization.(1) Healthcare
Improving safety of patient care
associated infections or nosocomial
is now global issue. Growing awareness
infections are major challenges to patient
of health related infection and patient
safety in both developed and poor
safety prompted WHO to promote the
resources countries and constitute a
creation of the world alliance to
significant burden both for the patient and
coordinate spread and accelerate
for health.(2) Estimating the burden of
improvements in patient safety by
health care acquired infections in Egypt
implementation of infection control
is challenging because of limited
universal precautions.(4) Infection
surveillance activities and limited
-1-
and conditions, health education, proper prevention and control is a discipline in
nutrition,Child health care,expanded which epidemiologic and statistical
program on immunization,follow up of principles are used in order to prevent or
immunization defaulters/drop control the incidence and prevalence of
out,maternal health care,reproductive infection. The primary role of infection
health, screening and early detection of prevention and control program is to
diseases,prevention and control of locally reduce the risk of acquisition of hospital -
endemic diseases, birth and death acquired infection, protect both patients
registration.(11) There is widespread and staff from adverse infection -related
interest in the redesign of primary health outcomes.(5) Health care acquired
care practice models to increase access infections caused by pathogens that
to quality health care. Nurses are well easily spread through body. In some
positioned to assume direct care and cases patients develop infections due to
leadership roles based on their poor conditions at health care facilities or
understanding of patient, family, and due to health care facilities staff not
system priorities, in addition to episodic follows proper procedure.(6)
and preventive care and chronic disease
Infection Control Standard
management.(12)
Precautions (ICSP) are designed to
Moreover, nurses play a critical prevent cross transmission from
role in dealing with problems of access recognized and unrecognized sources of
within primary health care system. infection. These sources of (potential)
Community nurse provide abroad range infection include blood and other body
of clinical nursing services such as fluid secretions or excretions and any
vaccination, wound management, equipment or items in the care
preventive women's health, health environment which are likely to become
assessment for all ages and chronic contaminated.(7) Standard precautions
disease education, delivering care and consist of hand hygiene, personal
advice in pandemic situations, early protective equipment as gloves, gowns,
identification and intervention services to face masks, face shields and respiratory
children ,young people, adults and their hygiene and cough etiquette.(8)
families.(13)
Heath care associated infection
Significance of the study: is an important global health problem
because they occur frequent. Nurses
Health care acquired infections
have an important role when it comes to
are global problem that cost billions of
working against heath care associated
dollars each year to deal with its
infection. The impacting factors on
complications, Prevalence of nosocomial
infection control practices are four main
infection in some countries in
categories; knowledge among health
Mediterranean region include Egypt is
care staff, relatives and patients,
10.5%.(14) These complications can be
leadership, resources and routines.(9)
avoided by applying infection control
Also, variety of challenges face infection
standard precautions that is cost effective
prevention and control in healthcare
and achievable. There are many
institutions, including inadequate
challenges that face infection prevention
supplies, shortage of staff, high work
and control in healthcare institutions.
load, low resources and task allocation.
There are challenges experienced (10)
including inadequate supplies, shortage
of staff, high work load, low resources The primary care center has
and task allocation.(10) Egyptian health identified sources of hospital care
reform program include ten work available within the community or a
streams, spreading the coverage of nearby community or region. Roles of
primary care services is one of the most primary health care (PHC) centers
crucial of it.(15) The main objective to aremanagement of common illnesses
-2-
through obstetric, pediatric, dental, Egyptian ministry of health concerning
family planning, physiotherapy, and family medicine program is promoting the
internal medicine clinics. Besides, they health of the rest of the population of the
have laboratory services as well as X- Arab Republic of Egypt in all age groups
ray and ultrasound units, in addition to and congregations residential and
the pharmacy, family files department, professional by offering an integrated
sterilization room, and administrative package of advanced health services to
offices.The team of each family health individuals, families and communities
center consists of physicians in various and take into account the quality of
specialties such as gynecologists, distributive justice.(16)
pediatricians, family physicians, and
Aim of the study:
dentists. There are also physiotherapists,
nurses, pharmacists, laboratory The aim of the current study was
assistants, radiography technicians, in to explore nurses' current performance
addition to the administrative and and barriers to use infection control
housekeeping staff. standard precautions in family health
centers in Mansoura city.
Study Subjects:
Research questions:
A convenient sample of 160
nurses working in family health centers, What is the level of nurses'
in Mansoura city, Dakahlia governorate performance regarding infection control
at the time of data collection. standard precautions in family health
centers?
What are nurses' barriers to
Sample size:
apply infection control standard
Sample size was calculated to precaution in family health centers?
measure an expected satisfactory
Is there relation between nurses'
knowledge rate of 32.5% or more (17),
performance and barriers regarding
with a 95% confidence level, and a 4%
infection control standard precautions in
standard error, with a design effect 1.2
family health centers?
for cluster sampling. Using the sample
size equation for estimation of single a Subjects and Methods
proportion, with finite population Research Design:
(18)
correction ,the required sample size
was 147 nurses. This was increased to A descriptive cross-sectional
160 to compensate for a non- design was used in conducting the
responserate of about 10%. current study.
(z a/2)2p(l-p) Study Setting:
S = ----------------------- The study was conducted in all
D2 (ten) family health centers at Mansoura
S city, Dakahlia Governorate. Family
n = ---------------------- health centers provide multiple basic
(1 + S/population) and essential services to the
Where: community. These include
S = sample size for infinite management of common illnesses and
population conditions, health education, child and
maternal health care, screening and
n = sample size for finite early detection of diseases, birth and
population death registration, expanded program
p = 0.325 on immunization and basic
environmental sanitation. These
D = 0.08 centers provide their diverse services

-3-
such as “workload,” “shortage of nurses,” Tools of data collection:
and “increased numbers of patients.”
Two tools were used namely a
And barriers related to patients such as
self-administered questionnaire, and
“false beliefs about infection,” and
observation checklists.
“economic reasons.”
Tool I: Self-administrated
Scoring System: The items were
questionnaire was prepared by the
checked on a 3-point Likert scale ranging
researcher to collect personal and
from “very important” to “not important.”
work data and determine nurses’
These were scored from two to zero
knowledge regarding infection control
respectively. The scores of the items of
standard precautions.
each category of barriers were summed-
up, converted into percent scores, and Personal and work data as age,
the total divided by the number of the nursing qualification, years of experience
items, giving a mean score for each in nursing and in family health centers,
category. The nurse was considered to previous work, etc. It also hadquestions
have a high perception of the barriers if about the presence and functions of an
the total score obtained was 60% or infection control committee in the center,
higher and a low perception if the total and respondent’s role in this committee.
score was less than 60%. For the Nurse’s knowledge regarding
purpose of presentation of each item, the infection control standard precautions. It
means, standard deviations, medians was developed by the researcher guided
and first and third quartiles were by the Egyptian Ministry of Health.(19) The
calculated for each statement with a questions assessed the areas of
maximum score of 2. cleaning, disinfection, general infection,
Tool II: Observation checklists; hand hygiene, needle stick injury,
personal protective equipment, safe
Part I:to collect data regarding nurses’
injection, and safe waste disposal. It was
practice regarding infection control
in the form of Multiple Choice Questions
standard precautions. It was developed
(MCQ), True/False question, and open-
based on related literature.(20, 21)The
end questions.
checklist was used to observe the
nurse’s practice in eight procedures; Scoring System: For each knowledge
hand washing, gloving, masking, question, a correct response was scored
gowning, safe injection, waste one and the incorrect zero. For each
management, sharps waste area of knowledge, the scores of the
management and vaccination. items were summed-up and the total
divided by the number of the items,
Scoring System: The items observed to
giving a mean score for the part. These
be done were scored “1” and the items
scores were converted into percent
not done were scored “0”. For each area,
scores. Knowledge was considered
the scores of the items were summed-up
satisfactory if the percent score was 60%
and the total divided by the number of
or more and unsatisfactory if less than
the items, giving a mean score for the
60%.
part. These scores were converted into
percent scores.The practice was Nurse’s views of the barriers
considered adequate if the percent score hindering the application of infection
was 60% or more and inadequate if less control standard precautions. It was
than 60%. Since not all procedures were guided by Gichuhi et al.(10) It included
applicable for all nurses, the nurse was three categories of barriers; barriers
observed only in the procedures she was related to facility such as “lack of
assigned to perform. guidelines for the nurse to apply
standards,” “lack of infection control
Part II: Inventory checklist for
team,” and “inefficiency of the infection
assessment of the environment of the
control team.”,barriers related to nurses
-4-
instructed in filling it out. Once done, the family health center.It was developed
form was collected by the researcher to guided by Ebied.(22) It assessed the
verify its completeness. Each nurse took presence of environmental sanitation
about 25-30 minutes to fill the form. conditions such as examination rooms,
windows, lighting, stairs, toilets, safe
The researcher then started the
waste disposal, etc. These were checked
process of observation of nurse’s
as either present or absent. The center
performance using the observation
fulfilling all the items was considered as
checklist. This was done by the through
having adequate environment.
observing the nurses while doing their
usual daily work without telling them. This Validity and reliability:
was done to avoid the observer bias if
the nurses know that they are under Face and content validity were
observation. The process took the whole done for the tools by three experts in
shift or sometimes more than one shift to Medical-Surgical Nursing, Community
fulfill all the sections of the observation Health Nursing, and infection control
checklist. Some of these sections, for face and content validation. This
particularly the vaccination task, were not was done through assessing its internal
performed by all nurses.The family health consistency. It showed a good level of
center environment was then observed reliability with Cronbach Alpha coefficient
by the researcher using the designed 0.632.
inventory checklist. This was done at the Pilot study:
end of the fieldwork in each center.The
actual fieldwork lasted from the A pilot study was carried out on
beginning of March2016 to the end of 16 nurses representing about 10% of
April 2016. The researcher visited the main study sample. The purpose
thefamily health centers 6 days per week was to test the applicability and clarity
from 9:00 A.M. to 4:00 P.M. Every family of the tools. Modifications were done
health center was visited two to four days accordingly and the tools were
according to numbers of nurses who finalized. The pilot study also served to
work in it and the time needed for assess the reliability of the barriers’,
observation. knowledge and practice scale. The pilot
subjects were not included in the main
Ethical considerations study sample.
The study protocol was approved Fieldwork
by the Research and Ethics Committee
at the Faculty of Nursing, Zagazig After obtaining the official
University. A verbal consent for permission from the Undersecretary of
participation of the subjects was taken the Ministry of Health, Dakahlia
after full explanation of the aim of the governorate, the researcher visited the
study as well as the participant rights. study settings and met with the directors
Nurses were informed about their rights and nurses at each family health center.
to refuse or withdraw from the study at The first visit was for explaining the aim
any time with no reason to be given. of the study and its procedures, and for
They were reassured about the seeking cooperation in data
confidentiality and privacy of any collection.The next visits were for actual
obtained information and that information data collection. The researcher met with
will be used for the research purpose the nurses, and explained to them the
only. study aim, procedures, and their rights.
Those nurses who accepted to
Statistical analysis: participate and fulfilled the eligibility
Data entry and statistical analysis criterion were enrolled in the study
were done using SPSS 20.0 statistical sample. They were handed the self-
software package. Data were presented administered questionnaire and

-5-
 Table (3) points to a wide using descriptive statistics in the form of
variation in nurses 'knowledge regarding frequencies and percentages for
infection control.Thus,all of them had qualitative variables, and means and
satisfactory knowledge of safe waste standard deviations and medians and
disposal ,and a great majority had interquartile ranges for quantitative
satisfactory knowledge of needle stick variables. Cronbach alpha coefficient
injury (91.9%) ,and personal protective was calculated to assess the reliability of
equipment (96.3%). At the other the developed tools through their internal
extreme, only 18.8% of them had consistency. Qualitative categorical
satisfactory knowledge of general variables were compared using chi-
infection. Totally, (58.8%) of the nurses in square test. Whenever the expected
the study sample had total satisfactory values in one or more of the cells in a
knowledge of infection control. 2x2 tables was less than 5, Fisher exact
test was used instead. Spearman rank
Table (4) indicates that certain
correlation was used for assessment of
infection control practices were
the inter-relationships among
adequately performed by all nurses in the
quantitative. Variables and ranked ones.
study sample. These are wearing masks
In order to identify the independent
and gowns as well as safe injection and
predictors of nurses' knowledge and
sharps waste management. Conversely,
performance scores, multiple linear
none of them had adequate practice of
regression analysis was used, and
gloving, and only2 (4.9%) had adequate
analysis of variance for the full regression
practice of vaccination .In sum,( 61.2%)
models was done. Statistical significance
of the nurses in the study sample had
was considered at p-value <0.05.
adequate total practice of infection
control. Results:
As illustrated in figure(1), the The study sample consisted of
nursing- related barriers were considered 160 nurses whose age ranged between
by the majority of the nurses as the most 26 and 59 years, with median 35.0 years
important(91.3%), where as the patient- (Table 1). All of them had secondary
related barriers were the lowest(14.4%). nursing school diploma, except 3 (1.9%)
Intotal,(73.1%) of the nurses had a high who had technical institute diploma. Their
perception of the barriers hindering their median total and family health center
application of infection control measures. (FHC) experience years were 16.5 and
As figure (2) displays, (70.6%) of the 13.0, respectively. About (70.0%) of
settings had adequate center nurses had previous work outside FHC,
environment with (100%) of the elements more in dispensaries (54.5%).
met.
As regards the infection control
Table ( 5) indicates the presence activities in nurses' work settings, (Table
of statistically significant weak positive 2) demonstrates that (21.3%) of them
correlations between the scores of FHC were member’s in infection control
environment and nurses' scores of committees, and (25.6%) shared in its
knowledge, practice, and perception of activities. Meanwhile, (71.9%) of the
barriers; the latter being the highest nurses reported that the infection control
(r=0.326). Meanwhile, the scores of committees had periodic check visits,
practice had statistically significant weak (61.9%) of them reported that ICC had
positive correlations with the scores of training activities for nurses, and ( 63.8%)
perception of barriers, and statistically of them reported that ICC had corrective
significant weak negative correlations actions. Overall, the activities of the
with the scores of knowledge. infection control committee were fully
performed in (50.6%) of nurses’
Discussion
responses.

-6-
care and mean years in practice was The current study results
11.5 ±8.9 years. revealed that, nurses' mean age was
36.8±7 years; this result might be due to
Considering infection control
the system of employment in Ministry of
activities in nurses' work, it was found
health where the hiring plan of ministry of
that more than half of nurses reported
health focus on hiring new graduated
that infection control committee had
nurses at central hospitals. This result
regular meeting, it is worth saying that,
was consistent with Abu Salam etal.(17)
ministry of health is implementing a
who conducted a study about infection
health sector reform project under which
control awareness among health care
infection control committees in health
providers in family health settings in
centers should conduct regular meeting.
Shebin El-kom district, Menoufia
This result agrees with Ebied (22) who
Governorate, Egypt and found that mean
conducted study about the impact of a
age of health care provider was
blood borne disease prevention program
37.88±10.08 years.
on compliance with infection control
standard precautions among nurses in Regarding nurses qualification,
family health centers, El- Fayoum the current study showed that nearly all
governorate, Egypt, and found that more nurses had secondary nursing diploma, it
than half of nurses reported that activities might be due to the ministry trend to
of infection control teams involve regular place high qualified nurses in critical
meeting. settings in hospitals like intensive care
units or emergency rooms. This result
According to the current study
disagreed with Al-Hraishawi and Naji (23)
result the total nurses' knowledge of
who conducted study to evaluate the
infection control was satisfactory as
impact of nurse's knowledge concerning
reported by more than half of them. This
infection control at primary health care
result might be attributed to periodic
centers in Al Amara city, Iraq and found
attendance of training courses. This
that 42.4% of nurses had secondary
result is inconsistent with Amin and
school of nursing. Such discrepancy may
Alwehedy (25) who studied health care
be attributed to the difference in
provider's knowledge of standard
educational systems or the hiring plans
precautions at primary health care level
between the two countries.
in Saudi Arabia and found that the level
of knowledge regarding health care As to years of experiences, the
associated infections by health care current study result revealed that the
workers was low (44.4%), in addition to majority of nurses had 20 years of
Abu Salam et al.(17) in Menoufia who experience or less at family health
found that 44.7% of nurses had good centers and the mean of years of
knowledge. Such difference might be experience at primary health care was
attributed to the difference in setting, 13.5±4.4 year. Possible explanation of
tools of data collection and also time, this result was that nearly all nurses in
where recently there is more stress on the current study had secondary nursing
the importance of following infection diploma, estimating that they graduated
control standard precautions in all health at age of 16 years, and also their mean
care setting including family health age was 36.8± 7 years, consequently
centers. they can have years of experience of 20
years or less. This result was consistent
Regarding nurses practice of
with Alnoumas et al.(24) who conducted
infection control standard precautions,
study about knowledge, attitude and
the current study resultsrevealed that
behavior of primary health workers
61.3% of nurses had adequate total
regarding health care associated
practice regarding infection control
infections in Kuwait, and found that
standard precautions. This result might
83.2% of health workers had less than
be due to the periodic attendance of
20 years of experience at primary health
-7-
 As regards nurses related training courses and close observation,
barriers as perceived by the nurses in the also the fact that seven out of the ten
study sample, the current study family health centers is accredited.
mentioned the most frequently reported Likewise the current study results Alice et
barriers was those of lack of sufficient al. (26) in Nigeria studied knowledge and
information about infection control practice of infection control among health
standards among nurses (99.4%), this workers in a tertiary hospital, and found
outcome may be the result of awareness that 61.4% of nurses had good practice.
of nurses that the first step of practice is On the contrary, Abu Salam et al.(17) in
having adequate knowledge. This result Menoufia found that 32.6% of nurses had
is found inconsistent with Atalla et al. (28) high practice level. Such discrepancy
in Egypt who studied the effect of nursing between results may be attributed to the
guidelines compliance to infection control difference in assessment tools.
among nurses, and observed that half of
Considering nurses' current
study and control groups indicating that
performance of infection control standard
lack of knowledge is the most common
precautions, the current study results
factor impending proper infection
revealed that 58.8% of study sample had
prevention precaution practice. This
satisfactory knowledge about infection
variation may be due to different years of
control measures compared to 61.3% for
experience between two samples.
adequate practice. This result may be
The current study results attributed to the fact that information is
revealed that the least agreed upon easily forgotten but the thing which is
barrier was related to absence of practiced can be done habitually. This
punishment (25%). This may be due to finding agrees with Al-Hraishawi and Naji
(23)
the nurses' ability to mitigate the in Iraq who reported that 62% of the
punishment or escape it in many times subject had adequate level of knowledge
through their fellowship and friendship. while 67.1% of them had adequate
On the contrary, Fayed et al. (29) in Egypt practice. This may be due to educational
studied the effect of instructional program level convergence between two samples.
on nurses' compliance with universal
Concerning barriers to use
precautions of infection control and found
infection control standard precautions,
that 88.3% of nurses attributed their lack
the current study results illustrate that
of adherence to infection control to
nearly all nurses (98.8%) perceived that
absence of punishment.
the most commonly cited barrier was
In relation to work environment, lack of supplies. this result can be
the current study resultsrevealed that all explained through the importance of the
centers in the study sample had most of availability of resources and equipment
elements of environmental safety, this to perform steps and techniques of
result is the conclusion that most of infection control precautions adequately
centers accredited by the ministry of so the absence of the resources can
health. On the contrary to Ebied (22) in interrupt nurse's performance. This result
Egypt who found that there were rubbish agree with Adly et al. (27) in Egypt who
and wastes around half of centers, none studied improving nurses' compliance
of clinics had disposable towel or enough with standard precautions of infection
soap or disinfectant for hand drying, in control in pediatric critical care units, and
only half centers toilets are clean and found that 86.7% of nurses reported that
were properly working and the majority of the most common barrier was
clinics which were equipped with fowler inadequate equipment. Although the
bed covered with unclean linen. Such setting are different but the consistency
difference between results may be of results reflects the similarity of barriers
attributed to the health progress which in and problems in the Egyptian health care
occurring from 2011 till now. system.

-8-
family health centers lacks to knowledge The present study indicated the
than practice. Whereas, nursing related presence of statistically significant
and facility related barriers were the associations between nurses' practice of
highly perceived barriers to hinder infection control measures and their
nurses' use of infection control standard perception of facility-related(p<0.001) It is
precautions. In addition, the adequacy of evident that more nurses with high
family health center environment is perception of these barriers were having
positively correlated with total nurses' adequate practice. This result shows that
knowledge, practice and perception of just the possibility of barriers never hinder
barriers with a statistical significance. nurses to perform their job adequately.
The current study revealed a
statistically significant negative
Recommendations
correlation between the score of
In the light of the current study knowledge and nurses age (r=-0.163)
results it is recommended to activate the and experience in family health centers
role of infection control committee in (r=- 0.222). This result may be due to
family health centers; empower nurses that being younger means having better
with updated knowledge regarding mind abilities to obtain and regain
Infection control standard precautions; knowledge easily. This result is
focus nurses' attention to infection control supported by Eskander et al.(30) who
standard precautions measures found that years of experience and age
especially gloving, vaccination, safe were negatively correlated with
injection and hand washing through knowledge and practice. In this regard Al
adequate distribution of posters and Wutaib et al.(31) in Kuwait studied
flyers in family health centers, advocate knowledge and attitude of physicians and
perceived barriers that can affect nurses' nurses regarding blood borne infections
compliance to infection control standard in primary health care setting, and found
precautions to authority figure in charge that older age is important determinant of
in order to establish strategies to lower level knowledge score.
improve performance of nurses toward
Concerning the relation between
infection control standard precaution at
nurses' knowledge and practice, the
family health centers; And further
current study revealed a statistically
research to replicate the current study in
significant negative correlation between
different settings on larger samples to
nurses' knowledge and practice. This
permits for generalizations.
result may be due to the study sample
Acknowledgements: dependence on routine practice
regardless of having adequate
The authors express their knowledge. This result is found
gratitude and thanks towards all who inconsistent with Fayed et al. (29) in Egypt
have directly or indirectly helped them who showed highly positive correlation
to complete this study and their between nurses' knowledge and
practice, this result may be due to
support in each major step of the study
different setting. In this respect Walsh
especially to those nurses who agree (2010)(32) emphasized on the fact that
to participate in the study . correct theoretical knowledge of
underlying principles of the action is
essential before practice has no effect.
Conclusion
According to the findings and
research question it concluded that
nurses' current performance to use
infection control standard precautions in
-9-
 Table 1:Socio-demographic characteristics of nurses in the study sample (n=160)
Socio -demographic characteristics Frequency Percent

Age:
 <35 67 41.9
 35+ 93 58.1
Range
Mean±SD 26.0-59.0
Median 36.8±7.0
35.0
Nursing qualification:
 Secondarynursingdiploma 157 98.1
 Technicalinstitutediploma 3 1.9
Experienceyears(total):
 <20 109 68.1
 20+ 51 31.9
Range 9.0-36.0
Mean±SD
18.0±6.1
Median
16.50
Experienceyears(FHC):
 <20 143 89.4
 20+ 17 10.6
Range 2.0-30.0
Mean±SD
13.5±4.4
Median
13.0
Previousworkoutsideprimaryhealthcare(FHC): 112 70.0
 Hospital
 Dispensary 51 45.5
61 54.5

Table2 :Jobcharacteristicsofnursesinthestudysample(n=l60)

Job characteristics of nurses Frequency Percent

Infection control committee (ICC):

 Member in ICC 34 21.3

 Share in ICC activities 41 25.6

 ICC has regular meetings 98 61.3

 ICC has periodic check visits 115 71.9

 ICC carries training for nurses 99 61.9

 ICC take corrective actions 102 63.8

Total ICC activities:

 Notdone 79 49.4
 Done 81 50.6

-10-
Table3: Frequency Distribution of knowledge of infection control among nurses in the study
sample (n=160)

Satisfactoryknowledge(60%+)of: Frequency Percent

Total knowledge:
 Satisfactory 94 58.8
 Unsatisfactory 66 41.3

Table 4 : Distribution of total practice of infection control precautions as observed

among nurses in the study sample (n=160)

Adequate practice (60%+)of: Frequency Percent

Hand washing 68 42.5

Gloving:
 Wearing 0 0.0
 Removing 0 0.0
Total 0 0.0

Masking:
 Wearing 160 100
 Removing 91 56.9
Total 134 83.8

Gowning:
 Wearing 160 100
 Removing 39 24.4
Total 124 77.5

Safe injection 48 30

Waste management 160 100

Sharp waste management 160 100

Vaccination (n=41) 2 4.9

-11-
 Total Practice:
 Adequate 98 61.2
 Inadequate 62 38.8

Figure1:Totalperceptionofbarriersamongnursesinthestudysample(n=160)

Figure2:Total FHC centers environment observation(n=160)

Table5: Correlation matrix of nurses’ scores of knowledge, practice, perception of

barriers and family health care centers (FHCC)environment.

Spear man's rank correlation coetiicient

Scores Knowledge Barriers Practice Environment

Knowledge

Barriers 0.01

Practice -.189* .305**

-12-
 FHCenvironment .167* .326** .208**

(*)statisticallysignificantatp<0.05 (**)Statisticallysignificantatp<O.01

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-15-
 ‫االداء الحالى للممرضات ومعوقات استخدام المعايير القياسيه لمكافحه العدوى فى مراكز‬
‫صحه االسره بمدينه المنصوره‬
‫(‪)3‬‬
‫منار مجدى احمد (‪،)1‬ايمان شكرى عبدهللا (‪ ،)2‬فاطمه محمد احمد‬
‫(‪)1‬بكالريوس تمريض ‪ -‬كليه التمريض ‪-‬جامعه المنصوره‪ )2(،‬أستاذ تمريض صحه مجتمع و رئيس قسم‬
‫تمريض المسنين ‪-‬كليه التمريض ‪-‬جامعه الزقازيق‪ )3(،‬مدرس تمريض صحه مجتمع‪ -‬كليه التمريض‪-‬جامعه‬
‫الزقازيق‬
‫تم تجميع البيانات باستخدام أداتين في جمع البيان‪AA‬ات‬
‫وهما‪:‬‬
‫مقدمة‪:‬‬
‫األداة االولى‪ :‬ورق‪AA‬ة اس‪AA‬تماره أس‪AA‬تبيان مكون‪AA‬ه من‬
‫ثالثة أجزاء‪ :‬البيانات الديمغرافية والمهني‪AA‬ة‪ ،‬معرف‪AA‬ة‬ ‫ت ستمر مكافحه العدوى في مرافق الرعاية الصحية‬
‫الممرضات بشأن المعايير القياسية لمكافحة‬ ‫في دول الع‪AAAA‬الم الن‪AAAA‬امي فى خل‪AAAA‬ق العدي‪AAAA‬د من‬
‫التحديات نتيجة انخفاض فى الم‪AA‬وارد االقتص‪AA‬اديه‪،‬‬
‫والبني‪AAA‬ة التحتي‪AAA‬ة ‪،‬والم‪AAA‬وارد البش‪AAA‬رية‪ .‬وس‪AAA‬المة‬
‫المرضى تعد قضية كبيرة تواجه منظمات الرعاية‬
‫الصحية في جميع أنحاء العالم‪.‬‬

‫العدوى‪ ،‬المعوقات التي تحول دون تطبيق المع‪AA‬ايير‬ ‫الهدف من الدراسة‪:‬‬

‫القياسية لمكافحة العدوى ‪.‬‬ ‫ه‪AAA‬دف الرس‪AAA‬اله ه‪AAA‬و أستكش‪AAA‬اف األداء الح‪AAA‬الى‬
‫للممرض‪AA‬ات ومعوق‪AA‬ات أس‪AA‬تخدام المع‪AA‬ايير القياس‪AA‬يه‬
‫األداة الثانية‪ :‬قائمتى مالحظه حول ممارسات‬ ‫لمكافح‪A‬ه الع‪A‬دوى بمراك‪A‬ز ص‪A‬حه األس‪A‬ره فى مدين‪A‬ه‬
‫الممرض‪AA‬ات للمع‪AA‬ايير القياس‪AA‬ية لمكافح‪AA‬ة الع‪AA‬دوى‪،‬‬ ‫المنصوره‪.‬‬
‫مالحظه البيئه بمركز طب االسره‪.‬‬
‫التصميم البحثى‪:‬‬
‫النتائج‪:‬‬
‫وقد استخدمت دراسه مقطعيه وص‪AA‬فيه الج‪AA‬راء ه‪AA‬ذا‬
‫كان ‪ %58.8‬من الممرضات لديهن درجة‬ ‫‪‬‬ ‫البحث‪.‬‬
‫مرضية من المعرفة‪.‬‬
‫مكان الدراسة‪:‬‬
‫ممارس‪AA‬ة الممرض‪AA‬ات للمع‪AA‬ايير القياس‪AA‬يه‬ ‫‪‬‬
‫لمكافح‪AAA‬ة الع‪AAA‬دوى ك‪AAA‬انت كافي‪AAA‬ه بنس‪AAA‬به‬ ‫فى جميع مراك‪AA‬ز ص‪AA‬حه االس‪AA‬ره بمدين‪AA‬ه المنص‪AA‬وره‬
‫‪.٪61.3‬‬ ‫وعددها ‪ 10‬مراكز‪.‬‬

‫وج‪AA‬د ان ‪ ٪91.3‬من الممرض‪AA‬ات ل‪AA‬ديهن‬ ‫‪‬‬ ‫عينة الدراسة‪:‬‬

‫إدراك ع‪AAAAA‬ال عن العوائ‪AAAAA‬ق المتعلق‪AAAAA‬ة‬
‫ب‪AA‬التمريض خاص‪AA‬ة افتق‪AA‬ار المعرف‪AA‬ة ل‪AA‬دى‬ ‫الممرضات العامالت بمراكز صحه االسره بمدينه‬
‫التم‪AAA‬ريض بش‪AAA‬أن االحتياط‪AAA‬ات القياس‪AAA‬ية‬ ‫المنصوره‬
‫لمكافحة العدوى (‪.)٪99.4‬‬
‫ادوات جمع البيانات‪:‬‬
‫‪-16-‬‬
‫نس‪AA‬تنتج أن ‪A‬ه فيم‪AA‬ا يتعل‪AA‬ق بمعرف‪AA‬ة الممرض‪AA‬ات‬ ‫هن‪AA‬اك عالق‪AA‬ة بين المعرف‪AA‬ة الكلي‪AA‬ة غ‪AA‬ير‬ ‫‪‬‬
‫بمكافحة الع‪AA‬دوى ف‪AA‬إن ‪ ٪58.8‬من الممرض‪AA‬ات‬ ‫مرض‪AA‬ية والممارس‪AA‬ة الكافي‪AA‬ة‪ ،‬على ال‪AA‬رغم‬
‫كانت معرفتهن مرضية مقارنت‪A‬ه بممارس‪A‬تهن (‬ ‫من أن هناك عالق‪AA‬ة بين المعرف‪AA‬ة مرض‪AA‬ية‬
‫‪ ) ٪61.3‬للمعايير القياس‪A‬يه لمكافح‪A‬ه الع‪A‬دوى‪،‬‬ ‫ومجم‪AAA‬وع العوائ‪AAA‬ق المنخفض‪AAA‬ة‪ ،‬وهن‪AAA‬اك‬
‫باإلضافه إلى أن ‪%70.6‬من مراكز طب‬ ‫عالق‪AA‬ة ذات دالل‪AA‬ة بين مجم‪AA‬وع الح‪AA‬واجز‬
‫العالية والممارسة الكافيه (‪.)p=0.001‬‬

‫الخالصة‪:‬‬

‫األسره لديهم البيئه المناسبه ‪ ،‬وهناك أرتباط إيجابى‬

‫ذات دالله إحصائيه مع معرفه الممرضات بمكافحه العدوى‬
‫وممارستهن وإدراكهن بالمعوقات‪.‬‬
‫التوصيات‪:‬‬

‫البد من تفعيل دور لجنه مكافحه العدوى بمراكز‬

‫صحه األسره وتزويد الممرضات بالمعلومات‬
‫الحديثه بشأن المعايير القياسيه لمكافحه العدوى‬
‫وتنبيه مسؤولى الشؤون الصحيه بالمعوقات‬
‫التى تؤثر على ألتزام الممرضات بالمعايير القياسيه‪.‬‬

‫‪-17-‬‬