الفهرس 
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Abstract
Hospital Acquired Infections (HAIs) are infections that a person may develop as a direct result of receiving healthcare at any setting. While the specific risks of acquiring infection may differ across settings, the basic principles of infection prevention and control should be applied regardless of their health care setting. Knowledge of and compliance with standard precautions is essential to prevent HAIs and protect patients as well as, HCPs from exposure to infectious agents. Non-adherence to Standard Precautions can result in infection with illness, disability, and fatality. Compliance with Standard Precautions encompass: compliance with hand hygiene, the use of personal protective equipment such as (gloves, gowns, masks), safe injection practices, decontamination of reusable medical equipment, decontamination of the environment, respiratory hygiene/cough etiquette, management of laundry, management of waste, and management of spillages of blood and body fluids.
Aims of the study:
Identify the relationship between Health Care Providers’ knowledge of and compliance with standard infection control precautions at Damanhour Fever Hospital.
Setting
This study was conducted in all inpatient units at Damanhour Fever Hospital namely:(Intensive care unit, Critical care unit, Male, Female, Pediatric, Liver, Isolation, Dialysis) units. Diagnostic departments include (Laboratory, Radiology) ;and nutrition department.
Subjects
Out of 576 of total population of HCPs in the selected setting, a hypothesized sample of all groups of HCPs were recruited using random sampling as shown in the following table.
1. Total population of HCPs = 576
2. Acceptable α error = 0.05
3. Effect size = 0.5
4. Minimum sample size = 84
Tools of the study
Two tools were used in this study.
Tool (1) Standard Infection Control Precautions Knowledge Questionnaire
It was developed by the researcher, after a thorough review of related literature(1,6,12,69,82,111) to assess HCPs’ knowledge regarding standard infection control precautions at Damanhour fever hospital. This tool comprises two parts:
Part one: Health care providers’ demographic characteristics include: age, sex, unit, department, educational degree, qualification, years of experience, and attendance of training program regarding standard infection control precautions.
Part two: Questionnaire include 45 multiple choice questions to assess health care providers’ knowledge distributed on 12 categories:(Standard Precautions general information, Hand Hygiene, Personal protective equipment, Safe injection practices, Medical equipment cleaning, Respiratory hygiene and cough etiquette, Blood borne diseases, Air pathogens, Contact pathogens, Droplet pathogens, Dispose of waste, and Safe management of linen). The number of questions in the questionnaire is different according to the study subject group of the HCPs. The number of questions answered by the nurses were 45 questions, for physicians 39, technicians 40, and auxiliary personnel are 10 questions. Respondents were asked to select the correct answer to each question. Correct answer=1 and wrong answer=0.
The scoring system for the level of knowledge ranges from 100%-≥80% that indicate a high level of knowledge, the range from <80%-≥60% indicates a moderate level of knowledge, and the range from <60% indicates a low level of knowledge. An English copy of tool I was delivered to physicians and an Arabic copy was delivered to nurses, technicians, and auxiliary personnel. (Appendix II)
Tool (2): Standard Infection Control Precautions Observation Checklist
It was developed by the researcher, after an extensive review of literature (12,79,82,111-115) to observe HCPs’ compliance with standard precautions in their patient care.
This tool consists of three parts:
Part 1: For coding health care providers previously mentioned demographic data were added to this tool including: age, sex, unit, department, educational degree, qualification, years of experience, and attendance of training program about standard infection control precautions.
Part 2: Observation checklist to assess the level of compliance of health care providers with standard infection control precautions in their patient care. The number of items in the observation check list is different according to the study subject group of the HCPs. The number of items for the nurses is 28 items, for physicians 20, technicians 23, and auxiliary personnel are 21 items. Observation rate was on four points scale as follows: Completely done=2, Not completely done=1, Not done=0, and Not applicable without score.
The scoring system for the level of compliance ranges from 100%-≥80% which indicates a good level of compliance, the range from <80%-≥60% indicates a fair level of compliance, and the range from <60% indicates a poor level of compliance. Variation in the number of items between four groups for HCPs was due to variation in roles they practice.
Part 3: Factors affecting HCPs’ compliance with Standard Infection Control Precautions. It includes 20 Factors distributed on five categories namely: personal factor (n=5), personal protective equipment related factor (n=4), organizational factor (n=5), supplies related factor (n=3), and patient related factor (n=3). The total factors for nurses, physicians, and technicians are 20, but for auxiliary personnel there are 17 factors. Variation in the number of factors between four groups of HCPs was due to variation in roles they practice. HCPs’ agreement about factors rated on five point likert scale from completely agree=5, agree=4, neutral=3, disagree=2, and completely disagree=1. Statements of this tool were inverted in data entry. The scoring system was categorized as follows : positive agreement range from 100%-≥80% to HCPs who agreed that factors are not affecting their compliance, neutral agreement ranged from <80%-≥60%, and negative agreement ranged from <60% to HCPs who agreed that factors are affecting their compliance with Standard Precautions. An English copy of tool II part three was delivered to physicians and an Arabic copy was delivered to nurses, technicians, and auxiliary personnel (Appendix II).
Method
1. An official permission was obtained from the faculty of nursing and the administrators of the identified hospital for data collection.
2. Tools of the study were tested for face validity and translation by five experts in the field of the study. They were one professor from medical-surgical department and two lecturers from nursing administration department Faculty of Nursing Alexandria University. Also, one professor and one assistant professor from nursing administration department, Faculty of Nursing Damanhour University. Accordingly, necessary modifications were made.
3. Reliability: internal consistency of the study tools was assessed using cronbach’s alpha co-efficient test. Tool I was 0.70. Tool II, part 2 was 0.77 and part 3 was 0.72.
4. Ethical considerations: an informed consent from the study subjects was obtained. Confidentiality of the data, privacy, and anonymity of the study subjects were maintained. The subjects’ right to withdraw from the study was assured.
5. A pilot study was carried out on a number equal to 10 % of study subjects but they were not part of the subjects. Nurses (n=6), physicians (n=2), technicians (n=1),and auxiliary personnel(n=1). The pilot study was carried out in order to check and ensure the clarity of tool, applicability, feasibility, identify obstacles and problems that may be encountered during data collection and the necessary modifications were made.
6. Data collection : were conducted by the researcher from each unit separately through 3 methods observation, questionnaire, and interview:
a- Observation of each study subjects was conducted separately for two successive shifts morning and evening. In the morning shift, the researcher carried out the observation from 8:00 to 10:30 am and from 12:00 to 1:30 pm in the morning shift. While from 2:00 to 4:00 pm and from 6:00 to 7:30 pm in the evening shift, as it’s the time they provide direct patient care. Between this was the distribution of questionnaires.
b- Questionnaires were hand delivered to physicians, nurses, and technicians who were included in the study subjects. Instructions needed were provided before the distribution of the questionnaires.
c- Tool I (assesses subjects level of knowledge) and tool II part three (assesses factors affecting compliance) were distributed on study subjects and completed in the presence of the researcher to ensure the objectivity of respondents’ responses, non-contamination of their opinions, and to check that all items were answered.
d- The interview was only done for auxiliary personnel to assess their knowledge, because more than half of them were able to read and write. It took approximately 20 minutes for every one of them.
e- The data collection lasted for a period of one month starting from 1-30 November 2017.
7. Statistical analysis
- After the data was collected, it was coded and transferred into specially designed formats, to be suitable for computer feeding.
- Verification processes were carried out to avoid any errors during data entry.
- Data was fed to the computer and analyzed using IBM SPSS software package version 20.0.(Armonk, NY: IBM Corp).
The followings are the main results yielded by this study:
The highest percentage of HCPs were female 77.4%.
The highest percent of nurses, physicians, technicians, and auxiliary have a moderate level of knowledge of standard precautions 67.9%, 68.8, 57.1, and 100% respectively.
Nurses and auxiliaries have a fair overall level of compliance with standard precautions (57.1%, 60.0%) respectively.
Physicians and technicians have a poor overall level of compliance with standard precautions (87.5%, 100.0%).
There was a statistical significant correlation between nurses, physicians, and technicians concerning their level of knowledge and their level of compliance with SP(r=0.268,P=0.046),(r=0.715,P=0.002),(r=0.778, P=0.039) respectively
There was a weak negative statistical significant correlation between nurses’ compliance with SP and the factors that affect their compliance (r=-0.282,P=0.035).
There was a statistical significant relation between nurses’ age and their overall knowledge level (P=0.023).
There was a statistical significant relation between nurses’ age, qualifications, years of experience, and their overall compliance with SP (p=0.002, <0.001, <0.001) respectively.
There was no statistical significant relation between physicians, technicians, and auxiliaries demographic characteristics and their overall level of knowledge or their level of compliance with SP (p>0.05).
Based on the findings of the present study, the following recommendations are suggested.
The findings of the study imply that there is a need for;
Hospital Administration
1. Arrange and conduct a training programs for all health care providers by the infection control committee on how to comply with Standard Precautions to protect themselves and others at Damanhur fever hospital.
2. Motivate complied HCPs in different health care units and supporting patient care units such as laboratory, radiation, nutrition, and laundry.
3. Provide sufficient facilities and equipment required for applying standard infection control precautions in both morning and evening shifts equally.
4. Supervise and assess HCPs’ level of compliance with SP frequently and provide a feedback report to HCPs in each unit.
5. Establish a disciplinary system for controlling HCPs who do not comply with standard precautions.
First line nurse manager
1. Keep written guidelines in the hospital and units policies related to standard infection control precautions accessible to all HCPs all the time.
2. Maintain a patient-staff ratio to avoid shortage in HCPs and work overload.
3. Utilize illustrated posters to remind HCPs how to comply with SP.
4. Monitor HCPs’ level of compliance with SP frequently and provide needed guidance.
Further study
1. Conduct a study to investigate the relationship between health care providers’ knowledge of and compliance with standard infection control precautions at more than different fever hospitals.
2. Investigate the relationship between health care providers’ knowledge of and compliance with standard infection control precautions at general hospital.