الفهرس 
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Abstract
On December 2019, the World Health Organization (WHO) was informed about cases of pneumonia of unknown etiology. Later, due to the fast spread, the severity of illness, and the continuous escalation in the number of affected countries, cases, and causalities, WHO declared coronavirus disease 2019 (COVID-19) a global pandemic in March 2020. In Egypt, from January 2020 till October 2022, there have been 515,388 confirmed cases of COVID-19 with 24,797 deaths, reported to WHO, and it was assumed that there was a significant number of unreported cases. By February 2022, 404 million people had been affected worldwide and more than 5 million deaths have been reported.
Infection control precautions were highly recommended by WHO for prevention of COVID-19 as there is high potential of transmission (WHO, 2020). Health Care Workers (HCWs) and health care field students are at higher risk of contracting COVID-19 at their work and practice settings. A report of Chinese center for disease control and prevention Centers for Disease Control [CDC] (2020) indicated that 1.716 HCWs contracted the COVID-19, WHO reported 22.073 cases and the European Respiratory Society (ERS) research revealed 67.569 cases of COVID-19 infected HCWs worldwide.
Health care workers and future health care workers (students) are the backbone of health systems. A healthy and competent workforce are the basic requirements to ensure healthy community, and especially during crisis such as COVID-19 pandemic and the emerging variants of the virus. Thus, HCW and health care field students should have good knowledge, attitude, and infection control precautionspractice about Covid-19, having these competencies and knowing the determinants of these competencies will help them protect themselves and the community.
- The aim of the current study is to identify the determinants of nursing students’ competencies toward COVID-19 infection control precautions.
Materials and Method
Materials
Research Design:
A descriptive- correlational research design was used in this study.
Setting:
This study was conducted in nine intensive care units (ICUs) of Alexandria Main University Hospital, namely the Casualty ICU (Unit 1:14 beds), the General ICUs (Unit 2:11 beds, Unit 3:16 beds, Unit 4:8 beds, Unit 5:12 beds, Unit 6:8 beds, Unit 7:4 beds) and the Medical ICUs (Unit A:10 beds and Unit B:7 beds). In addition to the classrooms 4, 5 and 6 of the Faculty of Nursing, Alexandria University.
Subjects:
A convenience sample of 170 undergraduate nursing students enrolled in the 3rd level at the Faculty of Nursing, Alexandria University and registered in the Critical Care Nursing II course during the COVID 19 pandemic, were included in the study.
Tools:
Three tools were used to collect the necessary data. Tools were developed by the researcher after reviewing the related literature, in addition to socio-demographic data, health related data, clinical data, and work-related data.
Tool I: COVID-19 infection control precautions knowledge questionnaire.
The aim of this tool is to identify nursing students’ knowledge toward COVID-19 infection control precautions and consisted of 15 questions.
Scores for each question were assigned as follows:
Correct answer = score one
Incorrect answer = score zero
Total score ranged from 0 -15. The level of knowledge was considered poor if the total score was ≤9 (60% or less), fair if the total score was 10 or 11 (66% -73%) and good if the total score was ≥ 12 (80% and above).
Tool II: COVID-19 infection control precautions observational checklist.
The aim of this tool is to identify nursing students’ skills toward COVID-19 infection control precautions and consisted of 17 procedures of infection control precautions each procedure included a number of items for a total of 126 items as follows: moments for hand hygiene (10 items), hand washing (20 items), hand disinfection (8 items) , wearing and removing face mask (12 items), respiratory etiquette (1 item), moments for wearing gloves (6 items),wearing gloves (2 items), moments for changing gloves (3 items), removing gloves (7 items), moments for wearing gown (8 items), wearing gown (3 items), removing gown (8 items), eye protection (8 items), equipment cleaning and disinfection (10 items), handling equipment and linens (8 items), transportation of equipment and linens (4 items),waste management (8 items).
A score was assigned for each of the item as follows:
Done: one (1)
Not done: zero
Score of items within each precaution were calculated as follows: done and complete, done but incomplete andnot done. If the students performed all items in the precaution, it was considered done and complete. If any item/items is/are not performed it was considered done but incomplete. Students who did not perform any of the items it was considered not done.
Nursing students practice was considered good if ≥ 75% of students performed all the infection control procedures done and complete(17 procedures).Nursing students practice was considered fair if 61%-74% of the nursing students performed all the infection control procedures done and complete. Nursing students practice was considered poor if ≤ 60% of nursing students performed all the infection control procedures done and complete.
Tool III: COVID-19 infection control precautions attitude questionnaire.
The aim of this tool is to identify nursing students’ attitude toward COVID-19 infection control precautions and included 18 sentences.
A five pointsLikert- scale was used as follows:
Strongly agree= (5), Agree= (4), Neutral= (3), Disagree= (2), Strongly disagree= (1).
Total score ranged from 18 to 90. The attitude was considered positive if the total score was ≥54 (60%) and negative if the total score was ≤53 (59%).
The developed tools were tested for reliability. Tool II: COVID-19 infection control precautions observational checklist (r=0.926) and tool III: COVID-19 infection control precautions attitude questionnaire (r=0.713). While the reliability of tool I: COVID-19 infection control precautions knowledge questionnaire could not be tested because of the nature of the tool according to the statistician opinion.
- Approval of the Research Ethics committee of the Faculty of Nursing, Alexandria University was obtained.
- An official letter was sent from the Faculty of Nursing to the Alexandria Main University hospital administrative authorities, and the ICUs’ directorto obtain the permission to conduct the study in the previously mentioned ICU settings after explanation of the aim of the study.
- Tools were submitted to a jury of five experts in the field of the study including two professors, one assistant professor and two lecturers in critical care and emergency nursing department in the Faculty of Nursing, Alexandria University to assess the content validity and the necessary modifications were done accordingly.
- A pilot study was carried out on 10% of nursing students (17) using the three developed tools, to assess the clarity and the applicability of the tools, and the necessary modifications were done accordingly. Subjects in the pilot study were excluded from the study sample.
Data were collected as follows:
• The selected students in each group were observed for COVID-19 infection control precautions implementation once by the researcher according to their schedule using tool II (COVID-19 infection control precautions observational checklist), for one clinical training day in the ICUs, for three hours.
• Upon completion of the selected nursing students’ observation regarding infection control precautions implementation, they were met in the classroom at the Faculty of Nursing before or after their lecture according to the lecturer’s preference, to answer tool I (COVID-19 infection control precautions knowledge questionnaire) and tool III (COVID-19 infection control precautions attitude questionnaire).
• Questionnaire took approximately 30 minutes to complete in the presence of the researcher to clarify any question when necessary.
• The students who could not attend in the day of collection of data, were met by the researcher in the followingday of their clinical training in the ICU to be observed for infection control precaution implementation using tool II or following lecture to answer tool I and tool III.
• Data collection took approximately three months starting from the beginning of March 2022 to the end of May 2022.
Result of the study:
Findings of the current study revealed that, the majority of the nursing students (94.7%) were in the age group 20 to < 23 years old and slightly less than two thirds of them (64.7%) were females. The majority of the nursing students (98.2%) were single, three quarters (75.3%) lived in urban area in Alexandria, and only 18.2% of the nursing students had previous nursing studies.
Knowledge. The majority (70.4%) of the nursing students had fair overall knowledge about COVID 19. Furthermore, the majority of them had good knowledge in relation to COVID 19 clinical signs and symptoms, diagnostic tools, incubation period, vaccination, and risk factors (95.3%, 88.2%, 86.5%, 85.9% and 84.1% respectively). Whereas 74.1%, 72.6%, 61.8% respectively have fair knowledge in relation to COVID 19 treatment and complications, mode of transmission and prevention; and 26.5% have poor knowledge in relation to COVID 19 quarantine and isolation.
Attitude. Nursing students had a general positive attitude (>60%) toward Covid 19, to mention, positive attitude regarding available information, exposure to COVID 19, greeting others, investment of resources in PPE, test and isolation, vaccination, covid 19 disease and regarding training (86.2%, 89.4%, 80.8%, 89.4%, 78.2%, 74.0%, 69.0%, 60.7%); 12.9% of the nursing students had a negative attitude towards training and 17.5% regardingCovid-19 disease.
Practice.Poor practices were shown by the nursing students. It was observed that eighty-seven-pointsix percent of the nursing students sanitized their hands in some of the required moments, and 12.4% of them did not sanitize their hands in any of the requited moments. Sixty percent of the nursing students did not wash their hands, 38.8% of them washed their hands but the process was incomplete and only 1.2% of them washed their hands correctly following all the steps.
All nursing students wore mask, but the process of wearing mask was incomplete, and none of them removed the mask after finishing the clinical training day. Furthermore, the majority of them (90%) followed respiratory etiquette by keeping or wearing the mask over nose and mouth while sneezing or coughing or covering nose and mouth with elbow.
The majority of the nursing students (93.5%) wore gloves in the right moments. More than ninety percent of the nursing students wore gloves in a complete way and only 9.4% of them wore the gloves incompletely and 68.2% did not change their gloves in the right moments compared to only 26.5% who changed the gloves in the right moments. In addition, the majority of the nursing students (98.2%) removed their gloves after the procedure’s completion or gloves contamination but without following all the steps of gloves removal.
It can be noticed that all nursing students did not wear gown in the right moments;furthermore, most of the nursing students (96.5%) did not wear gown properly. All the nursing students did not wear eye protection. More than half of the nursing students (58.2%) cleaned, disinfected and re-processed re-usable equipment but the process was incomplete, while more than one third of them (41.8%) did not do the procedure. Also, the majority of the nursing students (98.8%) did not handle equipment and linens in the proper wayand all of them followed the treatment of type of waste according to local regulations but the majority of them (94.1%) did it incompletely, and only 5.9% completed the procedure correctly.
Correlations. A significant correlation was found between nursing students’ knowledge and their age (p=0.015), nursing students’ attitude and their age (p=0.032) and between students’ level of knowledge and their marital status (p=0.041), while there are no significant correlations between gender, area of residence, previous nursing studies and students’ competencies.
A significant correlation was also found between students’ level of knowledge and their administration of Covid-19 vaccine(p= 0.017) and a significant correlation was also found between the nursing students’ practice and presence of allergies history (p=0.022).
A significant correlation between nursing student’s attitude and students applying Covid-19 infection control precautions was found (p:0.036), also, between nursing student’s attitude and their source of information about Covid -19 infection control precautions (p: 0.028). No significant correlation was found between nursing student knowledge or practice and their reported clinical related data.
A significant correlation between students’ level of knowledge regarding Covid 19 infection control precautions and the frequency of attended in-service education/training (p=0.024) was found, also a significant correlation was found between nursing students’ attitude and their working status (p=0.045), duration of their working experience (p=0.025), andthe frequency of attended in-service education/training regarding Covid 19 infection control precautions(p=0.005). Likewise, significant correlation was found between nursing students practice and which PPE are available at the place of work (p=0.021).
Finally, asignificant correlation is found between students the level of knowledge and their attitude (P= .000), while apparently there is no significant correlation between nursing student’s level of knowledge and their practice, also between the nursing student’s attitude and their practice.
Conclusion:
It can be concluded that nursing students have fair knowledge, positive attitude, and poor practices towards Covid-19 infection control precautions and that there is a significant correlation between nursing students’ knowledge and their attitude. Sociodemographic data, health, clinical and work-related data provided some of the determinants of nursing students competencies. Significant correlation was found between nursing students’ level knowledge about Covid-19 and their age, marital status, vaccination status, frequency of previous Covid-19 training provided to the nursing students at their place of work.
Significant correlations were also found between nursing students attitude towards Covid-19 and each of the following: age, following the infection control precautions, source of information about Covid-19 infection control precautions, job, duration of working experience, frequency of in-service education/training regarding Covid 19 infection control precautions in the place of work, and in relation to practice; nursing students past history of allergies and PPE available at work place were determinant factors for good practice of infection control precautions.
These findings provide a framework to establish interventions to improve the KAP of students. Emphasis should be given to empower students through education and training, as this is a key measure to avoid diagnosis delay, disease spread, and poor practice of infection control.
Based on the findings of this study, it is recommended:
- To conduct an educational program to improve the knowledge of nursing students on prevention, quarantine, and isolation regarding covid-19.
- To increase the awareness of nursing staff and students about infection rates and its consequences when there is non-compliance with standard precaution by HCWs and students.
- To enforce the implementation of hand washing technique that will be carefully observed by the clinical instructors before, during, after clinical practice in the lab and hospital settings.
- To provide an in-service training and follow-up of covid-19 infection control precaution to clinical instructors and nursing students for better implementation of infection control precaution.
- To ensure the availability of PPE for healthcare workers continuously, by the hospital administration.
- To encourage alternative plans that allow the provision of the necessary equipment and supplies such as external providers, donors, students’ extra budget, for a safe practice in terms of covid-19 standard precautions.