Official Journal of the College of Nursing, University of Mosul

Authors

1 Higher Health Institute, Kirkuk Health directorate ,Ministry of Health, Iraq

2 Department of community health nursing, College of Nursing, University of Kirkuk, City of Kirkuk, Iraq.

Abstract

Infection control are the cornerstone of infection prevention and control programs, especially healthcare-associated infection (HCAI), because of their importance in reducing mortality and morbidity for patients, protecting health care workers, reducing the financial burden for both the patient and health care facilities, as well as reducing the period of hospitalization of patients. The study's objective is to assess the nurse's knowledge, Attitude and practice regarding Infection Controls in Intensive Care Unit. A Quantitative(descriptive and observational) design are used in the current study, A nonprobability (convenient) sample of 68 nurses were participated from Intensive Care units, at Azadi Teaching , Kirkuk General and Maternity, Pediatric and Gynecology  Hospital in Kirkuk city. The present study shows that Most of the participants were 25-29 years old, male, single, bachelors’ science of nursing degree, 1-2 years of experience in intensive care unit and not received any training course about infection control. The nurses had good levels of knowledge about infection control (95%), attitude (78.57%) and practice (66.67%). There were a significant differences between mean of nurses' knowledge about infection control and years of experience (p=0.013) and between nurses practice and who exposed to infection while working (p=0.027). But no significant differences were found between nurse’s attitude and all other socio-demographic variables. Continuing education, training and providing scientific booklet and publication about the infection control in intensive care unit are also recommended.

Keywords

Assessment of Nurses’ Knowledge  Attitude and Practice regarding Infection Controls in Intensive Care Unit at Hospitals in Kirkuk City-Iraq

Zhuwan Adil Omer 1, Hewa Sattar Saleh 2 *

 

  1. Department of  nursing, Higher Health Institute, Kirkuk Health Directorate, City of Kirkuk, Iraq;
  2. Department of community health nursing, College of Nursing, University of Kirkuk, City of Kirkuk, Iraq.

 

Corresponding author:Zhuwan Adil Omer

Email: zhuwan.omer@univsul.edu.iq

ORCID

ABSTRACT

Infection control are the cornerstone of infection prevention and control programs, especially healthcare-associated infection (HCAI), because of their importance in reducing mortality and morbidity for patients, protecting health care workers, reducing the financial burden for both the patient and health care facilities, as well as reducing the period of hospitalization of patients. The study's objective is to assess the nurse's knowledge, Attitude and practice regarding Infection Controls in Intensive Care Unit. A Quantitative(descriptive and observational) design are used in the current study, A nonprobability (convenient) sample of 68 nurses were participated from Intensive Care units, at Azadi Teaching , Kirkuk General and Maternity, Pediatric and Gynecology  Hospital in Kirkuk city. The present study shows that Most of the participants were 25-29 years old, male, single, bachelors’ science of nursing degree, 1-2 years of experience in intensive care unit and not received any training course about infection control. The nurses had good levels of knowledge about infection control (95%), attitude (78.57%) and practice (66.67%). There were a significant differences between mean of nurses' knowledge about infection control and years of experience (p=0.013) and between nurses practice and who exposed to infection while working (p=0.027). But no significant differences were found between nurse’s attitude and all other socio-demographic variables. Continuing education, training and providing scientific booklet and publication about the infection control in intensive care unit are also recommended.

Keywords: Nurses, Knowledge, Attitude, Practice, Infection control 

Received: 20 August 2022, Accepted: 31 August 2022, Available online: on January 2023


 

 

INTRODUCTION

 

Infection control and prevention are essential in preventing and decreasing germs that cause harm to patients, health care workers (HCWs), and society world in general. It's a scientific approach and a practical solution based on pathology, epidemiology, and health-system reinforcement. Infection control occupies a unique place in the global health system because it promotes patient safety, prevents complications, and reduces country health-care costs. (World Health Organization [WHO], 2020a).

Infection control measures are the base of infection control and prevention strategies, and they apply to everyone, regardless of their potential or actual infectious condition. Hand hygiene, personal protective equipment (PPE) (e.g., gloves, gowns, and face masks), respiratory hygiene and cough etiquette, safe injection procedures, medical waste management, and cleaning, disinfection, and sterilization of patient care equipment are among these strategies. These measures are the first line way to prevent infection in health-care facilities, and they are used as a primary method for limiting infection spread. Infection control procedures limit the risk of pathogen transmission from one individual or area to another, even in high-risk conditions, and keep things and places as free of infectious agents as possible. (National Health & Medical Research Council [NHMRC], 2019).

Healthcare-associated infections cause many of problems for patients, including increased complications, prolonged hospital stays, death, and increased financial costs for both patients and the health-care system. As a result, HCWs should have a more knowledgeable about HCAIs and develop infection control strategies, which will help to reduce and prevent many of these problems. (Coffin & Zaoutis, 2008).

Nosocomial infections are a significant challenge for health-care systems, especially for people with serious diseases and weak immune systems, because therapeutic contexts, especially those that rely on interventions, increase complications, deaths, and long stays in intensive care units (ICUs), as well as financial costs. Preventing and controlling HCAIs in ICUs is essential for reducing cost, improving patient outcomes, and protecting all health care staff. (Malaysian Society of Anesthesiologists, 2015).

Hospital Acquired Infections (HAIs) are one of the most difficult challenges globally. HAIs are considered the most common harmful events during provide health care services. Globally Millions of peoples are influenced by NIs every year, which lead to increase death-rate, morbidity, length hospital stay, and financial costs for patients and health care systems (Varshney et al., 2014).

Due to their critical health condition or status associated with impaired immunity; length of hospital stay; frequent invasive procedures that penetrate the body's defenses mechanism and monitoring procedures; frequent use of antibiotics, which leads to multidrug-resistant pathogens; and risks of aseptic mistakes, patients admitted to ICUs are the most vulnerable to HCAIs. All of these factors raise the risk of HCAIs. (Mahfouz et al., 2013)

METHOD

A quantitative (descriptive and observational) design was carried out in the present study which was conducted from 7 February to 25 August 2022. The study was carried out on the nursing staff at the intensive care unit /Azadi Teaching, Kirkuk General and Maternity, Pediatric and Gynecology Hospital.in Kirkuk City. A non-probability (purposive) sampling technique was utilized to collect data from (68) nurses working in intensive care unit in Kirkuk city Hospitals. They were selected according to the following criteria which included both gender, Nurses who agree to participate in the study, Nurses who participate in the pilot study and nurses who work morning shifts and night shifts. And the exclusion criteria of the study included: Nurses who refuse to participate in the study, and Nurse’s experience is less than one year, Nurses who were not in position to give information due sickness or in leave at the time of interviews.. The study instrument was constructed depending on achievement of the objectives of the study, different tools were formulated. We developed our KAP questions on infection control based on the guidelines of the CDC (2020) and WHO (2020b). It is a questionnaire format for the research purpose and composed of five parts and these parts are:

Part one: Socio-demographic data of nurses

Part two: Assessment of nurses’ knowledge regarding infection control.

Part three: Assessment of nurses’ attitude regarding infection control

Part four: Assessment of nurses’ practice regarding infection control

The data summarized and analyzed through using application statistical package for social science (SPSS) version 22 and the following procedures used in Data Analysis: Descriptive and inferential statistical Data Analysis.

 

RESULTS

Partone: Distribution of Socio-demographic characteristics of the nurses:

Table (1) shows More than half of the nurses were male (55.9%) while the female nurses percentage were (44.1%) of these sample and Age Group that most of studied respondent were focused at the second and first age group (i.e. 20_29) years, since they accounted 55(80.88%) by mean of high significant different at P<0.01 among different age group, with regard to educational level, the College of Nursing Graduate high percentage and constitute 67(98.5%) respectively. About married subjects are accounted 39(57.4%), and single marital status were formed the leftover 29(42.6%) with no significant different at P>0.05 According to experience in intensive care unit the more than half (64.7%) of the sample had experience between (1- 2) years and second rank represent (14.7%)   of the sample were (3-4). Also the result shows Exposed to infection while working that half of the sample respondent were answer positively 34(50%). Finally, the result appear Less than half of sample 28(41.2%) were attending training course on infection control while 40(58.8%) of the samples were not attending.

Part two: Nurses' level of knowledge regarding infection control items

Table (2) shows data about nurses’ Knowledge related to infection control at intensive care unit. The most of nurses’ Knowledge accounted 19(95.0%) items were high mean scores.

Part three: Nurses’ level of Attitudes regarding infection control items.

            Table (3) shows data about nurses’ Attitudes related to infection control at intensive care unit. Results observed responses of high evaluated generally assigned, and they are accounted 11(78.57%) items, while leftover items were an assigned at moderate evaluation are 2(14.29%), and low evaluation 1(7.14%).

Part three: Nurses' practice regarding infection control items.

Table (4) shows result of nurses’ practice regarding infection control. Results that observed responses of high evaluated generally assigned, and they are accounted 7(46.69%) items, while leftover items were an assigned at low evaluation are 5(33.35%), and moderate evaluation 3(20%)

Part four: Relationships of nurses "Knowledge, Attitude and Practices" and their (SDCv.) and some related variables

Table (5) Results shows that significant levels in contrast of Nurse's Knowledge or Attitudes, observing that weak relationships are accounted, except between Knowledge "Work Experience per Years in intensive care unit and knowledge .", since significant relationship are accounted at P<0.05. With respect to "Practices" observing that weak relationships due to the non-significant level except between "Exposed to infection while working, and Hospitals", since significant relationships were accounted at P<0.05.

 

 

 

Table 1. Distribution of Socio-demographic characteristics of the nurses with comparisons significant.

 

SDCv. and some related variables

Classes

No

%

C.S. (*)

P-value

Gender

Male

38

55.9

P=0.396

 (NS)

Female

30

44.1

Age Groups

20 _ 24

17

25

χ2= 39.647

P=0.000

(HS)

25 _ 29

38

55.9

30 _ 34

9

13.2

35 _ 39

4

5.9

Mean ± SD

26.69 ± 3.25

Educational level

Bachelor of Nursing Science

67

98.5

P=0.000

 (HS)

Higher Degree of Nursing Science

1

1.5

Marital Status

Single

29

42.6

P=0.275

 (NS)

Married

39

57.4

Work Experience

Years in intensive care unit 

1 _ 2

44

64.7

χ2= 57.529

P=0.000

(HS)

3 _ 4

10

14.7

5 _ 6

7

10.3

> 7

7

10.3

Mean ± SD

2.69 ± 2.84

Exposed to infection while working

No

34

50

P=1.000

 (NS)

Yes

34

50

Received training course on infection control

No

40

58.8

P=0.182

 (NS)

Yes

28

41.2

(*) HS: Highly Sig. at P<0.01; Testing based on One-Sample Chi-Square test, and Binomial test.

 

 

 

 

Table 2. Nurses’ knowledge regarding infection control items.

 

Knowledge Items

Resp.

No.

%

MS

SD

RS%

Eva.

  1. Infection control measures are used for the care of all patients regardless of their diagnosis and perceived infection status. (Yes)

No

11

16.2

0.84

0.37

84

H

Yes

57

83.8

  1. Isolation precaution is one of the elements in infection control measures. (Yes)

No

1

1.5

0.99

0.12

99

H

Yes

67

98.5

  1. Washing hands after contact with the patient's environment is one of the elements in infection control measures. (Yes)

No

3

4.4

0.96

0.21

96

H

Yes

65

95.6

  1. Alcohol-based rubs are used after removing gloves. (Yes)

No

6

8.8

0.91

0.29

91

H

Yes

62

91.2

  1. Performing hand hygiene is required before and after patient care. (Yes)

No

1

1.5

0.99

0.12

99

H

Yes

67

98.5

  1. Hands should be washed with soap and water before and after handling potentially infectious materials irrespective of wearing gloves. (Yes)

No

9

13.2

0.87

0.34

87

H

Yes

59

86.8

  1. Personal protective equipment (PPE) is important in infection control because it acts as a barrier between infectious materials such as viral and bacterial contaminants and your skin, mouth, nose, or eyes (mucous membranes). (Yes)

No

1

1.5

0.99

0.12

99

H

Yes

67

98.5

  1. Gloves must be worn every time during handling potentially infectious materials. (Yes)

No

1

1.5

0.99

0.12

99

H

Yes

67

98.5

  1. Gloves must be changed during patient care if you move hands from 'contaminated body site' to 'clean body site'. (Yes)

No

2

2.9

0.97

0.17

97

H

Yes

66

97.1

  1. Surgical masks can protect the nose and mouth when procedures and activities are likely to generate splashes or sprays of blood and body fluids. (Yes)

No

3

4.4

0.96

0.21

96

H

Yes

65

95.6

  1. The purpose of using a gown or apron is to protect clothes from splashes or sprays of blood and body fluids. (Yes)

No

3

4.4

0.96

0.21

96

H

Yes

65

95.6

  1. Removed all personal protective equipment (PPE) before leaving the patient's environment. (Yes)

No

16

23.5

0.76

0.43

76

H

Yes

52

76.5

  1. Stationary, telephones kept in wards, and doorknobs can be sources of infections. (Yes)

No

6

8.8

0.91

0.29

91

H

Yes

62

91.2

  1. All linen from an infectious patient should be thrown in a red linen bag even when it is free from visible blood or body fluids. (Yes)

No

8

11.8

0.88

0.32

88

H

Yes

60

88.2

  1. Segregation of clinical and non-clinical waste is important for preventing the spread of infection. (Yes)

No

4

5.9

0.94

0.24

94

H

Yes

64

94.1

  1. Ampoules injection that has been used must be disposed of in the clinical waste bin. (Yes)

No

14

20.6

0.79

0.41

79

H

Yes

54

79.4

  1. Recapping of needles, in general, is not appropriate. (Yes)

No

30

44.1

0.56

0.50

56

M

Yes

38

55.9

  1. If you puncture hand with sharp instruments, you must report to the concerned authorities. (Yes)

No

13

19.1

0.81

0.4

81

H

Yes

55

80.9

  1. Puncture-proof containers should be used for disposal of sharps objects. (Yes)

No

1

1.5

0.99

0.12

99

H

Yes

67

98.5

  1. Mask must be placed on coughing patients to prevent potential dissemination of infectious respiratory secretions from the patient to others. (Yes)

No

10

14.7

0.85

0.36

85

H

Yes

58

85.3

                 

Ev. : Evaluation (0.00 – 33.33) Low (L); (33.34 – 66.66) Moderate (M); (66.67– 100) High (H).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 2. Nurses’ Attitude regarding Infection control items

.

Attitudes' Items

Resp.

No.

%

MS

SD

RS%

Eva.

1 .Infection control measures is not easy to follow. (Disagree)

Disagree

22

32.4

0.32

0.47

32

L

No opinion

6

8.8

Agree

40

58.8

2. Infection control measures prevent the spread of infections from patients to Health Care Workers (HCWs) and vice versa. (Agree)

 

Disagree

8

11.8

0.81

0.4

81

H

No opinion

5

7.4

Agree

55

80.9

3. Infectious diseases can be treated hence PPE are not required.

(Disagree)

Disagree

52

76.5

0.76

0.43

76

H

No opinion

4

5.9

Agree

12

17.6

4. Prefers to perform hand hygiene before and after any intervention with patients. (Agree)

Disagree

3

4.4

0.96

0.21

96

H

No opinion

0

0.00

Agree

65

95.6

5. Personal protective equipment (PPE) can be used during emergencies. (Agree)

Disagree

9

13.2

0.74

0.44

74

H

No opinion

9

13.2

Agree

50

73.5

6. Changing gloves is not necessary during procedures even if heavily contaminated. (Disagree)

Disagree

59

86.8

0.87

0.34

87

H

No opinion

2

2.9

Agree

7

10.3

7. It is difficult to work wearing PPE. (Disagree)

Disagree

39

57.4

0.57

0.5

57

M

No opinion

11

16.2

Agree

18

26.5

8. Healthcare providers should ensure the availability of adequate protective barriers.(Agree)

Disagree

6

8.8

0.84

0.37

84

H

No opinion

5

7.4

Agree

57

83.8

9. Health Care Workers should not use PPE because it may harm patients psychologically. ( Disagree)

Disagree

46

67.6

0.68

0.47

68

H

No opinion

11

16.2

Agree

11

16.2

10. Stationeries, telephones, and doorknobs are not sources of infections. ( Disagree)

Disagree

56

82.4

0.82

0.38

82

H

No opinion

4

5.9

Agree

8

11.8

11. Segregation of clinical and non-clinical waste is useful to prevent transmission of infections from one to another. (Agree)

 

Disagree

7

10.3

0.84

0.37

84

H

 

No opinion

4

5.9

 

Agree

57

83.8

 

12. Adequate disinfection of medical equipment should be ensured by all HCWs. (Agree)

Disagree

4

5.9

0.87

0.34

87

H

 

No opinion

5

7.4

 

Agree

59

86.8

 

13. Transmission of infectious organisms can be reduced by adhering to Infection control measures. (Agree)

Disagree

4

5.9

0.84

0.37

84

H

 

No opinion

7

10.3

 

Agree

57

83.8

 

14. It is not logical to assume all patients contagious unless their infection has been confirmed. (Disagree)

Disagree

35

51.5

0.51

0.5

51

M

 

No opinion

6

8.8

 

Agree

27

39.7

 

Ev. : Evaluation (0.00 – 33.33) Low (L); (33.34 – 66.66) Moderate (M); (66.67– 100) High (H).

Table 4. Nurses' practices regarding infection control items

 

Practices' Items

Resp.

No.

%

MS

SD

RS%

Eva.

  1. Performs hand hygiene when they come in contact with patients.

No

63

92.6

0.07

0.26

7

L

Yes

5

7.4

  1. Performs hand hygiene after taking off gloves.

No

52

76.5

0.24

0.43

24

L

Yes

16

23.5

  1. Washes hands immediately after contacting any blood, body fluid, secretion, excretion, or dirty substances.

No

14

20.6

0.79

0.41

79

H

Yes

54

79.4

  1. Wears gloves when drawing blood samples.

No

9

13.2

0.87

0.34

87

H

Yes

59

86.8

  1. Wears gloves when disposing of stool or urine.

No

0

0.00

1.00

0.00

100

H

Yes

68

100

  1. Wears gloves when handling impaired patient skin.

No

42

61.8

0.38

0.49

38

M

Yes

26

38.2

  1. Wears gloves when handling the patient's mucosa.

No

0

0.00

1.00

0.00

100

H

Yes

68

100

  1. Wears gloves when handling saliva or sputum culture.

No

0

0.00

1.00

0.00

100

H

Yes

68

100

  1. Wears gloves when performing parenteral injections of medications.

No

29

42.6

0.57

0.50

57

M

Yes

39

57.4

10.Wears gloves when dressing wounds.

No

1

1.5

0.99

0.12

99

H

Yes

67

98.5

11.Wears gloves when they come in contact with blood.

No

12

17.6

0.82

0.38

82

H

Yes

56

82.4

12.Wears mask when performing operations/procedures that might induce the spraying of blood, body fluid, secretions, or excretions.

No

54

79.4

0.21

0.41

21

L

Yes

14

20.6

13.Wears a protective eye patch or goggle when performing operations/procedures that might induce spraying of blood, body fluid, secretions, or excretions.

No

68

100

0.00

0.00

0.00

L

Yes

0

0.00

14.Wears protective suits or gown when performing operations/procedures that might induce spraying of blood, body fluid, secretions, or excretions.

No

55

80.9

0.19

0.40

19

L

Yes

13

19.1

15.Dispose of needles, blades, or any other single use sharp objects in a sharp disposal container after use.

No

24

35.3

0.65

0.48

65

M

Yes

44

64.7

                   

Ev. : Evaluation (0.00 – 33.33) Low (L); (33.34 – 66.66) Moderate (M); (66.67– 100) High (H).

 

 

Table 5. Relationships of nurses "Knowledge, Attitude and Practices" and their (SDCv.) and some related variables

 

Socio-demographical Characteristics and some related variables

Knowledge

Attitudes

Practices

Overall Evaluation

C.C.

Sig.

C.C.

Sig.

C.C.

Sig.

C.C.

Sig.

Gender

0.081

0.502

NS

0.118

0.329

NS

0.012

0.919

NS

0.059

0.625

NS

Age Groups

0.296

0.089

NS

0.050

0.982

NS

0.165

0.594

NS

0.153

0.650

NS

Level of Education

0.144

0.229

NS

0.121

0.314

NS

0.140

0.243

NS

0.121

0.314

NS

Marital Status

0.116

0.333

NS

0.147

0.220

NS

0.098

0.418

NS

0.030

0.806

NS

Work Experience

Yrs in intensive care unit.

0.371

0.013

S

0.162

0.609

NS

0.148

0.677

NS

0.250

0.209

NS

Exposed to infection while working

0.119

0.324

NS

0.059

0.628

NS

0.259

0.027

S

0.117

0.332

NS

Received training course on infection control

0.029

0.814

NS

0.060

0.622

NS

0.123

0.305

NS

0.000

1.000

NS

Hospitals

0.276

0.061

NS

0.093

0.741

NS

0.343

0.011

S

0.279

0.057

NS

(*) NS: Non-Sig. at P>0.05; S: Sig. at P<0.05; Testing is based on a Contingency Coefficient test.

 

 

 

 

DISCUSSION

Table (1) Shows analysis of the Socio-Demographical Characteristics Variables (SDCv.) of samples .The results shows in the age group, highest percentage of nurse’s age ranged between (25-29) years old. This finding supported by (Desta et al., 2018), who found in their study that (52%) of participants at age group (24-30) years old. Related to the gender male account more than half of the sample, this result is confirmed through a study done by (Alemayehu et al., 2016), who found that most participants (53.8%) were males. The researcher confirms the reason to the situation of hard work in ICU in our country lead to increase male than female. Also the results shows an educational level of studied subjects shows that most of them has graduate bachelor or more degrees, and they are accounted 67(98.5%). This result is confirmed by (Ghorbani et al., 2016), they found that (60%) of participants were graduated from the college of nursing. More than half of nurses had (1-2) years of experience in intensive care unit, followed by (3-4) years, these results agree with the study done by (Badawy, 2014), that shown the mean of years of experience was (1-5) in ICU. The majority of nurses who not received any training course about infection control reported more than half 40(58.8%) of the sample.

Table (2) This table shows a Results of assess the nurses knowledge that observed responses of high evaluated generally obtained, and they are accounted 19(95.0%) items.This rate is still higher than the rate reported by studies conducted in a hospital in Northern Cyprus (Abuduxike et al., 2021), among nursing students in Jordon (49.64%) (Darawad et al., 2012).

Table (3) This table shows according to answers of respondents in Attitude items the Results that observed responses of high evaluated generally assigned, and they are accounted 11(78.57%) items, while leftover items were a assigned at moderate evaluation are 2(14.29%), and low evaluation 1(7.14%). which is considerably higher compared with studies conducted in Iran (Sarani et al., 2015) and Jordon (Darawad et al., 2012),

Table (4) This table shows the recent study on nurse practice, Results that observed responses of high evaluated generally assigned, and they are accounted 7(46.67%) items, while leftover items were a assigned at low evaluation are 5(33.35%), and moderate evaluation 3(20%).

This rate is higher compared with the findings from studies conducted in Northern Cyprus (30.9%) (Abuduxike et al., 2021), but lower than the rate reported among nurses in Ethiopia (60.2%) (Asmr et al., 2019).These differences in the level of practice of infection control in different countries may be due to the differences in education, training, organizational culture, policies, the presence of infection control guidelines and monitoring of its implementation.

Table (5) This table shows years of experience in intensive care unit had effect on the knowledge of the participants relating infection control, which disagree by  another study conducted in UK reported that current medical students demonstrated better knowledge of needle stick injuries than the previous cohort (Elliott et al., 2015).

A statistically not association were found between nurses attitudes regarding infection control and their socio-demographic variables .That agreement with studies conducted in Federal Republic of Nigeria (Ogoina et al., 2015), also the eastern province of the KSA (Elsherbeny et al., 2018).

Finally, the results show significant association were found between nurses practice with exposed to infection while working. This findings disagree with a study conducted by Al-Ahmari et al., who reported that good level of practice was significantly associated with training in infection control and years of experience (2021).

 

CONCLUSIONS

The study sample revealed that  the Most of the participants were 25-29 years old, male, single, bachelor science of nursing degree, 1-2 years of experience and not received any training course about infection control.

Also,Most of the nurses had good level of knowledge and they had a good attitude and had moderate practices regarding infection control.

There were a significant differences was found between nurses' knowledge about infection control and years of experience in intensive care unit field.

According to the study that statistically no significant association between nurse’s attitude and their socio-demographic variables. Regarding nurses practice and socio-demographic there were statistically significant association between practice regarding infection control and who exposed to infection while working. 

 

ETHICALCONSIDERATIONSCOMPLIANCEWITHETHICALGUIDELINES

An administrative agreement was obtained from the head of the clinical nursing department. The study was approved by the College of Nursing and the College of the Medicine/ University of Sulaimani. Oral consent was gained from the nurses after explaining the purpose and objectives of the study and ensuring the confidentiality of the information.

FUNDING
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

AUTHORSCONTRIBUTIONS

Study concept; Writing the original draft; Data collection; Data analysis and reviewing the final edition by all authors.

DISCLOSURESTATEMENT:

The authors report no conflict of interest

ACKNOWLEDGEMENTS

We thank the anonymous referees for their useful suggestions.

REFERENCES

Abuduxike, G.; Acar Vaizoglu, S.; Asut, O.; Cali, S. An Assessment of the Knowledge, Attitude, and Practice Toward Standard Precautions Among Health Workers From a Hospital in Northern Cyprus. Saf. Health Work 2021, 12, 66–73, doi:10.1016/j.shaw.2020.09.003.

 

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Al-Ahmari, A.M.; AlKhaldi, Y.M.; Al-Asmari, B.A. Knowledge, attitude and practice about infection control among primary care professionals in Abha City, Kingdom of Saudi Arabia. J. Fam. Med. Prim. Care 2021, 10, 662–668, doi:10.4103/jfmpc.jfmpc_1278_20.

 

Asmr, Y.; Beza, L.; Engida, H.; Bekelcho, T.; Tsegaye, N.; Aschale, Y. Assessment of Knowledge and Practices of Standard Precaution against Blood Borne Pathogens among Doctors and Nurses at Adult Emergency Room in Addis Ababa, Ethiopia. Emerg. Med. Int. 2019, 2019, 2926415, doi:10.1155/2019/2926415.

 

Badawy, A. I. (2014). Impact of a structured teaching program for prevention of ventilator associated pneumonia on knowledge and practices of intensive care nurses at Central Quwesna hospital, Egypt. strategies, 10, 11.

 

Centre for Disease Control and Prevention(2020). Standard Precautions. Available online: https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/standard-precautions.html. 31.

 

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Desta, M., Ayenew, T., Sitotaw, N., Tegegne, N., Dires, M., & Getie, M. (2018). Knowledge, practice and associated factors of infection prevention among healthcare workers in Debre Markos referral hospital, Northwest Ethiopia. BMC health services research, 18(1), 465.

 

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Elsherbeny, E.E.; Shatla, M.M.; Niazy, N.A.; Hamied, A.M.A.E.; El-Masry, R. Physicians’ and nurses’ adherence to standard precautions in a tertiary health care facility in the eastern province, Saudi Arabia. Egypt. J. Occup. Med. 2018, 42, 33–44, doi:10.21608/ejom.2018.4937.

 

Ghorbani, A., Sadeghi, L., Shahrokhi, A., Mohammadpour, A., Addo, M., & Khodadadi, E. (2016). Hand hygiene compliance before and after wearing gloves among intensive care unit nurses in Iran. American journal of infection control, 44(11), e279-e281.

 

Mahfouz, A. A., El Gamal, M. N., & Al-Azraqi, T. A. (2013). Hand hygiene non-compliance among intensive care unit health care workers in   Aseer   Central   Hospital,   south-western   Saudi Arabia. International Journal of Infectious Diseases, 17(9), e729- e732.

 Malaysian Society Of Anesthesiologist's.(2015). Infection Control Measures In the Intensive Care Unit. By Intensive Care Section,. Pp: 1

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 Varshney, A. M., Ahmad, S., Bansal, R., Sharma, S., Parashar, P., Shukla, A., & Singh, S. K. (2014). Awareness about nosocomial infections among nurses and healthcare workers of hospitals in   Meerut Up. Asian pacific journal of nursing, 1, 46-51.

 World Health Organization. (2020a). Infection prevention and control. Retrieved from         https://www.who.int/infection- prevention/about/ipc/en/

 World Health Organization (2020b). Infection Control Standard Precautions in Health Care. Available online: https://www.who.int/csr/resources/publications/4EPR_AM2.pdf . APA 7TH EDITION STYLE.

 

Abuduxike, G.; Acar Vaizoglu, S.; Asut, O.; Cali, S. An Assessment of the Knowledge, Attitude, and Practice Toward Standard Precautions Among Health Workers From a Hospital in Northern Cyprus. Saf. Health Work 2021, 12, 66–73, doi:10.1016/j.shaw.2020.09.003.
 Alemayehu, R., Ahmed, K., & Sada, O. (2016). Assessment of knowledge and practice on infection prevention among health Care Workers at Dessie Referral Hospital, Amhara region, SouthWollo zone, north East Ethiopia. J Community Med Health Educ, 6(487).
 Al-Ahmari, A.M.; AlKhaldi, Y.M.; Al-Asmari, B.A. Knowledge, attitude and practice about infection control among primary care professionals in Abha City, Kingdom of Saudi Arabia. J. Fam. Med. Prim. Care 2021, 10, 662–668, doi:10.4103/jfmpc.jfmpc_1278_20.
 Asmr, Y.; Beza, L.; Engida, H.; Bekelcho, T.; Tsegaye, N.; Aschale, Y. Assessment of Knowledge and Practices of Standard Precaution against Blood Borne Pathogens among Doctors and Nurses at Adult Emergency Room in Addis Ababa, Ethiopia. Emerg. Med. Int. 2019, 2019, 2926415, doi:10.1155/2019/2926415.
 Badawy, A. I. (2014). Impact of a structured teaching program for prevention of ventilator associated pneumonia on knowledge and practices of intensive care nurses at Central Quwesna hospital, Egypt. strategies, 10, 11.
 Centre for Disease Control and Prevention(2020). Standard Precautions. Available online: https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/standard-precautions.html. 31.
 Coffin S. & Zaoutis T. (2008). Health care Associated Infections, Principles and Practice of Pediatric Infectious Diseases, 3rd edition. Churchill Living stone, Pp.101.
 Darawad, M.W.; Al-Hussami, M. Jordanian nursing students’ knowledge of, attitudes towards, and compliance with infection control precautions. Nurse Educ. Today 2013, 33, 580–583, doi:10.1016/j.nedt.2012.06.009.
 Desta, M., Ayenew, T., Sitotaw, N., Tegegne, N., Dires, M., & Getie, M. (2018). Knowledge, practice and associated factors of infection prevention among healthcare workers in Debre Markos referral hospital, Northwest Ethiopia. BMC health services research, 18(1), 465.
 Elliott, S.K.; Keeton, A.; Holt, A. Medical students’ knowledge of sharps injuries. J. Hosp. Infect. 2015, 60, 374–377, doi:10.1016/j.jhin.2015.01.033.
 Elsherbeny, E.E.; Shatla, M.M.; Niazy, N.A.; Hamied, A.M.A.E.; El-Masry, R. Physicians’ and nurses’ adherence to standard precautions in a tertiary health care facility in the eastern province, Saudi Arabia. Egypt. J. Occup. Med. 2018, 42, 33–44, doi:10.21608/ejom.2018.4937.
 Ghorbani, A., Sadeghi, L., Shahrokhi, A., Mohammadpour, A., Addo, M., & Khodadadi, E. (2016). Hand hygiene compliance before and after wearing gloves among intensive care unit nurses in Iran. American journal of infection control, 44(11), e279-e281.
 Mahfouz, A. A., El Gamal, M. N., & Al-Azraqi, T. A. (2013). Hand hygiene non-compliance among intensive care unit health care workers in   Aseer   Central   Hospital,   south-western   Saudi Arabia. International Journal of Infectious Diseases, 17(9), e729- e732.
 Malaysian Society Of Anesthesiologist's.(2015). Infection Control Measures In the Intensive Care Unit. By Intensive Care Section,. Pp: 1
 National Health & Medical Research Council (NHMRC). (2019). Australian Guidelines for the Prevention and Control Infection in Healthcare. Pp: 29, 111, 132, 90, 85,164, 165
 Ogoina, D.; Pondei, K.; Adetunji, B.; Chima, G.; Isichei, C.; Gidado, S. Knowledge, attitude and practice of standard precautions of infection control by hospital workers in two tertiary hospitals in Nigeria. J. Infect. Prev. 2015, 16, 16–22, doi:10.1177/1757177414558957.
 Sarani, H.; Balouchi, A.; Masinaeinezhad, N.; Ebrahimitabas, E. Knowledge, Attitude and Practice of Nurses about Standard Precautions for Hospital-Acquired Infection in Teaching Hospitals Affiliated to Zabol University of Medical Sciences (2014). Glob. J. Health Sci. 2015, 8, 193–198, doi:10.5539/gjhs.v8n3p193.
 Varshney, A. M., Ahmad, S., Bansal, R., Sharma, S., Parashar, P., Shukla, A., & Singh, S. K. (2014). Awareness about nosocomial infections among nurses and healthcare workers of hospitals in   Meerut Up. Asian pacific journal of nursing, 1, 46-51.
 World Health Organization. (2020a). Infection prevention and control. Retrieved from         https://www.who.int/infection- prevention/about/ipc/en/
World Health Organization (2020b). Infection Control Standard Precautions in Health Care. Available online: https://www.who.int/csr/resources/publications/4EPR_AM2.pdf . APA 7TH EDITION STYLE.