Infection Control Performance Research Articles

Development of an infection control competency scale for clinical nurses: an instrument design study.

Nurses work in close proximity to patients, and as such, they can have a direct impact on the control of infections; thus, it is important for nurses to be competent in infection control. However, the scales used to measure infection control performance in nurses are not suitable for measuring infection control competencies that reflect nurses' expertise, clinical environment, and work. Thus, this study aimed to develop a valid and reliable measure to assess infection control competency of clinical nurses. A concept analysis, using a hybrid model, was performed on the infection control competency of clinical nurses to confirm the components and develop 67 initial items. Ten experts evaluated the content validity of these items, and a Korean language expert and a Doctor of Nursing reviewed the questions to consolidate them into 59 items. Subsequently, 267 nurses working at a certified tertiary hospital in D City were surveyed to confirm the validity and reliability of the scale. As a result of the study, the final scale comprising seven factors and 33 questions was derived, and the cumulative explanatory power of these factors was 60.8%. To verify convergent and discriminant validity, confirmatory factor analysis was conducted, and the average variance extraction index, composite reliability values, and confidence interval of the correlation coefficient between factors were confirmed. Convergent and discriminant validities were verified by comparison with standard values. The Cronbach's α for the entire scale in this study was 0.93. Consequently, the validity and reliability of the clinical nurses' infection control competency measurement scale were verified. The validity and reliability of the infection control competency measurement scale for clinical nurses (ICCS-CN) developed in this study was verified, and the scale can be effectively used to measure the infection control competency of clinical nurses. Measuring the infection control competency of clinical nurses will help reduce the harm caused by infection and ensure patient safety by decreasing infection rates in medical institutions.

Effect of Virtual Reality-based Isolation Patient Infection Control Education Program

This study aims to identify the effect of a virtual reality (VR)-based isolation patient infection control education program on nursing students' infection control knowledge, awareness, and performance confidence. This research design was a quasi-experimental pre-test and post-test research design. The participants were 55 nursing students (experimental group 28, control group 27). Data were analyzed using descriptive analysis, the independent t-tests, and paired t-tests with SPSS version 27.0. The VR content included hand hygiene, donning and doffing personal protective equipment (PPE), post-exposure prophylaxis of sharps injury, and disposal of medical waste. The experimental group showed significantly improved in infection control knowledge (t=3.117, p=.003) and performance confidence (t=3.059, p=.004) than the control group,. However, after applying the education program, awareness of the control group showed a more significant change. This VR-based isolation patient infection control education program for nursing students can help increase competency in infection control practice.

Integrating energy efficiency and health safety in building design: A multi-objective optimization approach to minimize virus transmission risk

This study aims to develop an integrated design strategy for an office building in Tehran, optimizing energy efficiency and minimizing virus infection risk, addressing global challenges such as energy conservation and virus transmission. A multi-objective optimization model is developed to identify optimal design parameters for energy performance and infection risk reduction. Environmentally sustainable materials and energy-efficient equipment, such as solar panels, high-efficiency heat pump systems, and advanced air filtration techniques, are employed. The modified Wells-Riley Risk Model calculates infection risk, while energy efficiency is formulated based on the technologies used. Results showcase a significant 14% increase in energy efficiency and a 46% decrease in infection risk compared to traditional building designs, demonstrating the effectiveness of the proposed integrated approach. The optimal design parameters include ventilation rate, the number of solar panels, hot water pipe diameter, and heat pump condenser temperature. This study presents a practical, sustainable solution for designing office buildings that actively address pressing global concerns while fostering healthier, energy-efficient environments. The novelty of this research lies in the development of a multi-objective optimization model that synergizes infection control and energy efficiency, accounting for real equipment parameters and providing a new paradigm for HVAC design. This integrated strategy optimizes decision variables like ventilation rate, filtration level, solar panels, and heat pump operating conditions, offering a comprehensive approach to co-optimize infection control and energy performance.

Study on the infection control performance under interactive cascade ventilation: A focus on a conference room environment

With the rise of respiratory infectious diseases, many scholars focus on finding an appropriate ventilation method to effectively improve the indoor environmental protection effect, especially for crowded spaces, which can cause a widespread spread of the epidemic. Interactive cascade ventilation (ICV), as a recently proposed ventilation method, has presented advantages in thermal comfort, infection control and energy consumption. This study discusses the effect of the outlet/inlet locations on infection control performance under interactive cascade ventilation in a conference room with an experimentally verified model. Ninety-five simulations are carried out by considering changes in the location of the outlet/inlet opening and infection source. Particle removal efficiency (ε), predicted infection risk (Pi) and contaminant dispersion index (CDI) are introduced to evaluate the infection control performance comprehensively. The simulation results show that double-side supply air outlets coupled with double-side return air inlets can reduce Pi by 51.1 % compared with other ventilation strategies investigated in this paper. It indicates that ventilation zoning design is more effective for reducing cross-infection in dense spaces. The findings in this study can efficiently provide new insights for the actual application of ventilation strategies in conference rooms under epidemic normalization.

Factors Affecting the Performance of Infection Control of Multi-drug Resistant Organisms in Intensive Care Unit Nurses of General Hospitals based on the Theory of Planned Behavior: The Mediating Effect of Intention

Purpose: The purpose of this study is to analyze the factors that affect the performance of infection control of multidrug-resistant organisms (MDROs) by nurses in intensive care units (ICU) in general hospitals. Methods: Participants were 105 ICU nurses from 6 general hospitals. The questions for the survey performed were based on the theory of planned behavior, such as attitude towards infection control of MDROs, subjective norms, perceived behavioral control, intention, and performance. Results: In the relationship between subjective norms towards infection control of MDROs and performance, intention showed a significant complete mediating effect; and in the relationship between perceived behavioral control and performance, intention showed a partial mediating effect. The attitude towards infection control of MDROs was excluded from the mediating effect verification because there was no significant correlation between intention and performance. Conclusion: The results of this study suggest that department atmosphere and perceived behavior control promotion programs should be developed to enhance subjective norms in order to promote the performance of infection control of MDROs.

Virtual Reality Simulation for Advanced Infection Control Education in Neonatal Intensive Care Units: Focusing on the Prevention of Central Line-Associated Bloodstream Infections and Ventilator-Associated Infections.

This study examined the effects of a virtual reality simulation for advanced infection control education in neonatal intensive care units (VR_AICENICU) on nurses' infection control knowledge and performance confidence. We examined nurses' presence, empathy, and program satisfaction using a non-equivalent control group pre-post design. Nurses were divided into an experimental group (n = 20) experiencing VR simulation and routine NICU practice and a control group (n = 20) with routine NICU practice. The VR_AICENICU program comprised three scenarios: high-risk medication with lipid solution, dressing and management for peripheral inserted central line, and aspiration prevention and skincare management during ventilator use for premature infants. Data were collected between February and July 2022. The experimental group showed significantly greater improvements in infection control knowledge and performance confidence compared to the pre-test. The average scores of presence, empathy, and program satisfaction of the experimental group were 4.39 ± 0.36, 4.33 ± 0.75, and 4.90 ± 0.31, respectively. The VR_AICENICU program has implications for the education needs of nurses working in NICUs and enhances their knowledge and performance of infection control. Future studies should apply the VR_AICENICU program to different severity grades of NICU patients and develop additional VR programs.

Improvement in Infection Prevention and Control Performance Following Operational Research in Sierra Leone: A Before (2021) and After (2023) Study.

Infection prevention and control (IPC) is crucial to limit health care-associated infections and antimicrobial resistance. An operational research study conducted in Sierra Leone in 2021 reported sub-optimal IPC performance and provided actionable recommendations for improvement. This was a before-and-after study involving the national IPC unit and all twelve district-level secondary public hospitals. IPC performance in 2021 (before) and in 2023 (after) was assessed using standardized World Health Organization checklists. IPC performance was graded as: inadequate (0-25%), basic (25.1-50%), intermediate (50.1-75%), and advanced (75.1-100%). The overall IPC performance in the national IPC unit moved from intermediate (58%) to advanced (78%), with improvements in all six core components. Four out of six components achieved advanced levels when compared to the 2021 levels. The median score for hospitals moved from basic (50%) to intermediate (59%), with improvements in six of eight components. Three of four gaps identified in 2021 at the national IPC unit and four of seven at hospitals had been addressed by 2023. The study highlights the role of operational research in informing actions that improved IPC performance. There is a need to embed operational research as part of the routine monitoring of IPC programs.

Relationship between Nurse Performance and Implementation of Infection Prevention and Control at Hospital X Bogor, Indonesia

Relationship between Nurse Performance and Implementation of Infection Prevention and Control at Hospital X Bogor, Indonesia

Stress, COVID-19 related knowledge, attitude, and infection control performance of nurses at long-term care hospitals.

This study aimed to identify the stress level, knowledge, attitude, and infection control performance of nurses at long-term care hospitals (LTCHs) designated for infectious disease management and to investigate factors contributing to infection control performance. A total of 178 nurses who had worked for at least 1 month at seven LTCHs designated for infectious disease management and provided care for patients confirmed with COVID-19 were enrolled in the study. Data were collected from February to March 2022 using written and online self-report questionnaires. COVID-19 infection control performance was higher among married than among single participants (t = -3.71, p < 0.001), among those aged 40-49 versus 30-39 years (F = 4.10, p = 0.003), and those with 1-2, 3-4, or ≥5 sessions versus no prior education (F = 6.41, p < 0.001). COVID-19 infection control performance was negatively correlated with stress (r = 0.26, p < 0.001) and positively correlated with knowledge (r = 0.40, p < 0.001) and attitude toward COVID-19 (r = -0.36, p < 0.001). Stress (β = -0.17, p = 0.012), knowledge of COVID-19 (β = 0.28, p < 0.001), attitude toward COVID-19 (β = 0.20, p = 0.004), and marital status (β = 0.18, p = 0.009) were identified as predictors of COVID-19 infection control performance.

High level of infection prevention and control in surveyed hospitals in Colombia, 2021.

This study aimed to determine the performance of infection prevention and control (IPC) programs in eight core components in level 2 and level 3 hospitals across all provinces in Colombia. This cross-sectional study used self-assessed IPC performance data voluntarily reported by hospitals to the Ministry of Health and Social Protection during 2021. Each of the eight core components of the World Health Organization's checklist in the Infection Prevention and Control Assessment Framework contributes a maximum score of 100, and the overall IPC performance score is the sum of these component scores. IPC performance is graded according to the overall score as inadequate (0-200), basic (201-400), intermediate (401-600) or advanced (601-800). Of the 441 level 2 and level 3 hospitals, 267 (61%) reported their IPC performance. The median (interquartile range [IQR]) overall IPC score was 672 (IQR: 578-715). Of the 267 hospitals reporting, 187 (70%) achieved an advanced level of IPC. The median overall IPC score was significantly higher in private hospitals (690, IQR: 598-725) than in public hospitals (629, IQR: 538-683) (P < 0.001). Among the core components, scores were highest for the category assessing IPC guidelines (median score: 97.5) and lowest for the category assessing workload, staffing and bed occupancy (median score: 70). Median overall IPC scores varied across the provinces (P < 0.001). This countrywide assessment showed that 70% of surveyed hospitals achieved a self-reported advanced level of IPC performance, which reflects progress in building health system resilience. Since only 61% of eligible hospitals participated, an important next step is to ensure the participation of all hospitals in future assessments.

Factors Influencing SARS-CoV-2 Infection Control Practices of Nurses Caring for COVID-19 Patients in South Korea: Based on Health Belief Model

This study aimed to verify the level of COVID-19 infection control practices and the factors affecting the COVID-19 infection control practices of Korean nurses based on the health belief model. The participants were 143 nurses experienced in caring for COVID-19 patients in South Korea. Questionnaires were used to measure health beliefs, confidence in practice, knowledge of COVID-19, infection protection environment, and COVID-19 infection control practices. Data were analyzed by performing descriptive statistics, an independent t-test, one-way analysis of variance, the Mann-Whitney test and multiple regression analysis. The mean score for infection control practices related to COVID-19 was 4.76 on a 5-point scale where a higher score indicates superior infection control performance. Multiple regression analysis revealed that the factors that influenced COVID-19 infection control practices were gender, marital status, perceived susceptibility, and confidence in practice related to COVID-19. With COVID-19 approaching endemic and to prevent infectious diseases, it is necessary to emphasize perceived sensitivity by providing accurate information on the risk of infection rather than simply inducing infection control to be divided into individual activities. In addition, nurses' infection control practices should be implemented with confidence with the nurses themselves feeling the need for infection control and not being forced by the social atmosphere or the hospital.

SG-APSIC1123: Diagnostic and infection prevention and control (IPC) performance of rapid polymerase chain reaction (PCR) compared to conventional culture PCR methods for detecting carbapenemase-producing organisms (CPOs)

Objectives: In this study, we compared the performance of a rapid polymerase chain reaction (PCR) method in detecting carbapenemase-producing organisms (CPOs) and its impact on infection prevention and control (IPC) measures compared with a culture PCR method. Methods: All patients requiring CPO screening were included. Rectal swabs were collected with double rayon swabs (Copan 139C). They were simultaneously analyzed for the presence of CPOs using rapid PCR assay (Xpert Carba-R assay, Cepheid, Sunnyvale, CA) and a culture–PCR method (ChromID CARBA-SMART, bioMerieux, Marcy-l’Etoile, France). For CARBA-SMART, only colored colonies (ie, Enterobacterales) were evaluated for CPOs according to the prevailing institutional protocol. We tracked time to CPO detection. Using CPO positivity from either the rapid PCR or the culture PCR method as the gold standard, we calculated the sensitivity and specificity of both tests. We calculated the number of epidemiologically linked contacts generated when the first test results were known. We prospectively followed the ward census to identify the putative additional number of contacts generated by the later known result. Contacts were patients who shared the same ward (with overlapping time) as the CPO patients. Results: Between April 2019 and June 2020, culture PCR method detected CPOs in 316 (1.3%) of 24,514 samples (blaOXA48, N = 211; blaNDM, N = 51; blaIMI, N = 21; blaIMP, N = 10; blaKPC, N = 9; mixed genotypes, N = 14). The rapid PCR test detected CPOs in 605(2.5%) of 24,514 samples (blaOXA48, N = 266; blaNDM, N = 161; blaIMP, N = 99; blaVIM, N = 29; blaKPC, N = 15; mixed genotypes, N = 35). The sensitivity of direct PCR and culture PCR methods were 94.2% (95% CI, 92.1%–95.8%) and 43.5% (95% CI, 39.6%–47.4%), respectively. Both tests had 100% specificity. The median times to detection for the rapid PCR and culture PCR methods were 3–4 hours and 4 days, respectively. Compared with rapid PCR, the culture PCR method generated additional 7,415 contacts when it also tested positive for CPOs and an additional 23,135 contacts when it tested negative for CPOs. Conclusions: In our study, the rapid PCR test was more sensitive, identified CPO faster, and generated fewer epidemiologically linked contacts than the culture PCR method.

Perceived Importance, Performance, Barriers, and Strategies of VRE Infection Control among Nurses in Wards with Cohort Isolation Rooms: A Mixed-methods Study

Perceived Importance, Performance, Barriers, and Strategies of VRE Infection Control among Nurses in Wards with Cohort Isolation Rooms: A Mixed-methods Study

치위생과 학생들의 코로나19 지식, 태도에 따른 감염관리 수행 연구

Objectives: The purpose of this study was to understand the knowledge and attitudes of dental hygiene students regarding COVID-19 and their relationship to the level of infection control practiced by the students.&#x0D; Methods: Descriptive analysis, correlation analysis, and multiple regression analysis were conducted to investigate the COVID-19 knowledge, attitude, and performance of infection control measures by the dental hygiene students.&#x0D; Results: The average COVID-19 knowledge score of the students was 15.14 points, their average attitude score was 40.44 points, and their average infection control performance score was 24.63 points. Attitude toward COVID-19 infection and management of COVID-19 infection control(r=.669**, p&lt;.01) showed a positive correlation.&#x0D; Conclusions: It is important to develop an educational program that will improve dental hygiene students knowledge about and attitude toward COVID-19 in order to improve their practice of infection control.

노인요양시설 요양보호사의 감염관리 인지도 및 수행도

Purpose : Elderly people in nursing homes typically have multiple conditions that increase their risk for infection, including chronic diseases and depressed immune systems. Infections are common in nursing homes and contribute significantly to resident morbidity and mortality. Therefore, controlling of infections in nursing homes is an important issue and it is necessary to educate that can improve infection control for care workers. The objectives of this study are to describe the level of perception and performance of infection control of care workers in nursing home and to provide the basic data of the infection control education program for care workers.&#x0D; Methods : A descriptive cross-sectional survey was conducted with 120 care workers who are employed in 8 nursing homes. The data were collected by using self-report questionnaires from March 2 to June 15, 2021. Descriptive statistics, independent t-test, one-way ANOVA, and pearson correlation coefficient, stepwise multiple regression performed using SPSS Windows for 22.0 program.&#x0D; Results : The mean scores of perception and performance of infection control of care workers were 4.13±0.44 and 4.05±0.47. There were statistically significant differences in the perception of infection control according to age(F=3.35, p=.038), education level(F=4.33, p=.015) and nursing home size(F=4.34, p=.015). There were statistically significant differences in the performance of infection control according to nursing home size(F=6.85, p=.002). Performance of infection positively correlated with the perception of infection control(r=.92, p&lt;.001). Perception of infection control and nursing home size were the primary factors that impacted the care worker’s performance of infection control by explaining 85.5% of the variance. Particularly, perception of infection control was identified as factors influencing performance of infection control(β=.90, p&lt;.001).&#x0D; Conclusion : Findings from this study provide valuable information regarding perception of infection control was the major factor that impacts infection control performance. Therefore, it is necessary to increase the perception of infection control and provide systematic education about infection control.

종합병원 신규간호사의 COVID-19 두려움과 직업존중감이 감염관리 수행도에 미치는 영향

Purpose: This study aimed to investigate the effects of the factors of fear of COVID-19 and job-esteem on infection control in newly graduated registered nurses in a general hospital. Methods: This descriptive study used collected data from 159 newly graduated registered nurses working in a general hospital in Seoul; data were analyzed using t-test, ANOVA, Scheffe’s test, Pearson’s correlation coefficient, and multiple linear regression analysis. Results: Job-esteem (β = .20, p = .011) significantly influenced infection control, while fear of COVID-19 was ot related to the infection control performance. Conclusion: The study results indicate that job-esteem influences the infection control performance of new nurses. Therefore, to improve infection control performance, the reinforcing program of job esteem should be pursued to the newly graduated registered nurses.

Effectiveness and Utility of Virtual Reality Infection Control Simulation for Children With COVID-19: Quasi-Experimental Study.

BackgroundIt is essential that nurses quickly learn the proper methods for preventing and controlling nosocomial infection and managing intensive care patients during the COVID-19 pandemic, including the donning and doffing of personal protective equipment (PPE). Virtual reality (VR) simulation offers the advantage of learning in a safe environment with a sense of realism similar to that of an actual clinical setting and has been reported to enhance self-efficacy in infection control, safety performance, and learning satisfaction among students.ObjectiveThis study aims to develop a virtual reality infection control simulation (VRICS) program regarding donning and doffing of PPE and respiratory care for pediatric patients admitted to an isolation unit for COVID-19 and to identify the effects of the program on PPE knowledge, infection control performance, and self-efficacy for nursing students. Additionally, the realism of the VRICS program and the students’ level of satisfaction with the program were assessed.MethodsThis was a quasi-experimental study based on a controlled pretest-posttest design. Third- and fourth-year nursing students were divided into an experimental group (n=25) who participated in a VRICS program and a control group (n=25) with no participation. Data were collected from November 13 to December 10, 2021, and analyzed using descriptive statistics and the t test, paired t test, Mann-Whitney U test, and Wilcoxon matched-pair signed-rank test. The VRICS program consisted of a prebriefing, including direct practice of donning and doffing PPE, VR simulation, and debriefing. The VR simulation comprised 3 sessions: donning and inspection of PPE in the dressing room before entering the negative-pressure isolation unit; assessing for suction care, nasopharyngeal suctioning, and checking of COVID-19 patients in the negative-pressure isolation unit; and doffing PPE in the dressing room. The total execution time for the program was 180 min.ResultsCompared with the control group, the experimental group showed significantly greater improvements in PPE knowledge (z=–3.28, P<.001), infection control performance (t48=4.89, P<.001), and self-efficacy (t36.2=4.93, P<.001). The experimental group’s mean scores for realistic immersion and learner satisfaction were 4.49 (SD 0.50) points and 4.75 (SD 0.38) points (on a 5-point Likert scale), respectively.ConclusionsThe VR simulation training program involving pediatric COVID-19 patients combined skills training effectively and enhanced theoretical knowledge, respiratory care skills, and infectious disease preparedness. Thus, it could be applied to training nurses to respond more effectively to public health situations involving infectious diseases, including the COVID-19 pandemic.

Factors Affecting Infection Control Performance of School Health Nurses During the COVID-19 Pandemic in South Korea.

PurposeMany patients with coronavirus disease 2019 (COVID-19) are asymptomatic or infected by unclear infection routes. Significant group infections may result from transmission in schools, and thus, it is necessary to improve infection control efficiency in schools by identifying the factors associated with the performance of COVID-19 infection control by school health nurses.MethodsThe participants were 130 school health nurses in Korea. The survey variables included knowledge of COVID-19, infection control attitude, job stress, and school organizational culture.ResultsThe results demonstrated that among the variables, infection control attitude, job stress, and the level of infection control in schools perceived by school health nurses were significant. The explanatory power of the model including these variables was 25.8% (F=14.39, p<0.001, R2=0.255, Adj-R2=0.258).ConclusionThe results showed that the infection control attitude and job stress of school health nurses had a significant effect on their infection control performance during the COVID-19 pandemic. The results will be used as basic data for developing programs to enhance the competence of school health nurses to manage new infectious diseases.

Factors Affecting Compliance of Infection Control of Coronavirus Disease 2019 among Nurses Based on Health Belief Model

Background: The purpose of this study was to identify the influence of nurses’ knowledge and health beliefs on infection control performance with regard to coronavirus disease 2019 (COVID-19).Methods: The subjects of the research were 256 nurses working at three different university hospitals, and the survey was progressed from February 9, 2021 to March 18, 2021. The survey measured the subject’s general characteristics, knowledge, and health beliefs about COVID-19, and the infection control performance of the COVID-19.Results: The knowledge, perceived severity, and perceived benefit showed a significant correlation with the infection control performance. The three factors affecting the infection control performance were the nursing experience of patients with suspected or confirmed COVID-19 patients, knowledge of COVID-19, and perceived benefit.Conclusions: In order to improve the infection control performance of COVID-19, it is essential to establish infection control strategies enhancing experience, knowledge, and perceived benefit in terms of COVID-19.

705 Reduction in Central Line Associated Blood Stream Infection Rate with a Central Line Change-Over Protocol

IntroductionBurn Intensive Care Units (BICU)s traditionally have changed central lines over a wire (COWs) as a method to reduce infection. To date, there is not a standard timeline for this process and every center has their own timeline for this process. We aimed to create a standardized process for this practice to then have a baseline for future study.MethodsThe Change-Over-Wire (COW) process was evaluated with the BICU Infection Control Nurse and Performance Improvement Manager. A protocol was developed that includes step-by-step detail that was modified until it was deemed practical and acceptable to all involved parties as the best practice for maintaining the most sterility as possible. The protocol was provided to the Central Line team, the ICU Advisory Board, and the UNC CLABSI committee for reviewResultsWhile the hospital as a whole does not standardly endorse routine COWs, the protocol was reviewed and accepted as best practice by both the ICU Advisory Board and the UNC CLABSI committee. Additionally, the BICU had an 80% reduction in CLABSI’s from FY 2017 to 2020 with implementation of this protocol (p value = 0091).ConclusionsHaving a standardized method for COWs both allows for best practice and a starting point for study. Endorsement by both hospital committees allows this practice to be the published standard by which future studies can be measured.