Standard Precautions Adherence Research Articles

Associations between negative patient safety climate and infection prevention practices

The relationships among positive perceptions of safety climate and better healthcare worker behaviors have been increasingly documented in the literature. The potential influence of negative perceptions is underexplored and has not been examined in relationship to infection prevention practices. We begin to address this gap using data collected as part of a multi-site, cross-sectional study. This brief report describes associations identified between negative perceptions of patient safety climate and standard precaution adherence of hospital-based nurses.

RETRACTED: Safety climate, quality of care, adherence to and compliance with standard precautions among nurses: Structural equation modeling.

The aim was to investigate the interrelationships of nurses' safety climate, quality of care, and adherence to and compliance with standard precautions (SPs). Investigations about nurses' safety climate and quality care and their association with adherence to and compliance with SPs remain remarkably scant across literature, specifically among developing countries like the Philippines. Cross-sectional design and structural equation modeling (SEM) approach while complying with STROBE guidelines. Participant nurses were recruited using convenience sampling (n=870). Four validated self-report instruments were used to collect data from February to August 2022. Spearman rho, SEM, mediation, and path analyses were employed for data analysis. The emerging model showed acceptable model fit parameters. The safety climate positively influenced the quality of care and adherence to and compliance with SPs. Quality of care directly affected adherence to SPs, while adherence to SPs directly affected compliance with SPs. The quality of care mediated the relationship between safety climate and adherence to SPs. Whereas adherence to SPs mediated the relationships between safety climate and compliance with SPs and the quality of care and compliance with SPs. Nurses' safety climate directly affected the quality of care and SPs adherence and compliance. The quality of care mediated the impact of safety climate on SPs adherence. Finally, SPs adherence demonstrated a mediating effect among quality of care, safety climate, and SPs compliance. Nursing policymakers and administrators can use the findings to design strategic policies and sustainable in-service educational courses fostering and maintaining nurses' safety climate, quality of care, and SPs adherence and compliance.

Nurses' safety climate, quality of care, and standard precautions adherence and compliance: A cross-sectional study.

Investigations about the interrelationships of nurses' safety climate, quality of care, and standard precautions (SP) adherence and compliance remain particularly scarce in the literature. Thus, we tested a model of the associations between nurses' safety climate, quality of care, and the factors influencing adherence and compliance with SPs utilizing the structural equation modeling (SEM) approach. Cross-sectional design complying with STROBE guidelines. Using convenience sampling, nurses (n = 730) from the Philippines were recruited. Data were collected between April and September 2022 using four validated self-report measures. Spearman Rho, mediation and path analyses, and SEM were employed for data analysis. Acceptable model fit indices were shown by the emerging model. The safety climate is positively associated with quality of care and factors influencing adherence to and compliance with SPs. Quality of care directly affected factors influencing adherence to SPs. The factors influencing adherence to SPs directly affected SP compliance. Quality of care mediated between safety climate and the factors influencing adherence to SPs. Factors influencing adherence to SPs mediated between safety climate, quality of care, and SP compliance. The study's variables are not distinct but overlapping nursing concepts that must be examined collectively. Nurse administrators can utilize the emerging model to formulate strategies and regulations for evaluating and enhancing nurses' safety climate, quality of care, and SP adherence and compliance. Our findings may impact policymaking, organizational, and individual levels to improve nurses' clinical practice. This study had no patient contribution or public funding.

Radiographers’ knowledge, attitude and adherence to standard COVID-19 precautions and the policy implications: a national cross-sectional study in Nigeria

Background We investigated the knowledge of COVID-19 pathogenesis and prevention, attitude, and adherence to safe clinical practices among radiographers during the pandemic and made some informed policy recommendations. Materials and methods The study was an online cross-sectional survey. The questionnaire captured data on respondents’ demographics, knowledge of COVID-19, attitudes, practices, and standard precaution adherence during the pandemic. Data were analysed using descriptive statistics, Pearson’s correlation and one-way ANOVA tests. Results Of the 255 respondents, 17.3% were actively involved in the management of COVID-19 cases. Participants had high scores regarding their knowledge of COVID-19 pathology (82.46 ± 8.67%), prevention (93.43 ± 7.11%) and attitude (74.11 ± 11.61%), but low compliance to safety precautions (56.08 ± 18.56%). Knowledge about COVID-19 prevention strategies differed significantly across educational qualifications, F(3, 251) = 4.62, p = .004. Similarly, levels of compliance with safety precautions differed across educational qualification (F[3, 251] = 4.53, p = .004) and years-in-practice (F[4, 250] = 4.17, p = .003). Conclusion Participants’ adherence to standard COVID-19 precautions was low. The level of professional qualification influenced participants’ knowledge and safe practices during the pandemic. Upgrading the aseptic techniques and amenities in practice settings and broadening the infectious diseases modules in the entry-level and continuous professional education may improve radiographers’ response to COVID-19 and future pandemics. Key messages Radiographers whose qualifications were lower than a bachelor’s degree had significantly less knowledge of COVID-19 prevention. Generally, radiographers had a positive attitude towards safe practices during the pandemic, but inadequate education, standard operational guidelines and resources affected their level of adherence. Apart from the shortage of personal protective equipment, poor infrastructural design and inadequate hygienic facilities such as handwashing stations, running water and non-contact hand sanitizer dispensers hampered adherence to COVID-19 precautions in low-resource settings.

Impact of patient safety climate on infection prevention practices and healthcare worker and patient outcomes

BackgroundStandard precautions may prevent patient health care associated infections and provider occupational exposures but are not often used by health care workers. A positive patient safety climate might contribute to improved adherence. The aim of this study was to determine the relationships among patient safety climate, standard precaution adherence, and health care worker exposures and HAIs. MethodsThis multi-site, cross-sectional study included survey data from nurses on patient safety climate, observational data on adherence, and existing health care worker exposure and health care associated infections data. Data were aggregated to hospital unit level for correlational and multivariable regression analyses. ResultsA total of 5,285 standard precaution observations and 452 surveys were collected across 43 hospital units. Observed adherence to all categories of standard precautions was 64.4%; there were significant differences by provider role. Multivariable models identified key predictors explaining sizeable variance in methicillin-resistant Staphylococcus aureus (41%), catheter associated urinary tract infections (23%), mucotaneous exposures (43%) and needlestick and sharps injuries (38%). DiscussionThis study produced findings not previously published thus advancing the state of the science in patient and occupational health safety. These include identifying modifiable features of the safety climate and key organizational characteristics associated better outcomes. ConclusionsIn this novel study we identified that a positive patient safety climate and adherence to standard precautions predict key HAI and occupational health outcomes.

Nursing staff compliance and adherence to standard precautions during the COVID-19 pandemic: A cross-sectional study.

This study investigated the compliance and adherence of nursing staff (nurses, nursing assistants, and midwives) to standard precautions (SPs). A cross-sectional design while adhering to STROBE guidelines was used for this study. Nursing staff from a government tertiary hospital (n=515) were recruited and completed the Compliance with Standard Precautions Scale (CSPS) and Factors Influencing Adherence to Standard Precautions Scale (FIASPS). Analysis of variance, Pearson's correlation, and linear regression analysis were used to analyze the data. The overall average compliance with the SPs of the nursing staff was suboptimal, and the disposal of sharps domain had the lowest compliance. Nurses were more compliant with sharps disposal, and nursing assistants with waste disposal. Contextual cues were the most influential factor influencing participants' adherence to SPs. All CSPS domains were significantly correlated with the Contextual cues factor of the FIASPS. Finally, service years and educational attainment were significant predictors of SPs adherence. The findings underscore the organization's critical responsibility for actively enforcing policies using monitoring systems and contextual cues in the workplace to ensure staff compliance and adherence with SPs.

Knowledge, attitude and adherence to standard precautions among frontline clinical physiotherapists during the COVID-19 pandemic: a cross-sectional survey

Purpose To investigate the knowledge of pathology and prevention of the novel coronavirus (COVID-19), attitude towards clinical practice, and adherence to standard precautions among clinical physiotherapists during the pandemic. Material and methods A snowballing method was used to recruit physiotherapists (across 53 countries) who responded to a newly designed and validated survey on the participants’ demographics, knowledge of COVID-19, attitude, practices, and standard precaution adherence during the pandemic. Data were analysed using descriptive statistics, Cronbach’s Alpha, Pearson’s correlation, and ANOVA. Results All participants (n = 2550, 100%) were knowledgeable on COVID-19 symptomatology. However, only (n = 312, 12.2%) were actively involved in the management of confirmed cases. The percentage score of participants’ knowledge regarding COVID-19 pathology, and prevention, their attitude, and adherence to standard precautions averaged 77.73 ± 10.11, 89.70 ± 9.26, 77.44 ± 7.04, and 61.59 ± 16.63, respectively. Knowledge about COVID-19 pathology differed significantly across demographic variables (p < 0.001, Ƞ 2 ≤ 0.07). Most participants (n = 1936, 75.9%) reported an inadequate supply of personal protective equipment (PPE). Conclusion Participants had good knowledge of COVID-19 pathology and a positive attitude towards safe clinical practice. However, adherence to standard precautions was suboptimal due to inadequate infectious disease training and PPE supply.

STANDARD PRECAUTION ADHERENCE BY NURSING WORKERS: A MIXED METHODS STUDY

ABSTRACT Objective: to analyze standard precaution adherence and associated factors of nursing workers at a university hospital. Method: this is a study of mixed methods of convergent parallel strategy, carried out in Southern Brazil. The quantitative stage had 602 participants, using the instrument of sociodemographic and professional variables and the Instrument of Variables Related to Standard Precautions, analyzed using descriptive statistics. In the qualitative stage, a semi-structured interview was conducted with 24 workers, analyzed through content analysis. Results: the data showed an intermediate standard precaution adherence. In the Individual Factors dimension, the Prevention Effectiveness Scale showed high scores and the Risk Personality, Risk Perception and Knowledge about Occupational HIV Transmission scales, intermediate scores. In the dimension Work-related factors, both in the Obstacles to Following Standard Precautions Scale and in the Workload Scale, the scores were intermediate. In the Organizational Factors dimension, low scores were found for Climate of Safety and Training in Prevention of Exposure to the Human Immunodeficiency Virus and intermediate for Personal Protective Equipment Availability. Qualitative data showed that workers often select patients who they think are at greatest risk for occupational transmission to use standard precautions. Conclusion: standard precaution adherence does not occur fully among participants. Data integration allowed to conclude that, among the main elements that influence this phenomenon, is the lack of clarity of participants as to the purpose, indication and principles of standard precautions.

A Large-Scale Snapshot of Standard Precaution Adherence: “Do as I Say Not as I Do”

Background: Nearly 1 in 25 patients has a hospital infection at any given time, and 1 in 25 nurses suffers and bloodborne exposure every year. Basic procedures, termed standard precautions (SP) may prevent these outcomes, but they are not often used by healthcare workers. Unfortunately, data are largely limited by self-reporting because no standardized tools exist to capture observational data. Objective: The specific aim of this study was to describe the relationship between self-reported and observed SP adherence. Methods: This multisite, cross-sectional study included 2 elements: (1) surveys of nurses in US hospital units on perceptions of patient safety climate and reported SP adherence and (2) observational SP data. Survey data included 12 items on SP practices (eg, “how often you perform hand hygiene before touching a patient”) and 10 items on SP environment (eg, “my work area is not cluttered”), rated on a 5-point scale from “never” to “always” or from “strongly disagree” to ”strongly agree,” respectively. Using novel tools developed and previously pilot tested, we recruited and trained hospital-based staff on observational surveillance methodology to foster the National Occupational Research Agenda goals. The 10 observational SP items represented the following 4 categories: (1) hand hygiene, (2) personal protective equipment (PPE), (3) sharps, and (4) soiled linen handling. Observations of healthcare worker–patient interactions followed training and interrater reliability testing. All data were aggregated, and analyses were conducted at the unit level. Pearson correlation coefficients were calculated to determine the relationship between reported and observed SP practices (level of significance, P &lt; .05). Results: In total, 6,518 SP indications were observed and 500 surveys were collected from nurses on 54 units in 15 hospitals from 6 states. The final analytic sample included 5,285 SP indications and 452 surveys from 43 units in 13 hospitals that provided both types of data. Most indications observed were of HH (72.6%). Overall SP adherence was 64.4%. In descending order, adherence rates were PPE (81.8%), sharps handling (80.9%), linen handing (68.3%), and hand hygiene (58.3%). The aggregate of positive self-reported SP practices was 95.8%, and 77.3% rated unit environment for SP adherence positively. There was no correlation between observed adherence and reported adherence (r (41) = (−).024, P = .879). Conclusions: In this study, the largest study of SP adherence, observed practice was grossly suboptimal, particularly hand hygiene. Conversely, nurses on the same units rated adherence as high, despite the environment. In combination, both sources of surveillance data provide valuable and actionable insight to target interventions.Funding: and Disclosure Amanda Hessels reports that she is the principal investigator for the following studies: “Impact of Patient Safety Climate on Infection Prevention Practices and Healthcare Worker and Patient Outcomes” (grant no. DHHS/CDC/NIOSH 1K01OH011186 to Columbia University) and “Simulation to Improve Infection Prevention and Patient Safety: The SIPPS Trial” (AHRQ grant no. R18: 1R18HS026418 to Columbia University).

Compliance with Standard Precautions Among University Nursing Students From Croatia: A Cross-Sectional Study

Background: Stringent compliance with standard precautions is of utmost importance for reducing the spread of healthcare-associated infections (HAIs); however, the role of medical and nursing students is often underappreciated. Because undergraduate and graduate nursing programs combine classroom education and clinical training, nursing students are already important stakeholders in HAI risk reduction and patient safety endeavors. Objectives: In this study, we appraised self-reported adherence to standard precautions among university nursing students, and we examined factors that may influence their level of compliance. Methods: In total, 362 undergraduate and graduate university nursing students form the University North in Croatia (Europe), enrolled in courses or modules with clinical placement, were surveyed in this self-reported cross-sectional study. A 2-part self-administered questionnaire was used, consisting of a demographic survey and a globally applicable 20-item Compliance with Standard Precautions Scale (CSPS). Differences were examined by an independent t test and analysis of variance (ANOVA), and factors influencing compliance were further appraised by a standard multiple linear regression analysis. Significance was set at P &lt;.05 (2-sided). Results: The overall compliance rate in this study was 58.4%. The highest compliance rate was observed for wearing gloves when exposed to body fluids, blood products, and any excretion of patients (82.8%); conversely, the lowest compliance rate was reported for disposing a sharps box before it was full (27.2%). Higher rates of compliance were seen in female nursing students compared with their male counterparts (P = 0.039). Even though age was not a significant predictor, there was an increase in compliance rates according to the academic year level (P &lt; .001). Conclusions: Our results indicate that the overall compliance rate of the Croatian nursing students was moderate, although there was a trend toward more rigorous standard precaution adherence with more education and clinical experience. These findings highlight the need to improve the nursing curriculum to integrate more material on infection control practices early in the program, consequently bridging the gap between theory and practice. Finally, a supportive culture of infection control adherence in quotidian clinical practice must be continuously fostered.Funding: NoneDisclosures: None

Comparative Usability of Three Platforms for Collecting Standard Precautions Surveillance Data

Background: Although standard precautions are considered a building block in the prevention of healthcare-associated infections (HAIs) and bloodborne pathogen (BBP) exposures, little is known about the rate of adherence to standard precautions among healthcare workers in US acute-care hospitals and the processes used for measurement and surveillance. Methods: We evaluated the development and usability of electronic platforms to collect standard precautions surveillance data in support of the Simulation to Improve Infection Prevention and Patient Safety (SIPPS) Trial. SIPPS is a 5-year group-randomized group-interventional study to develop and test a simulation intervention to improve provider performance of standard precautions and prevent HAIs and occupational BBP exposures. In the pilot study, standard precautions adherence data were collected and validated using the Standard Precautions Observational Tool (SPOT) in a paper format. Adherence was measured using 10 indicators across the categories of hand hygiene, personal protective equipment, linen handling, and sharps disposal. The SPOT allows users to observe healthcare workers providing routine care and to record when an SP action is indicated and whether it was completed or missed. The data did not contain personally identifiable information or protected health information. The aim of this project was to design an electronic version of the SPOT that is simple and affordable to create, allows for rapid and structured data collection, and can be disseminated for broad standardization of standard precautions surveillance. Results: Three electronic platforms, including 2 survey-based platforms (Qualtrics and REDCap) and 1 website-based platform (Google), were evaluated for the following characteristics: (1) design interface, (2) customizability, (3) data entry speed, (4) accessibility, and (5) total cost. Both survey platforms performed well in design interface, allowing for a no- or low-code design and offered mobile-friendly formats. Rigid survey formats created obstacles in customization and rapid data collection, involving large amounts of scrolling or screen advancement. Survey-based platforms also required a subscription or access fee. Conversely, the website-based platform had a more challenging design interface but was easily customizable with low-level knowledge of hypertext mark-up language (HTML) and application programming interface deployment. The website platform allowed for a single screen view, mobile-phone–friendly design, and rapid data collection. It was developed using freely available resources. Conclusions: A website-based HTML form allows for faster data collection and a higher level of customization than survey-based platforms and can be designed and implemented free of cost using minimal web-development skills. This surveillance methodology will be field tested for fidelity of implementation and for broad use in surveillance.Funding: The Agency for Healthcare Research and Quality provided Funding: for this study (grant no. 1R18HS026418).Disclosures: Amanda Hessels reports that she is the primary investigator for the studies titled “Impact of Patient Safety Climate on Infection Prevention Practices and Healthcare Worker and Patient Outcomes” (grant no. DHHS/CDC/NIOSH 1K01OH011186 to Columbia University) and “Simulation to Improve Infection Prevention and Patient Safety: The SIPPS Trial (AHRQ grant no. R18: 1R18HS026418 to Columbia University)

Perceived Barriers to Adherence to Standard Precautions among Healthcare Personnel Working in a Teaching Hospital of Palpa District, Nepal

Introduction: The present study aimed to find out the perceived barriers to adherence to standard precautions among healthcare personnel working in a teaching hospital of Palpa district. Methods: A descriptive cross-sectional study was conducted among 191 healthcare personnel in April 2019. Barriers to standard precautions adherence were evaluated using ‘Factors Influencing Adherence to Standard Precautions Scale’. Mann Whitney U test and Kruskal Wallis H test were applied to examine the association of selected demographic variables: age, educational background, duration of employment, working areas and having attended trainings related to standard precautions with the perceived barriers to standard precautions adherence. Results: The mean age of participants was 24.87±6.05 years. Most (85.3%) of participants were nurses. 19.9% and 52.4% of participants always performed hand hygiene before and after using personal protective equipment respectively. The subscale scores in leadership and culture of the institute were 14.86±4.21 (possible range 0-24) and 14.59±2.60 (possible range 0-20) respectively. Subscale scores in judgement and contextual cues were 17.49±3.46 (possible range 0-20) and 18.02±5 (possible range 0-24) respectively. Score in justification was 7.52±5.12 (possible range 0-28). Age, educational background and duration of employment had a statistically significant association with subscale scores on justification and perceived culture of the institution. Conclusion: The present study revealed that only 19.9% of the participants would perform hand hygiene before using gloves and 52.4% of participants would do it afterwards. Personal judgement, dependence on contextual cues and inadequate leadership skills were found to be the major barriers to adherence to standard precautions.

Standard precaution adherence among clinical medical students in HIV and non-HIV ward in Indonesia.

INTRODUCTION:Health-care workers, especially medical intern, are at risk of exposed to blood and other body fluids in the course of their work. To reduce the risk, standard precaution (SP) is introduced. Among all communicable diseases that could be transmitted, human immunodeficiency virus (HIV) is the most stigmatized disease. However, there are some government hospitals that separated adult HIV patients with other patients to prevent additional infection. This study aims to evaluate the impact of ward separation on SP adherence.MATERIALS AND METHODS:This was an observational study conducted in March 2017 in a tertiary referral hospital for the eastern part of Indonesia. The participants were 150 medical students who underwent the past year of their clinical rotation. They were given a three-part questionnaire, consisting of their background, their SP practice in the HIV ward and non-HIV wards, and their perception and attitude regarding SP. McNemar's test and Fisher's exact test were used for the statistical analysis, using SPSS version 23.0 for Windows.RESULTS:Participants were more adhered to SP (hand hygiene, wear mask as indicated, and wear glove as indicated) in the HIV ward compare to non-HIV wards (P = 0.002, P = 0.001, and P = 0.001, respectively). Almost all participants were more careful in implementing SP in the HIV ward than in non-HIV wards and were more concerned of getting needlestick injury in the HIV ward than in non-HIV ward.CONCLUSION:HIV and non-HIV ward separation negatively impact medical students' SP adherence.

Relationship among safety culture, nursing care, and Standard Precautions adherence

Standard Precautions (SP) are an essential, although unmet, component of nursing care. Understanding conditions fostering the integration of SP within nursing workflow is imperative. This research describes the relationships among patient safety culture, adherence to SP, and missed nursing care.

Association between Hospital Nurses' Perception of Patient Safety Management and Standard Precaution Adherence: A Cross-Sectional Study.

Standard precautions should be applied to prevent health care-associated infections during every nursing activity. However, adherence to standard precautions was reported to be inadequate. Therefore, this study aimed to identify the rates of standard precaution adherence and the association between perception of patient safety management and standard precaution adherence. In this cross-sectional descriptive study, a convenience sample of nurses was recruited from a university-affiliated teaching hospital in Seoul, Korea. Data were collected using a structured self-report questionnaire. Among the 332 questionnaires returned (response rate: 94.9%), a total of 329 nurses were analyzed. In the present study, the overall standard precaution adherence rate was approximately 53.5%. The multiple linear regression results revealed that participants’ perceptions of patient safety management were only significantly associated with standard precaution adherence after adjusting other covariates (β = 0.412, p < 0.001). Nurse supervisors should focus more on raising awareness about nurses’ perception of patient safety management based on the specific work environment, such as the total number of nurses working together and the nurse-to-patient ratio. Nurse educators should develop integrated curricula to help graduate nurses transition smoothly into professional practice and enhance adherence to standard precautions in diverse health care settings.

Relationship between patient safety climate and adherence to standard precautions.

Standard precautions (SPs) are designed to limit bloodborne pathogen exposures among health care workers (HCWs) and health care-associated infections. SP adherence is globally suboptimal; however, reasons are underexplored. This study aim was to explore the relationships among safety climate factors and SP adherence by HCWs in hospitals using newly developed survey and observational tools. Cross-sectional data from 11 units in 5 hospitals were collected between March and September 2015. A patient safety and standard precaution survey was administered to nurses and pooled with data from observations of HCW-patient interactions using defined SP indications. Descriptive statistics of distributions, frequencies, and Pearson correlation coefficients were calculated to determine the unit-level relationships among dimensions of the patient safety climate and unit percentages of SP adherence (P < .05). There were 540 HCW-patient encounters with 1,713 SP indications and 140 surveys collected. Although most nurses (94%) reported always or often adhering to SPs and generally reported positive scores on unit safety climate, observed SP adherence was 62% (unit range, 31%-80%). Only 30% of nurses rated staffing positively, and this was inversely related to observed SP adherence. Adherence to the full complement of observed SP behaviors by HCWs of all types was suboptimal. The relationship between safety climate, particularly staffing, and adherence to SPs warrants further testing.

Investigating Compliance with Standard Precautions During Residency Physicians in Gynecology and Obstetrics

OBJECTIVES:Physician compliance with standard precautions is important in the specialty of gynecology and obstetrics because of the high frequency of invasive procedures. The current study investigated compliance with standard precautions among resident physicians working in gynecology and obstetrics.METHOD:A cross-sectional study was conducted among resident physicians in gynecology and obstetrics in their first (R1), second (R2) and third (R3) years of residency at a teaching hospital in a city in São Paulo. A structured questionnaire that included demographic and professional aspects and the Standard Precautions Adherence Scale were used to collect data. Statistical analysis was performed using IBM® SPSS version 20. Ethical aspects were considered.RESULTS:Fifty-eight resident physicians participated in the study. Of the enrolled participants, 27 (46.6%) were in R1, 12 (20.7%) were in R2 and 19 (32.8%) were in R3. The standard precautions compliance score was 4.1, which was classified as intermediate. There were no significant differences in the compliance scores of the resident physicians across the three years of residency (H=2.34, p=0.310).CONCLUSION:Compliance with standard precautions among resident physicians was intermediate. Preventive measures in clinical practice are not fully adopted in the specialty of gynecology and obstetrics. More important, many professionals claimed lack of sufficient training in standard precautions in the workplace. Such circumstances should draw the attention of hospital management with regard to occupational health risks.

Barriers to standard precautions adherence in a dental school in Iran: A qualitative study

Setting up good infection control practices in educational institutions is crucial in shaping future health professionals. The implementation of standard precautions (SPs) in Iranian dental schools has not been explored qualitatively to identify barriers to good practice. Twelve focus group discussions and 8 semistructured interviews were conducted with students, residents, and staff members (n=83) of the Shiraz University of Medical Sciences Dental School. The interview guide addressed performance, subjective norms, and behavioral control domains of SP-related behaviors. Thematic analysis was performed manually to identify barriers to SP practices. Proximal factors of poor SP adherence were a lack of knowledge and technical difficulties. These factors were compounded by intermediate factors in the work environment: lack of facilities, heavy workload, patient expectations, interprofessional conflicts, and lack of good role models. Two underlying distal factors were financial issues and unsupportive organizational culture. The social constructionism theory was useful in analyzing the situation and suggesting an educational approach as part of the solution. Complex and intertwined barriers of SP adherence were found in this dental school. A social construction approach may assist in addressing these problems by shifting the culture through education to construct a contextual new knowledge. Further research in medical sociology of SP practices would be useful.

Respect des « précautions standards » par le personnel infirmier d'un centre hospitalo-universitaire de l'ouest algérien

Health care workers are exposed daily to blood borne injury and infection with a high risk of hepatitis B or C and human immunodeficiency virus (HIV) transmission. In the 1980s, the US Centers for Disease Control and Prevention (CDC) developed a set of protocols and guidelines known as standard precautions (SP) to prevent accidental transmission of pathogens. The SP should be followed for each intervention or delivery of care in order to protect health care workers from risks associated with contact with blood and other biological liquids. A survey was conducted in a Western Algerian university hospital to assess nurses' adherence to SP practices. A questionnaire was administered to 450 nurses in the hospital workplace setting. A field survey was also conducted in order to take into account the means and support available to the nurses in these hospital departments, namely to determine availability of hand washing and drying facilities. A total of 133 nurses, 81 women and 52 men, participated in the survey. Personal and professional data, hand-washing frequency, glove wearing practices were collected as data. A large majority (95%) of nurses reported washing their hands after removing their gloves, and 69% of them reported washing their hands between two patients. Male nurses wear gloves more often than females (respectively 77% and 53%). Sharp instruments were correctly disposed of in a puncture-resistant container more of the time. Recapping needles has been reported by two-thirds of survey respondents. Lack of liquid soap and alcohol-based washing solution were noted as major deficiencies as well as the lack of means to properly dry hands in many health care wards. Lack of SP adherence is primarily due to the lack of awareness and knowledge as well as insufficient supply of equipment and materials for good hand hygiene maintenance. This study highlights the urgent need to implement a programme to improve SP adherence among nurses and to increase the supply of hand washing and drying materials. Greater adherence to SP practices will also reduce the risk of occupational exposure to blood borne injury and infection.