How do university education and clinical experience influence pre-registration nursing students' infection control practice? A descriptive, cross sectional survey.

AIMS: This study aims to explore nursing students' knowledge of infection control and investigate how university education and clinical experience influence their infection control practice. BACKGROUND: In order to prevent and control healthcare associated infections all healthcare staff must be knowledgeable about infection control. However, knowledge and practice of infection control are often sub-optimal. Education has had variable results in improving the infection control knowledge of healthcare professionals yet, there have been few studies examining this issue in relation to pre-registration nursing students in the United Kingdom. METHODS: This descriptive cross-sectional survey employed a questionnaire composed of predominantly closed questions for data collection. A non-probability, purposive sample of 354/444 (79.7%) nursing students from one university participated in the study. FINDINGS: Knowledge was generally adequate in questions related to pathogen transmission, hand hygiene principles, glove use, immediate action following sharps' injuries, and risk reduction in relation to sharps and waste management. Topics that received less positive results related to the chain of infection, the use of alcohol gel and Clostridium difficile and the definition of inoculation injury. University education was the main influence on knowledge and practice (340/353, 96.3%), but mentors (322/354, 91.2%), nurses (316/353, 89.3%), doctors (175/353, 49.4%) and other members of the multi-disciplinary team (213/352, 60.2%) were also deemed influential. Workload, time, and availability of facilities and equipment also contributed to the adoption of infection control precautions. The findings illustrated the importance of both theoretical and practical knowledge, supported by competent role models. CONCLUSION: The study identified the complexities of knowledge acquisition and application in a practice based discipline. The support of a competent role model to assist in applying theory to practice is vital. The study has identified that there are many variables that affect IPC practice, both positively and negatively.

Does education improve mental health practitioners' confidence in meeting the physical health needs of mental health service users? A mixed methods pilot study.

Mental health nurses are ideally placed to assess mental health service users' physical health and provide relevant interventions. However, they may lack the confidence and knowledge to do so, as a result of limited education on physical health issues. This mixed methods pilot study sought to evaluate the effect of education on confidence in assessing and addressing physical health needs following attendance at a module entitled "Physical health issues in adult mental Health practice." An explanatory sequential design was used in which quantitative data regarding participants' perceptions of their confidence on assessing and addressing physical health issues with service users were collected via a questionnaire pre- and post-module. Additionally, a focus group interview was conducted to expand on survey responses. Findings indicated that confidence scores increased for all participants following the module, with participants identifying new knowledge and plans for practice change. Further research is needed to educate and support mental health staff in improving their confidence and knowledge in this area.

The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre.

AIM: To examine the frequency of, and factors influencing, reporting of mucocutaneous and percutaneous injuries in operating theatres. BACKGROUND: Surgeons and peri-operative nurses risk acquiring blood-borne viral infections during surgical procedures. Appropriate first-aid and prophylactic treatment after an injury can significantly reduce the risk of infection. However, studies indicate that injuries often go unreported. The 'systems approach' to error reduction relies on reporting incidents and near misses. Failure to report will compromise safety. METHODS: A postal survey of all surgeons and peri-operative nurses engaged in exposure prone procedures in nine Welsh hospitals, face-to-face interviews with selected participants and telephone interviews with Infection Control Nurses. RESULTS: The response rate was 51.47% (315/612). Most respondents reported one or more percutaneous (183/315, 58.1%) and/or mucocutaneous injuries (68/315, 21.6%) in the 5 years preceding the study. Only 54.9% (112/204) reported every injury. Surgeons were poorer at reporting: 70/133 (52.6%) reported all or >50% of their injuries compared with 65/71 nurses (91.5%). CONCLUSIONS: Injuries are frequently under-reported, possibly compromising safety in operating theatres. IMPLICATIONS FOR NURSING MANAGEMENT: A significant number of inoculation injuries are not reported. Factors influencing under-reporting were identified. This knowledge can assist managers in improving reporting and encouraging a robust safety culture within operating departments.

Inter-professional differences in compliance with standard precautions in operating theatres: a multi-site, mixed methods study.

BACKGROUND: Occupational acquisition of blood-borne infections has been reported following exposure to blood or body fluids. Consistent adherence to standard precautions will reduce the risk of infection. OBJECTIVES: To identify: the frequency of self-reported adverse exposure to blood and body fluids among surgeons and scrub nurses during surgical procedures; contributory factors to such injuries; the extent of compliance with standard precautions; and factors influencing compliance with precautions. DESIGN: A multi-site mixed methods study incorporating a cross-sectional survey and interviews. SETTINGS: Six NHS trusts in Wales between January 2006 and August 2008. PARTICIPANTS: Surgeons and scrub nurses and Senior Infection Control Nurses. METHODS: A postal survey to all surgeons and scrub nurses, who engaged in exposure prone procedures, followed by face to face interviews with surgeons and scrub nurses, and telephone interviews with Infection Control Nurses. RESULTS: Response rate was 51.47% (315/612). Most 219/315 (69.5%) respondents reported sustaining an inoculation injury in the last five years: 183/315 (58.1%) reported sharps' injuries and 40/315 (12.7%) splashes. Being a surgeon and believing injuries to be an occupational hazard were significantly associated with increased risk of sharps' injuries (adjusted odds ratio 1.73, 95% confidence interval 1.04-2.88 and adjusted odds ratio 2.0, 1.11-3.5, respectively). Compliance was incomplete: 31/315 (10%) respondents always complied with all available precautions, 1/315 (0.003%) claimed never to comply with any precautions; 64/293 (21.8%) always used safety devices, 141/310 (45.5%) eye protection, 72 (23.2%) double gloves, and 259/307 (84.4%) avoided passing sharps from hand to hand. Others selected precautions according to their own assessment of risk. Surgeons were less likely to adopt eye protection (adjusted odds ratio 0.28, 0.11-0.71) and to attend training sessions (odds ratio 0.111, 0.061-0.19). The professions viewed the risks associated with their roles differently, with nurses being more willing to follow protocols. CONCLUSION: Inter-professional differences in experiencing adverse exposures must be addressed to improve safety and reduce infection risks. This requires new training initiatives to alter risk perception and promote compliance with policies and procedures.

Commentary: the importance of education and vaccination in reducing the risk of hepatitis infection among nursing students.

BACKGROUND: Healthcare workers are at risk of contracting blood-borne viral infection during contact with blood and body fluids. Nursing students may be at particular risk because of their inexperience. Adoption of suitable precautions, hepatitis B vaccination and appropriate post-exposure prophylaxis will significantly reduce the risk of infection. AIM: This commentary puts into context the findings of a study by Yamazhan et al. who explored nursing students' knowledge on hepatitis together with their immunization status. EVALUATION: Knowledge of hepatitis, its mode of transmission and the risks of infection following adverse exposure to blood and body fluids are essential to ensure safe practice. This paper identifies that nursing students' knowledge of hepatitis is moderate only and varies between universities. However, the uptake of hepatitis B vaccination among the sample was high, suggesting a high commitment to reducing the risk of this infection by the universities and clinical placements. IMPLICATIONS: This paper highlights the need for a standardized education package to be developed and delivered by all universities in Turkey to ensure that nursing students have a sound knowledge of hepatitis and other blood-borne infections. Vaccination programmes must continue to ensure that nursing students are protected from hepatitis B.

Review of personal protection equipment used in practice.

Standard precautions offer a consistent approach to infection control that does not rely on knowledge or suspicion of infection, and contributes to staff and patient safety by reducing the risk of exposure to potentially infectious material. One of the cornerstones of standard precautions is the appropriate use of personal protective equipment (PPE) whenever contact with blood or body fluids is anticipated. However, evidence suggests that compliance with standard precautions including correct use of PPE is inadequate. Demographic and epidemiological changes in the U.K., and the drive to provide more complex patient care outside acute hospitals may lead to increased infection risks for both patients and community healthcare workers. This review examines the importance and use of PPE by community nurses and discusses the implications for practice of poor compliance with standard precautions. Recommendations for practice will be made aimed at improving compliance with this important element of standard precautions.

Review of standard precautions and sharps management in the community.

Standard precautions are imperative for staff and patient safety and provide a basis for sound infection control practice in all health-care settings. One key element of these precautions relates to the safe handling and management of sharps to prevent occupational acquisition of blood-borne viral infection. Many inoculation injuries could be avoided by following standard precautions whenever contact with blood or body fluids is anticipated. However, evidence suggests that compliance with standard precautions is inadequate. With the modernization of the health service in the UK, community health care is becoming more complex, potentially increasing the risk of inoculation injury to community nurses. Although compliance with standard precautions in hospitals is well documented, there is limited research specific to community nurses. This review examines compliance with standard precautions by community nurses and discusses some strategies aimed at improving compliance with one of the key elements of standard precautions, i.e. sharps management.

Uptake of guidelines to avoid and report exposure to blood and body fluids.

BACKGROUND: Mucocutaneous and percutaneous exposure to blood and body fluids (inoculation injury) are major risk factors for occupational acquisition of bloodborne infection in health care professionals. Compliance with prescribed 'universal precautions' during exposure-prone procedures has been shown to reduce the risk of acquiring bloodborne viral infection. In addition, reporting such exposures facilitates prophylaxis. AIM: The aim of this paper is to report a study to identify strategies to minimize professionals' risks of acquiring bloodborne infections during exposure-prone procedures. METHOD: All surgeons, theatre nurses who scrub for surgery and midwives employed in general operating theatres and delivery suites within one UK National Health Service trust (n = 276) were surveyed by postal questionnaire. Data were analysed using univariate and bivariate techniques in SPSS version 10. Content analysis was undertaken on the one open-ended question. FINDINGS: The response rate was 72.5% (200/276). Only 1.5% (3/200) of respondents adopted universal precautions for all patients irrespective of whether their bloodborne viral status was known. On average, only half the recommended theatre-specific precautions were always adopted (mean 3.725/7, SD = 1.385). Most respondents (63.3%) admitted making judgements related to nationality, lifestyle or sexual orientation when making decisions about protective clothing. Many respondents (74%, 145/196) reported sustaining an inoculation injury in the 10 years prior to the study. However, under-reporting of injuries was common, and 32.4% (47/145) admitted failing to report injuries. Guideline adherence was influenced by profession, but not by time since qualification. CONCLUSIONS: The findings suggest that strategies must be developed to improve compliance with universal precautions and reporting guidelines by all health care professionals. The extent of, and reasons for, non-compliance with both local and national guidelines remain relatively unexplored.