A review of the evidence for suboptimal compliance of healthcare practitioners to standard/universal infection control precautions.

AIMS: The review examines from international research: the extent to which practitioners comply with infection control precautions; the pertinent issues that are considered influential in compliance; what strategies have been evaluated to instigate positive behaviour changes amongst practitioners and the effect of these interventions. BACKGROUND: Internationally, standard/universal precautions (UP) are regarded as fundamental in the prevention and control of infection, and effective in protecting practitioners and patients. However, adherence has been problematic and the practice of standard/UPs is globally suboptimal. DESIGN AND METHODS: Literature review where relevant evidence was identified using several electronic databases, from 1994 to 2006, with number of key terms utilized. Data were extracted by using key headings, which facilitated analysis. RESULTS: Thirty-seven studies were appraised. Twenty-four related to measuring practitioner compliance and 13 studies that evaluated the effect of a research intervention on compliance. In addition, other studies were included which examined the specific reasons for suboptimal compliance, or discussed infection control precautions generally. CONCLUSIONS: Compliance to infection control precautions is internationally suboptimal. The evidence confirms that compliance to specific aspects of standard/UPs varies, and practitioners are selective in their application of recommended practice. Compliance does improve following a structured intervention; however, research fails to indicate for how long the intervention affects practitioner compliance, or whether compliance after a period of time returns to the norm. Several reasons for non-compliance are discussed, and recommendations for future research are suggested. Relevance to clinical practice. Suboptimal compliance has significant implications for staff safety, patient protection and the care environment. Infection control teams and researchers need to consider the reasons for non-compliance and provide a supportive environment that is conducive to the routine, long-term application of standard precautions.

A study to ascertain the effect of structured student tutorial support on student stress, self-esteem and coping.

The overall aim of this intervention study was to investigate, and measure quantitatively, the psychological effects of structured student tutorial support, on undergraduate students' level of stress, self-esteem and cognitive coping. A quantitative research approach was adopted using a quasi-experimental design (post-test only, non-equivalent control group design) in order to ascertain whether there were any significant differences between the experimental conditions (n=25) and a control group (n=25). The independent variable was structured student tutorial support and the dependent variables were student stress, self-esteem and cognitive coping. A total of 50 subjects were randomly assigned to either the experimental or control group. Quantitative data were collected using: the Student Nurse Stress Index (Jones, M.C., Johnston, D.W., 1997a. The derivation of a 22 item Student Nurse Stress Index, using exploratory, confirmatory and multi-sample confirmatory factor analytic techniques. In: Paper Presented at the Annual Nursing Research Conference, 18-20th April, University of Wales, Swansea; Jones, M. C. Johnston, D.W., 1999. Derivation of a brief Student Nurse Stress Index. Work and Stress 13(2), 162-181), the Self Esteem Scale (Rosenberg, M., 1965. Society and the Adolesent Self Image. Princeton University Press, Princeton, NJ) and a Linear Analogue Coping Scale (Gammon, J., 1998. Analysis of the stressful effects of hospitalisation and source isolation on coping and psychological constructs. International Journal of Nursing Practice 4(2), 84-97). The methods of data analysis were the application of the t-test and descriptive statistics. The results indicated a significantly lower level of stress in the experimental group (t=-3.85, p=0.001) and a significantly higher self esteem (t=4.11, p=0.001). Results also suggested that students who were provided with structured tutorial support perceived they coped more effectively with their studies (t=4.65, p=0.001). The study concluded that structured tutorial support was an influential variable in reducing student stress, promoting self-esteem and facilitating more effective coping, suggests further interventional research is needed to evaluate this further.