compliance with standard precautions among hospital nurses

Journal of Multidisciplinary Studies Vol. 4 No. 1, pp. 108-138, August 2015 ISSN 2350-7020 (Print) ISSN 2362-9436 (Online) doi: http://dx.doi.org/10.7828/jmds.v4i1.855

Compliance with Standard Precautions among

Hospital Nurses in Ozamiz City, Philippines

Jezreel Marc E. Pasay1, Marie Rosellynn C. Enguito2, Chona J. Robles1, Anthony L. Awa3

1College of Nursing and Midwifery, Misamis University, Ozamiz City, Philippines

2Natural Sciences Department, College of Arts & Sciences, Misamis University, Ozamiz City, Philippines

3College of Arts & Sciences, Misamis University, Ozamiz City, Philippines Corresponding author: Jezreel Marc E. Pasay, email: [email protected]

Abstract

Ozamiz City is the center for health and people from nearby places choose to access its health services because of the available amenities for life-threatening conditions. With the increasing incidence of infectious diseases, compliance of nurses with standard precautions (SP) is necessary to control healthcare-associated infections. This study determined the compliance with SP of 100 nurses in two tertiary hospitals in Ozamiz City using a structured questionnaire that passed the Cronbach’s alpha reliability test. The study utilized the Kruskal-Wallis H test, Mann-Whitney U test, and Pearson’s correlation statistical models. Findings revealed a very high compliance among nurses in 82.6% of the SP. Older and male nurses assigned to pedia ward with more years of work experience and attended SP training exhibited better compliance to SP. Nurses who experienced needlestick injury, not exposed to patient’s body fluids, and vaccinated with the hepatitis B virus also showed better compliance. The difference in compliance among nurses when grouped by profile was not statistically significant (p<0.05). The correlation between knowledge and compliance was not also significant. The findings could help the administrators identify areas for improvement in nosocomial infection control in hospitals in this part of Mindanao. Keywords: health, infections, knowledge, needlestick, nosocomial

108

Journal of Multidisciplinary Studies Vol. 4, No. 1, pp. 108-138, August 2015ISSN 2350-7020 (Print)ISSN 2362-9436 (Online)doi: http://dx.doi.org/10.7828/jmds.v4i1.855

Compliance with Standard Precautions among J. M. E. Pasay, M. R. C. Enguito, Hospital Nurses in Ozamiz City, Philippines C. J. Robles & A. L. Awa

Introduction

Hospital-acquired infections (HAIs) remain a public concern worldwide, threatening the health of the patients and medical workers (Luo et al., 2010). Infections acquired during medical treatment have been increasing over the past decade causing high mortality (Suganya & Thomas, 2014). Middle East respiratory syndrome coronavirus, severe acute respiratory syndrome, avian flu, and Ebola are rapidly increasing worldwide and become a burden on public health (Suwantarat & Apisarnthanarak, 2015; Milinovich et al., 2014).

The term HAIs has been commonly used for nosocomial infections to reflect better the diversity of the modern healthcare systems that the patients encounter in recent time (Paitoonpong et al., 2013). Patients under medical or surgical treatment are not the only ones at risk for HAIs, but physicians and nurses are also susceptible. Healthcare workers are at direct risk of exposure to blood and other body fluids during their work (Amoran & Onwube, 2013). Specifically, nurses are prone to acquiring blood-borne viruses such as Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) during direct contact with the patients (Chan et al., 2002; Shiao et al., 2002). Needlestick injury is the most common cause of transmission of these blood-borne infections to nurses (Amoran & Onwube, 2013; Ilhan et al., 2006).

The higher prevalence of HAIs has burdened the developing countries more than the high-income countries (Habibi et al., 2008; Lahsaeizadeh et al., 2008). The occurrence of device-associated infection in the low- and middle-income countries is up to 13 times higher than in developed countries (World Health Organization [WHO], 2014). A study in Philippine ICU (Intensive Care Unit) on device-associated healthcare-associated infections (DA-HAI) showed an overall rate of 4.9 infections per 1,000 ICU-days with ventilator-associated pneumonia constituting the greatest risk (Navoa-Ng et al., 2011). Hence, more emphasis has been given to SP to prevent the spread of infectious diseases (Luo et al., 2010). The SP are considered basic protective measures that apply to all patients (Mukherjee et al., 2013) and reduce the risk of acquiring an occupational infection among healthcare workers (Siegel et al., 2007).

109

J. M. E. Pasay, M. R. C. Enguito,C. J. Robles & A. L. Awa

Compliance with Standard Precautions amongHospital Nurses in Ozamiz City, Philippines

Journal of Multidisciplinary Studies Vol. 4 No. 1, pp. 108-138, August 2015

Compliance with SP among healthcare workers can prevent the spread of potentially life-threatening infectious diseases (Chan et al., 2002). However, noncompliance with SP among nurses worldwide has been reported (Kim et al., 2001; Chan et al., 2002; Askarian & Ghavanini, 2002). Nurses exhibit low-level conformity on handwashing (Stein et al., 2003), use of gloves (Kermode et al., 2005a), and use of masks (Chan et al., 2002). Studies showed that lack of knowledge, training and time are factors to noncompliance (Sax et al., 2005; Oliveira et al., 2010; Luo et al., 2010).

In the Philippines, few studies were carried out in the compliance with SP among healthcare workers in hospitals (Padilla et al., 2006; Tayaben, 2015). These studies are only focused on compliance with prevention guidelines related to needlestick injury among healthcare workers. Research on SP is important and timely taking into account the high incidence of infectious diseases in various regions of the country. In Northern Mindanao for example, a 30.92% increase of notifiable diseases was reported in 2013 (Department of Health – Northern Mindanao, 2013). Among these notifiable diseases, increases were seen in typhoid fever, foot and mouth disease, influenza, and measles. Cholera, acute encephalitis syndrome, and neonatal tetanus had similar trends. From the year 1991 to 2013, a total of 102 individuals were HIV-positive in this part of Mindanao. Within the area, the province of Bukidnon has seven acquired immunodeficiency syndrome (AIDS) cases, Camiguin has two, and Misamis Oriental and Cagayan de Oro have 60. Lanao del Norte including Iligan City has 19 AIDS cases. Misamis Occidental including Ozamiz City has 14 cases (Malalis, 2013).

Ozamiz City is regarded as the center for health (Atienza, 2014) because of the available hospital amenities for life-threatening conditions. People from nearby places choose to access its hospital services, so it is imperative to determine if health workers are able to conform with SP. This study is an attempt to determine the compliance with SP of hospital nurses in the city. This study also tried to find out if the compliance significantly differs when nurses are grouped by profile and correlates with their knowledge on SP. The findings could help the hospital administrators identify areas for improvement in nosocomial infection control in hospitals in this part of Mindanao.

110

Journal of Multidisciplinary Studies Vol. 4, No. 1, pp. 108-138, August 2015


Materials and Methods Research design and instrument The study used the descriptive-inferential research design. The survey was conducted in Ozamiz City utilizing a questionnaire modified from the instrument developed by Luo et al. (2010). Integration of the compliance activity on handling injured skin, discarding sharps boxes, handling used linens, and transporting laboratory specimens was one of the modifications. Included also in the questionnaire is an item on the knowledge of nurses on the single use of syringes.

The questionnaire consists of three parts. Part I gathered the profile of the respondents regarding age, gender, the area of assignment, years of work experience, and SP training. This section of the questionnaire also obtained data regarding needlestick injury of nurses, their exposure to patient’s body fluids, and hepatitis B vaccination. Part II with 23 items investigated the respondent’s compliance. This portion of the questionnaire used the five-point scale: 0 = never, 1 = seldom, 2 = sometimes, 3 = usually, and 4 = always. The Cronbach’s alpha value of 0.78 suggests that the items are reliable. The weighted mean was calculated for each item and interpreted using the following scales: 3.20-4.00 (Very high compliance); 2.40-3.19 (High compliance); 1.60-2.39 (Moderate compliance); 0.80-1.59 (Low compliance); 0.00-0.79 (Very low compliance).

Part III of the questionnaire consists of 25 items that assessed the respondent’s knowledge about SP. The respondents chose ‘yes’ or ‘no’ for their answer. A value of 1 was given for the ‘yes’ answer and 0 for the ‘no’ answer. The value of 0.79 from Cronbach’s alpha test suggests the reliability of the items. The mean rank determines the compliance of nurses when they are grouped by their profile. The higher the mean rank, the more compliant are the nurses. Selection of respondents and sampling procedures

Simple random sampling was used in selecting the 100 nurse-respondents in two tertiary care hospitals in Ozamiz City. The sample size was determined using the Sloven’s formula (Olatunde & Joshua, 2012)

111




with 95% level of confidence. The respondents were informed of the scope of the study, the anonymity, and confidentiality of their responses, their voluntary participation, and the right to refuse participation. The questionnaire was distributed after the respondents gave the accomplished informed consent. The sampling was carried out in a two-month period, from March to April 2014.

Statistical tests

The study utilized the SPSS version 16.0. For descriptive analysis, percentage distribution and average weighted mean were used to measure the compliance of nurses. For inferential analysis, the Kruskal-Wallis H test, Mann-Whitney U test, and Pearson’s correlation test were used. For the analysis of more than two groups, the Kruskal-Wallis H test was used to determine if there is a significant difference in the compliance of nurses when they are grouped by age, years of work experience, and area of assignment. For two-group analysis, the Mann-Whitney U test was used to determine if there is a significant difference in the compliance of nurses when they are grouped by their gender, needlestick injury, exposure to patient’s body fluid, hepatitis B vaccination, and SP training. The Pearson’s correlation test determines if there is a significant correlation between the compliance and SP knowledge of nurses. Results and Discussion Table 1 presents the degree of compliance of hospital nurses with SP. Findings showed a very high compliance among nurses in 82.6% (19 out of 23 activities) of the SP. There was a very high compliance with handwashing protocol. Similar studies in Afghanistan and Jamaica also showed a remarkable proportion of respondents always practicing handwashing (Fayaz et al., 2014; McGaw et al., 2012). However, low compliance to handwashing was seen in Turkey (Kuzu et al., 2005). Requiring the nursing students for return demonstration of the handwashing procedures before their exposure to hospitals has enhanced their competence (Blum et al., 2010).

112


Com

plia

nce

with

Sta

ndar

d Pr

ecau

tions

am

ong

J.

M. E

. Pas

ay, M

. R. C

. Eng

uito

, H

ospi

tal N

urse

s in

Oza

miz

City

, Phi

lippi

nes

C

. J. R

oble

s & A

. L. A

wa

Ta

ble

1. C

ompl

ianc

e of

hos

pita

l nur

ses w

ith st

anda

rd p

reca

utio

ns.

C

ompl

ianc

e A

ctiv

ities

R

espo

nse

W

eigh

ted

Ave

rage

In

terp

reta

tion

Alw

ays

(4)

Usu

ally

(3

) So

met

imes

(2

) Se

ldom

(1

) N

ever

(0

) A

. H

andw

ashi

ng

1.

W

ashi

ng o

f han

ds if

con

tact

ing

diffe

rent

pat

ient

s. 95

4

1 0

0 3.

94

Ver

y hi

gh c

ompl

ianc

e 2.

W

ashi

ng o

f han

ds a

fter t

akin

g of

f the

glo

ves.

96

3

1 0

0 3.

95

Ver

y hi

gh c

ompl

ianc

e 3.

W

ashi

ng o

r di

sinfe

ctin

g of

han

ds i

mm

edia

tely

afte

r co

ntac

ting

any

bloo

d, b

ody

fluid

, sec

retio

n, e

xcre

tion

or d

irty

subs

tanc

es.

95

4 0

1 0

3.93

V

ery

high

com

plia

nce

Ove

rall

3.

94

Ver

y hi

gh c

ompl

ianc

e

B. U

se o

f Per

sona

l Pro

tect

ive

Equi

pmen

t

4.

W

earin

g of

glo

ves d

urin

g bl

ood

draw

ing

80

10

5 5

0 3.

65

Ver

y hi

gh c

ompl

ianc

e 5.

W

earin

g of

glo

ves d

urin

g di

spos

al o

f sto

ol a

nd u

rine

95

3 1

1 0

3.92

V

ery

high

com

plia

nce

6.

Wea

ring

glov

es w

hen

cont

actin

g th

e br

oken

ski

n of

th

e pat

ient

s 91

9

0 0

0 3.

91

Ver

y hi

gh c

ompl

ianc

e

7.

Wea

ring

glov

es w

hen

cont

actin

g th

e m

ucos

a of

the

patie

nts

97

3 0

0 0

3.97

V

ery

high

com

plia

nce

8.

Wea

ring

of g

love

s dur

ing

saliv

a sp

ecim

en c

olle

ctio

n 95

1

1 3

0 3.

88

Ver

y hi

gh c

ompl

ianc

e 9.

W

earin

g of

gl

oves

du

ring

intra

mus

cula

r or

hy

pode

rmic

inje

ctio

n 51

24

13

8

4 3.

10

H

igh

com

plia

nce

10.

Wea

ring

of g

love

s dur

ing

dres

sing

chan

ge

91

8 0

0 1

3.88

V

ery

high

com

plia

nce

11.

Wea

ring

of g

love

s dur

ing

clea

ning

blo

od tr

ace

94

6 0

0 0

3.94

V

ery

high

com

plia

nce

12.

Wea

ring

of g

love

s dur

ing

veno

us p

unct

ure

67

18

10

4 1

3.46

V

ery

high

com

plia

nce

13.

Wea

ring

of g

love

s dur

ing

cont

actin

g bl

ood

sam

ple

89

5 3

1 2

3.78

V

ery

high

com

plia

nce

14.

Wea

ring

of t

he f

ace

mas

k to

pro

tect

the

ora

l an

d na

sal m

ucos

a in

the

proc

edur

es th

at m

ight

indu

ce th

e sp

rayi

ng o

f blo

od, b

ody

fluid

, sec

retio

n or

exc

retio

n.

91

5 0

3 1

3.82

V

ery

high

com

plia

nce

113



Jour

nal o

f Mul

tidisc

iplin

ary

Stud

ies V

ol. 4

No.

1,

pp. 1

08-1

38, A

ugus

t 201

5

Ta

ble

1 co

ntin

ued:

Com

plia

nce

of h

ospi

tal n

urse

s with

stan

dard

pre

caut

ions

.

C

ompl

ianc

e A

ctiv

ities

R

espo

nse

W

eigh

ted

Ave

rage

In

terp

reta

tion

Alw

ays

(4)

Usu

ally

(3

) So

met

imes

(2

) Se

ldom

(1

) N

ever

(0

) 15

. W

earin

g of

pro

tect

ive

eye

patc

h an

d go

ggle

s to

pr

otec

t the

eye

s in

pro

cedu

res

that

mig

ht in

duce

the

spra

ying

of b

lood

, bod

y flu

id, s

ecre

tion

or e

xcre

tion

54

7 11

13

15

2.

72

H

igh

com

plia

nce

16.

Wea

ring

of p

rote

ctiv

e su

it/go

wn

in t

he p

roce

dure

s th

at m

ight

indu

ce th

e sp

rayi

ng o

f blo

od, b

ody

fluid

, se

cret

ion

or e

xcre

tion.

57

13

11

14

5 3.

03

Hig

h co

mpl

ianc

e

17.

Wea

ring

of a

pro

tect

ive

cap

or s

hoe

shad

e to

pro

tect

ha

ir or

sho

es i

n th

e pr

oced

ures

mig

ht i

nduc

e th

e sp

rayi

ng,

flow

ing

or l

eaki

ng o

f bl

ood,

bod

y flu

id,

secr

etio

n or

exc

retio

n.

55

12

10

11

12

2.87

H

igh

com

plia

nce

18.

Pers

onal

pro

tect

ive

equi

pmen

t is u

sed

whe

n ha

ndlin

g us

ed li

nens

. 69

20

7

3 1

3.53

V

ery

high

com

plia

nce

Ove

rall

3.

56

Ver

y hi

gh c

ompl

ianc

e

C. O

ther

com

plia

nce

activ

ities

19.

The

seco

nd-h

and

syrin

ge

is no

t re

used

or

re

proc

esse

d.

80

4 4

2 10

3.

42

Ver

y hi

gh c

ompl

ianc

e

20.

The

seco

nd-h

and

shar

ps a

nd b

lade

s ar

e di

spos

ed o

f in

the

spec

ial s

harp

s disp

osal

box

91

4

1 1

3 3.

79

Ver

y hi

gh c

ompl

ianc

e

21.

If th

e sk

in is

inju

red

by c

onta

min

ated

sha

rps,

it sh

all

be s

quee

zed

to a

llow

blo

od t

o flo

w a

nd t

hen

be

thor

ough

ly c

lean

ed, d

isinf

ecte

d an

d ta

ped

up.

75

13

3 3

6 3.

48

Ver

y hi

gh c

ompl

ianc

e

22.

Shar

ps b

ox is

disc

arde

d w

hen

less

than

¾ fu

ll.

63

27

7 3

0 3.

50

Ver

y hi

gh c

ompl

ianc

e 23

. La

bora

tory

spe

cim

ens

are

plac

ed in

pla

stic

bags

and

in

an

up

right

po

sitio

n du

ring

trans

porta

tion

to

prev

ent l

eaka

ge.

64

22

6 5

3 3.

39

Ver

y hi

gh c

ompl

ianc

e

Ove

rall

3.52

V

ery

high

com

plia

nce

114



Regarding the use of personal protective equipment (PPE), nurses in this study had a very high compliance with wearing of gloves except during intramuscular or hypodermal injection. Adversely, low compliance of glove usage was observed in Hongkong and Malaysia when performing invasive procedures (Chau et al., 2011; Naing et al., 2001). The majority of nurses had a very high compliance with wearing of face mask in this study. Studies from Toronto (Loeb et al., 2004) and Hong Kong (Seto et al., 2003) also documented the use of face masks to protect nurses against highly contagious diseases.

Based on the findings, the majority of nurses did not have a very high compliance on the wearing of the eye patch, goggles, gown, cap, and shoe shade. Nurses in this study preferred to use gloves more frequently than the goggles or eye patch similar to the findings in Hongkong (Chan et al., 2002). Nurses in Nigeria showed low compliance with wearing of eye protection during deliveries and surgeries (Sadoh et al., 2006) but operating room nurses in Australia exhibited high compliance with the use of this PPE (Osborne, 2003). Nevertheless, the compliance of nurses with the use of eye protection in this present study is higher compared to South India (Holla et al., 2014) and Poland (Ganczak & Szych, 2007).

Nurses in this study had a very high compliance in other activities that involved sharp instruments, but hospital administration could still adopt the new safety engineered devices that are effective in reducing sharp injuries (Jagger et al., 2008; Adams & Elliott, 2006). One of the health concerns of the nurses in the Philippines is needlestick injury (de Castro et al., 2009). In the study of Tayaben (2015) in two government tertiary care hospitals in the Philippines, nurses were compliant with guidelines of preventing sharps injury before and during a procedure but less compliant after the procedure.

The compliance of nurses in this study on the single use of syringes was very high. However, 10% of the respondents claimed to reuse always the disposable syringe during withdrawal of medications from vials, and administration of intravenous through tubing (IVTT). Despite the risk of cross-infection, reusing syringes to different patients is still prevalent in resource-limited countries like the Philippines.

115




The Centers for Disease Control and Prevention [CDC] (2011) reported that one of the contributing factors of the hepatitis outbreaks is the reuse of the disposable syringe. Reusing needles is common in Ethiopia and India (Ademe & Mekonnen, 2014; Guh et al., 2012; Kermode et al., 2005b) and worsening the problem is the presence of methicillin-resistant Staphylococcus aureus in the paraphernalia.

In this study, the compliance on managing injured skin by squeezing to allow blood to flow, thorough cleaning, disinfecting and taping up was very high. In India, the majority of the nurses washed the site of injury with soap and water (Sharma et al., 2010).

This study showed that the various profiles of nurses yielded different results on their compliance with SP (Figures 1a-1c). The oldest nurses had the highest compliance (Figure 1a) similar to the findings of Chan et al. (2002) but different with the results of Gebresilassie et al. (2014), Yassi et al. (2007), and Gershon et al. (1999) showing resistance of older nurses to behavior change with the SP implementation. The findings of this present study pose concern since 86% of the nurses with the lowest compliance are 20-30 years old. Perrin et al. (2007) reported that most of the nurses in the Philippines are young. Hence, formulating programs that can improve the compliance of younger nurses is important.

Regarding gender, men had better compliance to SP than the women nurses in this study. The result is similar to the findings of Efstathiou et al. (2011). The predominance of female nurses (71%) with relatively lower compliance to SP in Ozamiz City poses a concern despite the fact that Yassi et al. (2007) and Creedon (2008) claimed that women nurses are more compliant to SP. The predominance of women in nursing service is also seen in the United Kingdom, Switzerland and Canada (Yassi et al., 2007; Stein et al., 2003). According to the WHO (2012), women compose more than 75% of the healthcare workforce in many countries making them very significant healthcare providers. Improving the compliance of female nurses in Ozamiz City can help prevent HAIs.

116



Figure 1a. Compliance of hospital nurses with SP when grouped by age and gender.

Figure 1b shows the compliance of hospital nurses with SP when

grouped by area of assignment, the length of work experience, and training on SP. Nurses assigned to the pedia ward had the highest compliance while the ICU nurses had the lowest compliance. Despite the highest compliance with SP in pedia ward, only a small percentage (5%) of the nurses was assigned to the area. There is also a concern to 9% of nurses in ICUs with the lowest compliance because they are supposed to exhibit the full conformity to SP considering the severity of cases in the area. In South Korea and Malaysia, nurses complied better in the ICU (Lee et al., 2012; Naing et al., 2001).

N (Age): 86 (20-30 years); 6 (31-40 years); 4 (41-50 years); 4 (>50 years)

N (Gender): 29 (male); 71 (female)

020406080

100

20-30 31-40 41-50 >50

Com

plia

nce

(mea

n ra

nk)

Years

Age

020406080

100

Men Women

Com

plia

nce

(mea

n ra

nk)

Gender

117




Figure 1b. Compliance of hospital nurses with SP when grouped by area of assignment, the length of work experience, and SP training.

N (Area of assignment): 16 (Surgical ward); 35 (Medical ward); 5 (Pedia ward); 10 (Operating/Delivery room); 9 (ICU); 2 (Communicable ward); 16 (ER); 7 (OB/GYNE ward)

N (Length of experience): 86 (0-5 years); 4 (6-10 years); 5 (11-15 years); 4 (16-20 years); 1 (>20 years)

N (SP training): 14 (With training); 86 (Without training)

020406080

100

0-5 6-10 11-15 16-20 >20

Com

plia

nce

(mea

n ra

nk)

Years

Length of Work Experience

020406080

100

With training Without training

Com

plia

nce

(mea

n ra

nk) SP Training

020406080

100

Com

plia

nce

(mea

n ra

nk)

Hopital Department

Area of Assignment

118



Hospital environment significantly affects the infection control of health workers (Yassi et al., 2007), the type of administration, and the size of the department (Naing et al., 2001). The presence of less blood in medical ward compared to the operating room, for instance, resulted in the disregard of the SP by nurses in China (Luo et al., 2010) similar to the finding of this present study. However, the study of Cawich et al. (2013) showed a different result in the OR of Jamaica.

This study also revealed that nurses with more years of work experience had higher compliance compared to the least experienced which is similar to the finding of Fayaz et al. (2014) in Afghanistan. The longer professional exposure of nurses may attribute to their better compliance. The concern is that majority of the respondents of this study have been working for only five years or less which is a typical scenario in the Philippines. Filipino nurses tend to gain at least a minimum of two years hospital experience to comply the requirement abroad. Thus, the majority of nurses going abroad are the more experienced leaving behind those with lesser experience. The decline of the more experienced nurses has brought a negative impact on the nursing workforce in the country. The decline has also jeopardized the integrity and quality of the Philippine health services (Lorenzo et al., 2007). This trend is also seen in United Arab Emirates, Northern Nigeria, and Zambia (Amoran & Onwube, 2013; Sreedharan et al., 2011; Mukwato et al., 2008). Actions to improve compliance with SP should primarily target these least experienced nurses.

As shown in this study, nurses who attended SP training had higher compliance than those who had not attended. However, only 14% of the nurses had training related to SP, making the remaining percentage susceptible to infectious diseases. Almost all nurses still desire to undergo SP training to equip themselves against HAIs. The nurses perceived their training to be insufficient. On-going training for hospital staff is necessary to sustain competency and warrant that SP are complied. Nurses claimed that their training usually focuses on topics in proper handwashing, waste management, and appropriate sharp disposal. The findings imply that nurses lack the structured SP training that should focus on areas of which compliance is suboptimal.

119




The compliance of hospital nurses when grouped by needlestick injury, exposure to patient’s body fluids, and HBV vaccination is shown in Figure 1c. Regarding needlestick injury, nurses who were injured within the past six months complied better compared to those not injured. Since the majority of the nurses (88%) in our study were not injured from the accidental piercing of needles, there is a need to improve the compliance of these nurses with SP to reduce their risk. Nurses who were injured tend not to report the situation formally. They considered their injury and the nonreporting as a learning experience to be cautious next time and to comply with SP for their safety. The reasons for their nonreporting include the lack of time to report due to excessive paperwork, the injury does not constitute a risk, and they are not using the needles to any patient. However, the main reason for the nonreporting is their idea that there is no particular active infection control department in the hospital responsible in case of incidence. Several studies showed the nonreporting of injuries by nurses (Smith & Leggat, 2005; Stein et al., 2003; Debnath, 2000; Au et al., 2008; Makary et al., 2007). Nurses have a high risk of needlestick injury exposure in their daily job (American Nurses Association [ANA], 2002) making the nonreporting a problem. The failure to report deters the practice for post-exposure care. In India, Sharma et al. (2010) showed that health workers used the post-exposure procedures poorly. In Ozamiz City, this post-exposure care is also a concern.

Regarding exposure to blood and other body fluids, results showed that compliance with SP was higher among nurses not exposed to patient’s body fluids. Those exposed should have been cautious after their exposure to reduce the risk of acquiring and spreading blood-borne infections in the hospital.

In this study, nurses with hepatitis B vaccination conformed highly to SP than those without the immunization. Those not immunized should have been compliant because they are susceptible to blood-borne infections. The vaccination is not mandatory for nurses in the Philippines, but the CDC (2014) is strongly recommending it to healthcare personnel since they are prone to body fluids exposure. The mandatory vaccination in the country against HBV virus is for the infants with costs shouldered by the government. In this situation, nurses who intend to protect

120



themselves against HBV should carry on the high cost of vaccination. The expenses may be one of the reasons why a significant number of nurses in this study were not vaccinated. Similarly, hospital workers in South India did not complete their HBV vaccination schedule (Punia et al., 2014).

Figure 1c. Compliance of hospital nurses with SP when grouped by needlestick injury, exposure to patient’s blood and other body fluids, and HBV vaccination.

N (Needlestick injury): 88 (Injured); 12 (Not injured)

N (Body fluid exposure): 40 (exposed); 60 (exposed)

N (HBV vaccination): 93 (with vaccination); 7 (without vaccination)

020406080

100

Injured Not injured

Com

plia

nce

(mea

n ra

nk)

Needlestick Injury

020406080

100

Exposed Not exposed

Com

plia

nce

(mea

n ra

nk)

Exposure to Blood and other Body Fluids

020406080

100

With vaccination Without vaccination

Com

plia

nce

(mea

n ra

nk)

HBV Vaccination

121




In the Philippines, requiring the nursing students in recent years for HBV immunization provides protection against the virus before their official exposure to hospitals. However, the cost of vaccination is not covered by the government. In effect, nurses who paid for immunization may be more knowledgeable about its benefits in infection control and most probably will follow the practice of SP for protection. In this study, there was no significant difference in the compliance of nurses with standard precautions taking into account the variables examined in their profile (Table 2). Assessing other variables that most likely influence the compliance with SP among nurses in the area may provide extensive information. The firm commitment of nurses to a workplace and their job satisfaction may affect their compliance. Other factors also include the commitment of hospital administration to safety program for healthcare workers, as well as the level of stress, and the barriers to the safe practice of nurses (Gershon et al., 1999). The compliance with SP among nurses has been unsatisfactory universally (Gammon et al., 2008). With the use of a questionnaire for this present study, the data obtained were limited by its dependence on self-reporting rather than by observing the nurse’s practice of SP. However, some people tend to work harder and perform better in response to their awareness of being observed as a result of Hawthorne Effect (Cherry, 2014). Table 2. Resulting p-values of the tests for significant difference in the

compliance of hospital nurses with SP when grouped by profile.

Variables

p-value

Age

0.690 Gender

Area of assignment 0.194

0.394 Length of work experience 0.490

SP training 0.495 Needlestick injury 0.621

Exposure to blood and other body fluids 0.164 HBV vaccination 0.073

*Significant at p<0.05

122



Table 3 shows the knowledge of nurses on SP and the correlation of their knowledge with their compliance. The findings revealed the lack of significant association between the knowledge of nurses and their compliance. Based on the results, the majority of the respondents (78%) did not recognize that the primary goal of standard precautions is not only to protect the medical staff but the patients as well from the transmission of infection. The finding is in contrast to a study in Brazil (Melo et al., 2006), where the majority of interviewees declared that SP protects both the healthcare workers and patients. There is a need to practice SP when providing care to all patients regardless of the diagnosis, infection status or whether the patients appear ill or asymptomatic (Mukherjee et al., 2013). A high percentage of nurses performed the SP to all patients regardless of their underlying conditions (Motamed et al., 2006). However, 26% of the respondents in this study believed that standard precautions are only applicable for patients with a confirmed diagnosis of infection or in the latent period. This study revealed that most of the respondents had knowledge that SP can prevent diseases associated with airborne and contact transmissions. However, it is worth noting that a considerable number of nurses still did not recognize the fundamental concepts of SP. A study by Luo et al. (2010) stressed that substantial knowledge of SP principles is a factor impacting nurses’ compliance. Chan et al. (2002) noted the inadequate knowledge of nurses of the fundamental principles of universal precautions. An investigation by Li and Zhao (2005) found that 25% of healthcare workers did not understand the concepts of standard precautions. Gloves do not eliminate 100% contamination of pathogens because fluids are still capable of passing through the microscopic holes in the gloves (Mahony, 1998). However, several studies affirmed the efficacy of gloves in reducing pathogen transmission and preventing contamination of healthcare workers (WHO, 2009). It is good to note that the findings of this study showed that all respondents had knowledge of wearing gloves for the procedures that may contact with the secretion and excretion of patients. However, there was an apparent discrepancy between the knowledge and the reported compliance of nurses with the use of gloves in this procedure.

123




Table 3. Knowledge of hospital nurses on standard precautions and its correlation with their SP compliance.

Statements

Percentage of nurses with

correct knowledge

A. Handwashing

1. Handwashing is performed immediately after contacting blood, other body fluids, excretion or dirty substance.

95

2. Health care workers must do handwashing after having contact with different patients.

95

3. Since the gloves can prevent from contaminated hands, there is no need to wash hands after taking off gloves.

Overall percentage

99

96 B. Use of Personal Protective Equipment

4. Health care workers shall not share gloves, mask, and other PPE with others.

96

5. Health care workers shall change gloves between procedures on the same patient after handling materials that may contain a high concentration of bacteria.

95

6. Health care workers shall wear gloves during blood drawing, venous puncture, etc.

99

7. Health care workers do not need to wear gloves in procedures that may contact the mucosa of the patients.

98

8. Health care workers shall wear gloves in the procedures that may contact with the secretion and excretion of patients.

100

9. Health care workers shall change the gloves if handling different patients.

97

10. Health care workers shall wear the face mask in the procedures that might induce the spraying of blood, other body fluids, secretion or excretion.

94

11. Health care workers shall wear the protective eye patch or goggles in the procedures that might induce the spraying of blood, other body fluids, secretion or excretion.

97

12. Health care workers shall wear the protective cap or shoe in the procedures that might induce the spraying, flowing or leaking of blood and other body fluids, secretion or excretion.

92

13. Health care workers shall wear the protective suit/gown in the procedures that might induce spraying of blood, other body fluids, secretion or excretion.

Overall percentage

97

97

124



Table 3 continued: Knowledge of hospital nurses on standard precautions and its correlation with their SP compliance.

Statements Percentage of nurses with

correct knowledge

C. Other Compliance Activities

14. Standard precaution is only applicable for the patients with the confirmed diagnosis of infection or in the latent period of infection.

74

15. The primary goal to implement standard precautions is to protect the medical staff.

22

16. Contaminated protective articles should not come in contact with the surface of the clothes or the staff outside the ward.

97

17. Health care workers shall place the sharps disposal box near the applicable area for sharp instruments.

95

18. The caring of patients with HBV only needs the standard precaution.

92

19. The caring of patients with active PTB or varicella requires the SP associated with the prevention of the airborne diseases.

89

20. The caring of patients with intestinal infection or skin disease needs the SP related to the prevention of the diseases by contact transmission.

92

21. Needles, cannula, and syringes are sterile and single-use items; any use will result in paraphernalia contamination.

99

22. Needles, cannula, and syringes are contaminated once used to enter or connect to any component of a patient's intravenous set.

94

23. Nurses can administer the medications from a syringe to multiple patients after replacing a new needle on the syringe.

94

24. Nurses can use bottles of intravenous solution as a common source of medication or fluid for multiple patients.

94

25. An item designated for a single use like syringes can be reused or reprocessed.

94

Overall percentage

86

r-value p-value

Knowledge vs. Compliance

-0.167

0.096

*Correlation is significant at p<0.05 (2-tailed)

125




A high proportion of nurses recognized the necessity to wear the mask, goggles, and protective suit when there is a risk of spraying with body fluids from the patients. All healthcare workers shall wear the appropriate PPE to prevent possible contamination (Occupational Safety and Health Administration, 2003). In this study, there was also an apparent discrepancy between the knowledge and the reported compliance of nurses with the wearing of goggles, suit, cap, and shoe shade. A notable number of respondents thought that caring patients with HBV only needs SP. Hoy and Richmond (2009) emphasized that both SP and immunization against hepatitis B are the salient modes to prevent acquiring and spreading HBV. The result of this study indicates that the knowledge on SP is negatively correlated with the compliance of nurses, but the correlation showed no significance. The findings of Labrague et al. (2012), Askarian et al. (2007), and Chan et al. (2002) supported this finding. In contradiction, studies by Luo et al. (2010), Motamed et al. (2006), and Kermode et al. (2005a) suggested that nurses with better knowledge comply more with SP. Conclusion and Recommendations

The very high compliance of a greater percentage of nurses in Ozamiz City to the majority of the SP is a positive indication for a possible reduction in healthcare-associated infections. However, the remaining small percentage of nurses that seldom or have not practiced the protocol indicates their susceptibility to cross-infection. The lack of significant difference in the compliance of nurses with regards to the variables examined in this study suggests that other factors of noncompliance have to be considered. The lack of significant association between their knowledge and compliance suggests the same.

Despite the high conformity of nurses to SP, there is a need to improve the infection control system in hospitals in Ozamiz City. Continuous training may improve the usage of personal protective equipment. Ensuring an ongoing monitoring system for HAIs by hospital management can improve the practice of SP. Assessing other

126



variables that can affect the compliance of nurses with SP not covered in this study can be an area for future research. Acknowledgment The authors are grateful to the Misamis University for the grant. The respective hospital administration is also acknowledged. Literature Cited Adams, D., & Elliott, T. S. J. (2006). Impact of safety needle devices on

occupationally acquired needlestick injuries: A four-year prospective study. Journal of Hospital Infection, 64(1), 50-55.

Ademe, M., & Mekonnen, Z. (2014). Repeated reuse of insulin injection

syringes and incidence of bacterial contamination among diabetic patients in Jimma University Specialized Hospital, Jimma, Ethiopia. Asian Pacific Journal of Tropical Disease, 4, S712-S716.

American Nurses Association. (2002). American Nurses

Association's needlestick prevention guide. Retrieved from http://www.nursingworld.org/MainMenu Categories/Workplace Safety/ Healthy-Work Environment/ Safe Needles/ Need lestick Prevention.pdf

Amoran, O. E., & Onwube, O. O. (2013). Infection control and practice

of standard precautions among healthcare workers in Northern Nigeria. Journal of Global Infectious Diseases, 5(4), 156-163.

Askarian, M., & Ghavanini, A. A. (2002). Survey on adoption of

measures to prevent nosocomial infection by anaesthesia personnel. Eastern Mediterranean Health Journal= La Revue de Sante de la Mediterranee Orientale=Al-Majallah Al-sihhiyah Li-sharq Al-mutawassit, 8(2-3), 416-421.

127




Askarian, M., McLaws, M. L., & Meylan, M. (2007). Knowledge, attitude, and practices related to standard precautions of surgeons and physicians in university-affiliated hospitals of Shiraz, Iran. International Journal of Infectious Diseases, 11(3), 213-219. doi:10.1016/j.ijid.2006.01.006

Atienza, R. P. (2014). Credit Card Usage Pattern in Ozamiz City,

Philippines. Journal of Multidisciplinary Studies, 3(1), 60-85. doi: http://dx.doi.org/10.7828/jmds.v3i1.626

Au, E., Gossage, J. A., & Bailey, S. R. (2008). The reporting of

needlestick injuries sustained in theatre by surgeons: Are we under-reporting?. Journal of Hospital Infection, 70(1), 66-70. doi:10.1016/j.jhin.2008.04.025

Blum, C. A., Borglund, S., & Parcells, D. (2010). High-fidelity nursing

simulation: Impact on student self-confidence and clinical competence. International Journal of Nursing Education Scholarship, 7(1), 1-14.

Cawich, S. O., Tennant, I. A., McGaw, C. D., Harding, H., Walters,

C. A., & Crandon, I. W. (2013). Infection control practice in the operating room: Staff adherence to existing policies in a developing country. Permanente Journal, 17(3), e114-e118. doi: 10.7812/TPP/12-093

Centers for Disease Control and Prevention. (2011). Injection

Safety.Safe injection practices to prevent transmission of infections to patients. Retrieved from http://www.cdc.gov/ injectionsafety/IP07_standardPrecaution.html

Centers for Disease Control and Prevention. (2014). Healthcare

personnel vaccination recommendations. Retrieved from http://www.immunize.org/catg.d/ p2017.pdf

128



Chan, R., Molassiotis, A., Eunice, C., Virene, C., Becky, H., Chit-Ying, L., ... & Ivy, Y. (2002). Nurses’ knowledge of and compliance with universal precautions in an acute care hospital. International Journal of Nursing Studies, 39(2), 157-163. doi: http://dx. doi.org/10.1016/S0020-7489(01)00021-9

Chau, J. P. C., Thompson, D. R., Twinn, S., Lee, D. T., & Pang, S. W.

(2011). An evaluation of hospital hand hygiene practice and glove use in Hong Kong. Journal of Clinical Nursing, 20(9‐10), 1319-1328. doi: 10.1111/j.1365-2702.2010.03586.x

Cherry, K. (2014). What is the hawthorne effect? About Education.

Retrieved from http://psychology.about.com/od/hindex/g/ def_hawthorn.html

Creedon, S. (2008). Hand hygiene compliance: Exploring variations in

practice between hospitals. Nursing Times, 104(49), 32-35. de Castro, A. B., Cabrera, S. L., Gee, G. C., Fujishiro, K., & Tagalog,

E. A. (2009). Occupational health and safety issues among nurses in the Philippines. AAOHN Journal: Official Journal of the American Association of Occupational Health Nurses, 57(4), 149-157.

Debnath, D. (2000). Improving reporting of sharp injuries. Hospital

Medicine (London, England:1998), 61(12), 852-854. Department of Health - Northern Mindanao. (2013). Disease

Surveillance Report, 2ndQuarter Report, January 1 - June 30, 2013. Retrieved from www.chd10.doh.gov.ph/component/ attachments/download/523

Efstathiou, G., Papastavrou, E., Raftopoulos, V., & Merkouris, A.

(2011). Compliance of Cypriot nurses with standard precautions to avoid exposure to pathogens. Nursing & Health Sciences, 13(1), 53-59. doi: 10.1111/j.1442-2018.2011.00576.x.

129




Fayaz, S. H., Higuchi, M., Hirosawa, T., Sarker, M. A. B., Djabbarova, Z., & Hamajima, N. (2014). Knowledge and practice of universal precautions among health care workers in four national hospitals in Kabul, Afghanistan. The Journal of Infection in Developing Countries, 8(04), 535-542. doi:10.3855/jidc.4143

Gammon, J., Morgan‐Samuel, H., & Gould, D. (2008). A review of the

evidence for suboptimal compliance of healthcare practitioners to standard/universal infection control precautions. Journal of Clinical Nursing, 17(2), 157-167. doi: 10.1111/j.1365-2702.2006.01852.x

Ganczak, M., & Szych, Z. (2007). Surgical nurses and compliance with

personal protective equipment. Journal of Hospital Infection, 66(4), 346-351. doi:10.1016/j.jhin.2007.05.007

Garcia-Zapata, M. R. C., e Souza, A. C. S., Guimarães, J. V., Tipple,

A. F. V., Prado, M. A., & García-Zapata, M. T. A. (2010). Standard precautions: Knowledge and practice among nursing and medical students in a teaching hospital in Brazil. International Journal of Infection Control, 6(1), 1-8. doi: 10.3396/ijic.V6i1.005.10

Gebresilassie, A., Kumei, A., & Yemane, D. (2014). Standard

precautions practice among health care workers in public health facilities of Mekelle Special Zone, Northern Ethiopia. Journal of Community Medicine and Health Education, 4(3), 286. doi: 10.4172/2161-0711.1000286

Gershon, R. R., Karkashian, C. D., Vlahov, D., Kummer, L.,

Kasting, C., Green-McKenzie, J., ... & Martin, L. (1999). Compliance with universal precautions in correctional health care facilities. Journal of Occupational and Environmental Medicine, 41(3), 181-189.

130



Guh, A. Y., Thompson, N. D., Schaefer, M. K., Patel, P. R., & Perz, J. F. (2012). Patient notification for bloodborne pathogen testing due to unsafe injection practices in the US health care settings, 2001–2011. Medical Care, 50(9), 785-791. doi: 10.1097/MLR. 0b013e31825517d4

Habibi, S., Wig, N., Agarwal, S., Sharma, S. K., Lodha, R.,

Pandey, R. M., & Kapil, A. (2008). Epidemiology of nosocomial infections in medicine intensive care unit at a tertiary care hospital in northern India. Tropical Doctor, 38(4), 233-235. doi: 10.1258/td. 2008.070395

Holla, R., Kanchan, T., Kumar, N., Unnikrishnan, B., Rekha, T., Mithra,

P. P., ... & Darshan, B. B. (2014). Perception and practices of standard precautions among health care professionals at tertiary care hospitals in coastal South India. Asian Journal of Pharmaceutical and Clinical Research, 7(2), 101-104.

Hoy, J., & Richmond, J. (2009). Standard precautions and

infection control. Healthcare Infection, 14(1), 27-32. doi: http://dx.doi.org/10.1071/HI09003

Ilhan, M. N., Durukan, E., Aras, E., Türkçüoğlu, S., & Aygün, R.

(2006). Long working hours increase the risk of sharp and needlestick injury in nurses: The need for new policy implication. Journal of Advanced Nursing, 56(5), 563-568. doi: 10.1111/j.1365-2648.2006.04041.x

Jagger, J., Perry, J., Gomaa, A., & Phillips, E. K. (2008). The impact of

U.S. policies to protect healthcare workers from bloodborne pathogens: The critical role of safety-engineered devices. Journal of Infection and Public Health, 1(2), 62-71. doi:10.1016/j.jiph.2008.10.002

131




Kermode, M., Holmes, W., Langkham, B., Thomas, M. S., & Gifford, S. (2005b). Safer injections, fewer infections: Injection safety in rural North India. Tropical Medicine & International Health, 10(5), 423-432. doi: 10.1111/j.1365-3156.2005.01421.x

Kermode, M., Jolley, D., Langkham, B., Thomas, M. S., Holmes, W., &

Gifford, S. M. (2005a). Compliance with universal/standard precautions among health care workers in rural North India. American Journal of Infection Control, 33(1), 27-33. doi:10.1016/j.ajic.2004.07.014

Kim, K. M., Kim, M. A., Chung, Y. S., & Kim, N. C. (2001).

Knowledge and performance of the universal precautions by nursing and medical students in Korea. American Journal of Infection Control, 29(5), 295-300. doi:10.1067/mic.2001.114837

Kuzu, N., Özer, F., Aydemir, S., Yalcin, A. N., & Zencir, M. (2005).

Compliance with hand hygiene and glove use in a university-affiliated hospital. Infection Control and Hospital Epidemiology, 26(3), 312-315. doi: http://doi.org/10. 1086/502545

Labrague, L. J., Rosales, R. A., & Tizon, M. M. (2012). Knowledge and

compliance of standard precautions among student nurses. International Journal of Advanced Nursing Studies, 1(2), 84-97. doi: 10.14419/ijans.v1i2.132

Lahsaeizadeh, S., Jafari, H., & Askarian, M. (2008). Healthcare-

associated infection in Shiraz, Iran 2004–2005. Journal of Hospital Infection, 69(3), 283-287. doi: http://dx.doi.org/ 10.1016/j.jhin.2008.05.006

Lee, K. A., Kim, H. S., Lee, Y. W., & Ham, O. K. (2012). Factors

influencing compliance with standard precautions in intensive care unit and emergency room nurses. Journal of Korean Academy of Fundamentals of Nursing, 19(3), 302-312. doi: 10.7739/jkafn.2012.19.3.302

132



Li, X. X., & Zhao, J. K. (2005). Study on current situation and counter measure of infection management in second general hospitals in Luo Yang. Henan Journal of Preventive Medicine, 16, 367-369.

Loeb, M., McGeer, A., Henry, B., Ofner, M., Rose, D., Hlywka, T., ... &

Walter, S. D. (2004). SARS among critical care nurses, Toronto. Emerging Infectious Diseases, 10(2), 251-255. doi: https://dx.doi.org/10.3201/eid1002.030838

Lorenzo, F. M. E., Galvez‐Tan, J., Icamina, K., & Javier, L. (2007).

Nurse migration from a source country perspective: Philippine country case study. Health Services Research, 42(3p2), 1406-1418. doi: 10.1111/j.1475-6773.2007.00716.x

Luo, Y., He, G. P., Zhou, J. W., & Luo, Y. (2010). Factors impacting

compliance with standard precautions in nursing, China. International Journal of Infectious Diseases, 14(12), e1106-e1114. doi:10.1016/j.ijid.2009.03.037

Mahony, C. (1998). The need for a clear policy on glove use. Nursing

Times, 94(17), 52-54. Makary, M. A., Al-Attar, A., Holzmueller, C. G., Sexton, J. B., Syin, D.,

Gilson, M. M., ... & Pronovost, P. J. (2007). Needlestick injuries among surgeons in training. The New England Journal of Medicine, 356(26), 2693-2699. doi: 10.1056/NEJMoa070378

Malalis, A. C. (2013, March 27). AIDS cases up in NorMin. Sun. Star

Cagayan de Oro. Retrieved from http://archive.sunstar.com.ph/ cagayan-de-oro/local-news/2013/03/27aids-cases-normin-274992

133




McGaw, C. D., Tennant, I., Harding, H. E., Cawich, S. O., Crandon, I. W., & Walters, C. A. (2012). Healthcare workers’ attitudes to and compliance with infection control guidelines in the operating department at the university hospital of the West Indies, Jamaica. International Journal of Infection Control, 8(3). doi: 10.3396/ijic.v8i3.023.12

Melo, D. D. S., Souza, A. C. S., Tipple, A. F. V., Neves, Z. C. P. D., &

Pereira, M. S. (2006). Nurses’ understanding of standard precautions at a public hospital in Goiania-GO, Brazil. Revista Latino-Americana de Enfermagem, 14(5), 720-727. doi: http://dx.doi.org/10.1590/S0104-11692006000500013

Milinovich, G. J., Williams, G. M., Clements, A. C., & Hu, W. (2014).

Internet-based surveillance systems for monitoring emerging infectious diseases. The Lancet Infectious Diseases, 14(2), 160-168. doi: http://dx.doi.org/10.1016/S1473-3099(13)70244-5

Motamed, N., Baba Mahmoodi, F., Khalilian, A., Peykanheirati, M., &

Nozari, M. (2006). Knowledge and practices of health care workers and medical students towards universal precautions in hospitals in Mazandaran Province. Eastern Mediterranean Health Journal, 12(5), 653-661.

Mukherjee, S., Bhattacharyya, A., SharmaSarkar, B., Goswami, D. N.,

Ghosh, S., & Samanta, A. (2013). Knowledge and practice of standard precautions and awareness regarding post-exposure prophylaxis for HIV among interns of a medical college in West Bengal, India. Oman Medical Journal, 28(2), 141-145. doi: 10.5001/omj.2013.38

Mukwato, K. P., Ngoma, C. M., & Maimbolwa, M. (2008). Compliance

with infection prevention guidelines by health care workers at Ronald Ross General Hospital Mufulira District. Medical Journal of Zambia, 35(3). doi: http://dx.doi.org/10.4314/mjz. v35i3. 46530

134



Naing, L., Nordin, R., & Musa, R. (2001). The prevalence of, and factors related to, compliance with glove utilization among nurses in Hospital UniversitiSains Malaysia. The Southeast Asian Journal of Tropical Medicine and Public Health, 32(3), 636-642.

Navoa-Ng, J. A., Berba, R., Galapia, Y. A., Rosenthal, V. D.,

Villanueva, V. D., Tolentino, M. C. V., ... & Mantaring, J. B. V. (2011). Device-associated infections rates in adult, pediatric, and neonatal intensive care units of hospitals in the Philippines: International Nosocomial Infection Control Consortium (INICC) findings. American Journal of Infection Control, 39(7), 548-554. doi: http://dx.doi.org/10.1016/j.ajic.2010.10.018

Occupational Safety and Health Administration. (2003). Model plans

and programs for the OSHA booldborne pathogens and hazard communications standards. Washington, DC: Occupational Safety and Health Administration, 3-4.

Olatunde, P., & Joshua, P. (2012). Determinants of female students’

performance in primary schools in Loitokitok District of Rift Valley Province, Kenya. International Journal of Business and Social Science, 3(12).

Oliveira, A. C., Cardoso, C. S., & Mascarenhas, D. (2010).

Contact precautions in intensive care units: Facilitating and inhibiting factors for professionals’ adherence. Revista da Escola de Enfermagem da USP, 44(1), 161-165. doi: http://dx.doi.org/10.1590/S0080-62342010000100023.

Osborne, S. (2003). Influences on compliance with standard precautions

among operating room nurses. American Journal of Infection Control, 31(7), 415-423. doi:http://dx.doi.org/10.1067/mic.2003.68

Padilla, R. R., Rogado, M. I., Tagalog, E., America, E. (2006). Needle

stick injury: Philippine Perspective. Philippine Journal of Nursing, 76(1), 3-6.

135




Paitoonpong, L., Wong, C. K. B., & Perl, T. M. (2013). Healthcare-associated infections. In Infectious disease epidemiology theory and practice (pp. 369-466). USA: Jones & Bartlet Learning.

Perrin, M. E., Hagopian, A., Sales, A., & Huang, B. (2007). Nurse

migration and its implications for Philippine hospitals. International Nursing Review, 54(3), 219-226. doi: 10.1111/j.1466-7657.2007.00567.x

Punia, S., Nair, S., & Shetty, R. S. (2014). Health care workers and

standard precautions: Perceptions and determinants of compliance in the emergency and trauma triage of a tertiary care hospital in South India. International Scholarly Research Notices, 2014, 1-5. doi: http://dx.doi.org/10.1155/2014/ 685072

Sadoh, W. E., Fawole, A. O., Sadoh, A. E., Oladimeji, A. O., &

Sotiloye, O. S. (2006). Practice of universal precautions among healthcare workers. Journal of the National Medical Association, 98(5), 722-726.

Sax, H., Perneger, T., Hugonnet, S., Herrault, P., Chraïti, M. N., &

Pittet, D. (2005). Knowledge of standard and isolation precautions in a large teaching hospital. Infection Control and Hospital Epidemiology, 26(3), 298-304. doi: http://dx.doi.org/10.1086/ 502543

Seto, W. H., Tsang, D., Yung, R. W. H., Ching, T. Y., Ng, T. K., Ho,

M., ... & Advisors of Expert SARS Group of Hospital Authority. (2003). Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS). The Lancet, 361(9368), 1519-1520. doi:10.1016/S0140-6736(03)13168-6

136



Sharma, R., Rasania, S. K., Verma, A., & Singh, S. (2010). Study of prevalence and response to needle stick injuries among health care workers in a tertiary care hospital in Delhi, India. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine, 35(1), 74-77. doi: 10.4103/0970-0218.62565

Shiao, J., Guo, L., & McLaws, M. L. (2002). Estimation of the risk of

bloodborne pathogens to health care workers after a needlestick injury in Taiwan. American Journal of Infection Control, 30(1), 15-20. doi:10.1067/mic.2002.119928

Siegel, J. D., Rhinehart, E., Jackson, M., Chiarello, L., & Health Care

Infection Control Practices Advisory Committee. (2007). 2007 Guideline for isolation precautions: Preventing transmission of infectious agents in health care settings. American Journal of Infection Control, 35(10 Suppl 2), S65-S164.

Smith, D. R., & Leggat, P. A. (2005). Needlestick and sharps injuries

among nursing students. Journal of Advanced Nursing, 51(5), 449-455. doi: 10.1111/j.1365-2648.2005.03526.x

Sreedharan, J., Muttappillymyalil, J., & Venkotramana, M. (2011).

Knowledge about standard precautions among university hospital nurses in the United Arab Emirates. EMHJ-Eastern Mediterranean Health Journal, 17(4), 331-334.

Stein, A. D., Makarawo, T. P., & Ahmad, M. F. R. (2003). A survey of

doctors’ and nurses’ knowledge, attitudes and compliance with infection control guidelines in Birmingham teaching hospitals. Journal of Hospital Infection, 54(1), 68-73. doi: http://dx.doi.org/10.1016/S0195-6701(03)00074-4

137




Suganya, M. V., & Thomas, P. M. (2014). Education on prevention of nosocomial infections among staff nurses at neonatal intensive care unit in Sri Ramakrishna Hospital, Coimbatore. Narayana Nursing Journal, 3(3), 33-35.

Suwantarat, N., & Apisarnthanarak, A. (2015). Risks to healthcare

workers with emerging diseases: Lessons from MERS-CoV, Ebola, SARS, and avian flu. Current Opinion in Infectious Diseases, 28(4), 349-361. doi: 10.1097/QCO. 0000000000000183

Tayaben, J. L. (2015). Compliance with sharps injury prevention

guideline among nurses in tertiary care hospitals in the Philippines. International Journal of Infection Control, 11(2), 1-8. doi: 10.3396/IJIC.v11i2.015.15

World Health Organization. (2009). Glove use information leaflet.

Retrieved from http://www.who.int/gpsc/5may/Glove_Use_ Information_Leaflet.pdf

World Health Organization. (2012). Spotlight on statistics. A fact file

on health workforce statistics.Program-Health Workforce (Issue No. 2. February 2008). Retrieved from http://www.who. int/hrh/statistics/spotlight_2.pdf

World Health Organization. (2014). Healthcare associated infection fact

sheet. Retrieved from http://www.who.int/gpsc/country_work/ gpsc_ccisc_fact_sheet_en.pdf

Yassi, A., Lockhart, K., Copes, R., Kerr, M., Corbiere, M.,

Bryce, E., ... & SARS Study Team. (2007). Determinants of healthcare workers’ compliance with infection control procedures. Healthcare Quarterly (Toronto, Ontorio.), 10(1), 44-52.

138


compliance with standard precautions among hospital nurses

Documents