Διερεύνηση της συμμόρφωσης των κύπριων νοσηλευτών με τις οδηγίες προφύλαξης από την επαγγελματική έκθεση σε παθογόνους μιρκοοργανισμούς

Abstract

Health Care Associated Infections have become a serious concern for modern health care systems. They may affect both patients and health care professionals. Standard Precautions, are a set of guidelines aiming to protect both patients and health care professionals from health care associated infections, but only of they are fully and systematically implemented. However, reluctance among nurses to comply with Standard Precautions is described within international nursing literature. Many studies have also investigated the factors that influence nurses' compliance with Standard Precautions. Unfortunately, there is no such information concerning compliance with the guidelines among nurses in Cyprus or on the factors that influence their compliance. There are only some empirical observations which show that nurses in Cyprus very often suffer from occupational exposures to pathogens and that they do not implement Standard Precautions. The knowledge that can derive from such studies offers the opportunity for taking appropriate measures for improving compliance, and increase nurses safety during their daily clinical practice. In addition, there are no international published studies measuring compliance with Standard Precautions among nurses using their latest version. Finally, more studies investigating the factors that influence nurses' compliance with Standard Precautions do that only by studying those that make a negative influence. Aim: The aim of this study was: a) to investigate the level of occupational exposure to pathogens among Cypriot nurses, b) to investigate the level of compliance with Standard Precautions among Cypriot nurses in order to avoid occupational exposure to pathogens, c) to investigate the factors than influence Cypriot nurses' compliance with Standard Precautions in order to avoid occupational exposure to pathogens and d) to understand why a certain behaviour is adopted among Cypriot nurses concerning the compliance with Standard Precautions. To achieve this, two new instruments have been developed: a) one measuring the level of compliance with the latest version of Standard Precautions and b) one investigating the factors that influence nurses' compliance with Standard Precautions, having as a theoretical framework the Health Belief Model. Method: For developing the new instruments a mixed (qualitative and quantitative) approach was followed. Data to be included into both instruments were gathered via a review of the literature. In addition, for the instrument that investigates the factors that influence nurses' compliance with Standard Precautions, discussions within focus groups were organised followed by a thematic analysis of their content. Various versions of the instruments were developed and statistically checked (e.g. internal consistency-Cronbach's alpha, Cronbach's alpha if item deleted, factor analysis-exploratory and confirmatory, test-retest). The final versions were distributed to a convenience sample of 668 Cypriot nurses. Response rate was 89.37% (n=577). Data were statically analysed using descriptive statistics (percentages, means, and standard deviations) as well as the chi-square test2, the t-test, ANOVA, U-Mann Whitney και Kruskal-Wallis. Results: Both new instruments showed good psychometric properties, but they can also be improved in terms of content. Cypriot nurses compliance appears to be inadequate (e.g. only 9% fully implement Standard Precautions), a fact that confirms previous findings internationally. This study also showed that there are many factors that can influence nurses' compliance with Standard Precautions, either positively (e.g. providing care to adults, providing care to foreigners, reminding) or negatively (no protective equipment to use, bad quality of protective equipment). This combination of positive and negative factors, as they derive from the Health Belief Model, explains why such behaviour exists. Conclusion: Although both newly developed instruments showed good psychometric properties, its content can be substantially improved. The observed inadequate compliance with Standard Precautions may put Cypriot nurses into the danger for acquiring a Health Care Associated Infection. By knowing the factors that affect their compliance, appropriate measures can be taken to improve it. Negatively influencing factors should be eliminated and positively influencing factors should be reinforced. The implementation of a nurse-tailored Risk Management program can facilitate the above.