Berdida - 2023 - Nursing staff compliance and adherence to standard

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R E S E A R CH A R T I C L E
Nursing staff compliance and adherence to standard
precautions during the COVID-19 pandemic:
A cross-sectional study
Daniel Joseph E. Berdida PhD, RN, RM
Faculty, College of Nursing, University of
Santo Tomas, Manila, Philippines
Correspondence
Daniel Joseph E. Berdida, College of Nursing,
University of Santo Tomas, Manila, Philippines.
Email: deberdida@ust.edu.ph; djeberdidarn@
gmail.com
Abstract
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, Pear-
son'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' adher-
ence 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 monito-
ring systems and contextual cues in the workplace to ensure staff compliance
and adherence with SPs.
K E YWORD S
adherence, compliance, COVID-19, nursing staff, Philippines, standard precautions
Key points
• Nursing staff had suboptimal compliance with SPs. Decontamination of spills and used arti-
cles, and disposal of sharps, received the highest and the lowest levels of SPs compliance,
respectively.
• The FIASPS factors of Justification and Leadership were significantly correlated to multiple
CSPS domains (Prevention of cross-infection from person to person, Disposal of sharps, Use
of protective device). Participants' years of service and educational attainment were signifi-
cant predictors of SPs adherence.
• Nurse managers should provide theoretical and practical training in SPs and opportunities to
improve contextual cue recognition. Compliance and adherence are crucial behaviors in
strengthening infection control and prevention.
Received: 8 October 2022 Revised: 20 November 2022 Accepted: 24 November 2022
DOI: 10.1111/nhs.12998
Nurs Health Sci. 2022;1–12. wileyonlinelibrary.com/journal/nhs © 2022 John Wiley & Sons Australia, Ltd. 1
https://orcid.org/0000-0002-5001-6946
https://twitter.com/DJBerdidaPhD
mailto:deberdida@ust.edu.ph
mailto:djeberdidarn@gmail.com
mailto:djeberdidarn@gmail.com
http://wileyonlinelibrary.com/journal/nhs
1 | INTRODUCTION
The COVID-19 pandemic underscored the importance of standard
precautions (SPs) for healthcare workers and the general population.
SPs are infection prevention practices that apply to all patients irre-
spective of their presumed health status and diagnosis (Centers for
Disease Control and Prevention [CDC], 2018). The CDC (2018)
reported that healthcare professionals play a pivotal role in preventing
and controlling the cross-transmission of microorganisms among
patients when SPs are practiced consistently. SPs involve handwash-
ing; wearing appropriate personal protective equipment (PPE;
e.g., gloves, gown, cap, eye shield, mask); the handling of devices,
medical equipment, and clothing used during patient care; environ-
mental regulations (surface cleaning guidelines and waste disposal);
and appropriate disposal of used sharps (Gammon & Hunt, 2018).
Although there is a subtle difference between compliance with and
adherence to SPs, understanding the difference is vital. Compliance is
the behaviors of individuals that conform to the prescriptions of author-
ity (Lam, 2011, 2014). In contrast, adherence corresponds to a person's
behavior agreeing with a healthcare provider's recommendations (World
Health Organization [WHO], 2003). Adherence is a more positive, proac-
tive engagement based on individual commitment to a daily regimen,
such as nurses following SPs. In contrast, compliance is a person's behav-
ior merely doing as instructed or following a specified list of protocols.
Healthcare workers, particularly nurses, are on the frontline
performing vital roles in preventing infections, clinically managing
infected persons, and applying prevention control measures (Alhumaid
et al., 2021). They are essential players in the implementation of health
standards and the reduction of healthcare-related infections. However,
in performative examinations of infection prevention and control policies
and procedures established in the hospital context, healthcare person-
nel's compliance and adherence to SPs remain unsatisfactory. In Hong
Kong, healthcare workers' compliance with infection control and preven-
tion was low during patient care (54%) and invasive procedures (46%)
(Wong et al., 2021), while Malaysian healthcare workers' compliance
was 63.7% (Mohamad et al., 2022). South Korean nurses reported a
76.8% observed adherence to SPs (Kim & Lee, 2022). Similarly, subopti-
mal compliance with SPs was reported among nurses in Brazil (69.4%),
Hong Kong (57.45%) (Pereira et al., 2015), and Singapore (76.68%) (Lim
et al., 2021).
The suboptimal adherence or compliance of nurses to SPs could
be attributed to several factors. The organization of nursing staff,
workplace environment, nursing care context, managerial and inter-
professional relationships, and individual nurse factors were the major
themes of a scoping review on missed nursing care during implemen-
tation of SPs (McCauley et al., 2021). In an Italian qualitative study on
Intensive Care Unit nurses' compliance with SPs, the pressure of lim-
ited time, inadequate competencies regarding SPs, and overcrowding
during emergency conditions were identified as the causes of poor
compliance with SPs (Donati et al., 2019). Nurses comply and adhere
to SPs when they have role models to follow, and when there is con-
stant reinforcement from those role models and training from their
facilities (Lim et al., 2021).
As the frontline of healthcare, the nursing staff is undeniably
essential in providing high-quality treatment to patients, particularly
during the pandemic of the coronavirus disease 2019 (COVID-19),
which has a very high risk of transmission (Mohapatra et al., 2020).
Nursing staff in any healthcare setting are usually composed of
nurses, nursing assistants, and midwives (Oldland et al., 2020). This
type of healthcare team provides complex and interrelated care to
diverse clients.
In the current pandemic environment, it is critical to determine
and understand the factors influencing the nursing staff's compliance
and adherence to infection prevention and control procedures
(Adams & Walls, 2020; Bani-Issa et al., 2021). As healthcare workers,
they are the primary resource for combating a pandemic. Therefore,
high compliance and adherence with SPs worldwide are essential for
maintaining a competent infection prevention and control resource to
manage present and future outbreaks (Etafa et al., 2021; Jin et al., 2020;
Wong et al., 2021).
To the best of my knowledge, studies on the compliance and
adherence of nurses to SPs in the Philippines remain underreported.
Compliance of nurses to SPs was reported for a single-site hospital
outside Metro Manila (De Vera & Nero, 2020; Pasay et al., 2015), and
in a qualitative inquiry on the facilitators and barriers to infection con-
trol among nurses, physicians, and clinical pharmacists (Mitchell
et al., 2017). However, these studies were conducted before the
COVID-19pandemic. The current study aimed to assess the compli-
ance and adherence of nurses, midwives, and nursing assistants to
infection prevention and control practices during the pandemic in a
tertiary-level hospital in Manila. Further, this study sought to identify
demographic variables that predict compliance and adherence to SPs.
The findings from this study may help enhance the compliant and
adherent behavior of nurses, nursing assistants, and midwives during
a pandemic, and contribute to considerations of essential factors that
promote compliance and adherence with SPs to strengthen infection
prevention and control practices in general.
2 | METHODS
2.1 | Aim
The aim was to investigate the compliance and adherence of nurses,
nursing assistants, and midwives to SPs using a correlational and pre-
dictive approach.
2.2 | Research design
This cross-sectional study aimed to evaluate the compliance and
adherence of nurses, midwives, and nursing assistants to infection
prevention and control practices in a tertiary-level hospital in Manila.
Further, this study determined demographic variables that predict
compliance and adherence to SPs. This study adhered to the STROBE
guidelines for cross-sectional studies.
2 BERDIDA
2.3 | Study setting, participants, and sampling
This study was conducted in a 1500-bed government tertiary hospital
in Manila, Philippines. This hospital was founded in 1945. It serves as
a medical, nursing, and research training center under the Department
of Health. Convenience sampling was utilized in recruiting participants.
The inclusion criteria were (i) belonging to the nursing staff in the study
setting (nurse, nursing assistant, or midwife); (ii) being employed for at
least 1 year; and (iii) voluntarily consenting to participate. In the
Philippines, nursing assistants work under the supervision of a licensed
nurse and perform routine nursing tasks (e.g., ambulation, bathing,
checking and recording vital signs). The eligible population was
562 (320 nurses, 210 nursing assistants, and 32 midwives). A total of
515 participants completed the survey (response rate: 91.63%).
An online calculator was used to determine the desired sample
size (Soper, 2021). With a 45-item instrument, an anticipated effect of
0.1, a statistical power of 95%, and a 0.05 probability, the requisite
sample size was 448. Thus, this study satisfied the number of required
participants.
2.4 | Ethical consideration
The Ethics Review Board of the Universidad de Manila approved this
study (approval number: UdM-ERC-2021-36; approved: 10/22/2021).
After submitting the necessary documentation and protocols and upon
acceptance by the ethics board, data gathering commenced. The
study's purpose, benefits, potential risks of participation, participants'
rights, and willingness to participate were explicitly presented on the
first page of a Google survey form. This information was included in
the opening section of the online survey to ensure that potential partic-
ipants were sufficiently informed. Completion of the online survey form
by the participants was regarded as implicit consent to participate in
the study. Participants were allowed to withdraw their responses dur-
ing and after data collection. Anonymity and confidentiality were
strictly observed. The data were stored in a Google drive and protected
by a password. Only the investigator had access the collected data. The
stored data will be deleted 2 years after the study's publication.
2.5 | Instrument
The study instrument had two sections. Section 1 obtained partici-
pants’ demographic profiles. Two scales collected psychometric data
in the second section, the Compliance with Standard Precautions
Scale (CSPS) and the Factors Influencing Adherence to Standard Pre-
cautions Scale (FIASPS). Permission to use these scales for this study
was obtained from the authors.
The CSPS was created to give a quantitative assessment of nurse
compliance with SPs (Lam, 2011, 2014). Healthcare staff must priori-
tize and follow strict infection prevention and control policies to pro-
tect patients and themselves. Multiple factors influence SP
compliance, including enough information, the availability of PPE,
workload, time, confidence in one's therapeutic skills, and organiza-
tional factors (Adebimpe & Ibirongbe, 2019; Nofal et al., 2017). The
CSPS is made up of 20 items that cover five domains: Prevention of
cross infection from person to person, Disposal of sharps, Disposal of
waste, Decontamination of spills and used articles, and Use of protec-
tive devices (Lam, 2014). The CSPS was created in accordance with
the WHO's SPs recommendations (Lam, 2011; WHO, 2005). A
4-point scale (0 = never, 1 = seldom, 2 = sometimes, and 3 = always)
was used to obtain participant responses. The CSPS had a total possi-
ble score range of 0 to 20, with a higher grade indicating a higher
compliance rate with the practice of SPs. In a previous testing, reliabil-
ity (Cronbach's alpha = 0.73) and validity (content validity index 0.90)
were found to be satisfactory (Lam, 2014).
The FIASPS was created to systematically examine healthcare
professionals' adherence to SPs (Bouchoucha & Moore, 2019). The
FIASPS comprises 25 questions grouped into five factors: Judgment,
Leadership, Contextual cues, Culture/practice, and Justification. A
5-point Likert scale was used to answer the questions (from 1 = not
at all, to 5 = very much). The total possible scores in each factor vary
from 5 to 25 (≤10 = low score, 11 to 15 = moderate score, and
≥ 16 = high score). In terms of reliabilities (Cronbach's alpha values
from 0.61 to 0.85 for the five factors) and stability for usage, the
FIASPS reported good psychometric qualities (Bouchoucha &
Moore, 2019).
A pilot test was conducted on the two scales among 33 partici-
pants. They were excluded from the final study participants. The origi-
nal English versions of the scales were used in data collection because
participants are English literate. The CSPS and FIASPS yielded Cron-
bach's alpha values of 0.95 and 0.96, respectively, indicating high reli-
ability (Taber, 2018).
2.6 | Data collection
Data were collected through a Google survey from January 20 to
March 25, 2022. Due to existing health protocols for preventing
transmission of COVID-19, face-to-face gathering was prohibited. All
nursing staff meeting the eligibility criteria could access the online sur-
vey. A link to a Google survey form was distributed to their registered
email addresses and via Facebook Messenger. Participants' implied
consent to participate in this study was deemed to be confirmed
when they completed and submitted the survey form. Data collection
started after the Ethics Review Board granted permission to conduct
the study.
Poor response rates, representativeness, and item-response issues
are common problems in online surveys (Polit & Beck, 2017). The avoid
these problems and raise the standard of the online survey, this study
used a language in which the participants were proficient, excluded
questionnaires answered in less than 10 min, refrained from utilizing
grids or matrices to depict responses on the Likert scale, and pilot
tested the instruments using a Google survey form. The original English
versions of the instruments were not translated into the participants'
native language because they were proficient in English.
BERDIDA 3
2.7 | Data analysis
Data were encoded using MS Excel. The statistical analyses were con-
ducted using STATA ver. 16.0 software. Descriptive statistics were
used to summarize the participants' demographic profiles and
responses to the CSPS and FIASPS. Frequency and proportion were
used for categorical variables, while mean and SD were utilized for
continuous variables. Analysis of variance (ANOVA) was employed to
compare the CSPS and FIASPS scores according to participants' role
designation (nurse, nursing assistant, midwife).Pearson correlation
analysis was used to determine correlations between FIASPS factors
and CSPS domains. Linear regression was used for multivariable data
analysis to determine the demographic predictors of the CSPS and
FIASPS outcomes. The level of significance was set at 0.05.
2.8 | Validity and rigor
To evaluate the reliability of the psychometric scales, 33 eligible
participants responded to an initial pretest. Testing for reliability
with the entire sample showed acceptable to high-reliability coeffi-
cients, with overall Cronbach's alpha values of 0.95 and 0.96 for the
CSPC and FIASPS, respectively. In terms of the subscale reliability
coefficients, the CSPS's domains of Prevention of cross infection
from person to person, Disposal of sharps, Disposal of waste,
Decontamination of spills and used articles, and Use of protective
devices revealed Cronbach's alpha values of 0.94, 0.93, 0.96, 0.96,
and 0.95, respectively. Similarly, the factors of the FIASPS also
showed good reliability coefficients: Justification (0.95), Leadership
(0.94), Contextual cues (0.97), Culture/practice (0.95), and Judg-
ment (0.94). These results support the validity and reliability of the
survey instruments.
3 | RESULTS
3.1 | Participants' demographic profiles
Table 1 presents the distribution of participants according to their
demographic profiles. Most participants were 30 years old and
above (84.85%), and almost two-thirds were females (70.10%).
Nurses comprised more than half of the participants (56.89%), fol-
lowed by nursing assistants (40%) and midwives (4.47%). The major-
ity of the participants were assigned (45.05%) to general wards,
were in service for less than 20 years (89.71%), and college gradu-
ates (81.36%).
3.2 | Participants' self-reported CSPS practice
The participants' self-reported compliance with SPs practice is pre-
sented in Table 2. The overall average compliance of the participants
was 78.2%. The highest SPs compliance was for the domain of
Decontamination of spills and used articles (92.6%), whereas the low-
est SPs compliance was for Disposal of sharps (44.4%). The items with
the highest self-reported compliance were “I put used sharp articles
into sharps container” and “My mouth and nose are covered when I
wear a mask,” with a 97.9% overall compliance rate. On the other
hand, the item with the lowest reported compliance was “The sharps
container is disposed of when its contents reach the full line on the
container” (14.8%).
3.3 | Mean scores on the CSPS domains according
to participants' role designation
The mean scores for the CSPS by domain and comparisons by role
designation are presented in Table 3. The scores across the three
designations of nurse, nursing assistant, and midwife were almost
the same for the domains of Prevention of cross infection from
person to person, Decontamination of spills and used articles, and
Use of protective device. As for the domains of Disposal of
sharps and Disposal of waste, there was a statistically significant
difference in the mean scores across the three designations
(p = <0.0001). Significant differences were found in the disposal
of sharps, between nurses and nursing assistants (0.39, Hedges'
G = 0.66) and between nurses and midwives (0.49, Hedges'
G = 0.77), and in the disposal of waste, between nurses and nurs-
ing assistants (0.67, Hedges' G = 0.71).
TABLE 1 Participants' demographic profile (n = 515)
Variable Frequency Percentage
Age
Less than 30 years old 78 15.15
30 years old and above 437 84.85
Gender
Female 361 70.10
Male 154 29.90
Role designation
Nurse 293 56.89
Nursing assistant 199 38.64
Midwife 23 4.47
Assignment
General wards 232 45.05
Special area (e.g., emergency room,
intensive care unit)
283 54.95
Years of service
Less than or equal to 20 years 462 89.71
More than 20 years 53 10.29
Educational attainment
High school/vocational/college
undergraduates
96 18.64
College graduates 419 81.36
4 BERDIDA
TABLE 2 Nurses, nursing assistants, and midwives' compliance with items and domains of the CSPS (n = 515)
Domains, items
Compliance with CSPS items
Overall %
compliance rateNever Seldom Sometimes Always
Prevention of cross infection from person to person (domain)
1. I wash my hands between patient contacts. 1.2% 0.6% 7.4% 90.9% 90.9%
2. I only use water for hand washing. 40.4% 8.3% 12.2% 39.0% 40.4%
3. I use alcoholic hand rubs as an alternative to soap and
water if my hands are not visibly soiled.
2.5% 3.5% 14.0% 80.0% 80.0%
4. I take a shower in case of extensive splashing even
after I have put on Personal Protective Equipment
(PPE).
0.6% 3.3% 10.7% 85.4% 85.4%
5. I would cover my wound(s) or lesion(s) with waterproof
dressing before patient contacts.
1.0% 1.0% 10.1% 88.0% 88.0%
6. I change gloves between patient contacts. 1.0% 1.4% 7.0% 90.7% 90.7%
7. I decontaminate my hands immediately after removal
of gloves.
0.4% 0.8% 5.0% 93.8% 93.8%
Average overall compliance for domain 81.3%
Disposal of sharps (domain)
8. I recap used needles after giving an injection. 20.6% 6.6% 11.3% 61.6% 20.6%
9. I put used sharp articles into sharps container. 0.6% 0.2% 1.4% 97.9% 97.9%
10. The sharps container is disposed of when its contents
reach the full line on the container.
14.8% 7.0% 6.2% 72.0% 14.8%
Average overall compliance for domain 44.4%
Disposal of waste (domain)
11. Waste contaminated with blood, body fluids,
secretion and excretion is placed in red plastic bags
irrespective of the patient's infection status.
34.2% 7.2% 11.3% 47.4% 47.4%
Average overall compliance for domain 47.4%
Decontamination of spills and used articles (domain)
12. I decontaminate surfaces and equipment after use. 0.4% 0.8% 8.0% 90.9% 90.9%
13. I wear gloves to decontaminate used equipment with
visible soils.
1.0% 0.4% 4.1% 94.6% 94.6%
14. I clean up spillage of blood or other body fluids
immediately with disinfectants.
1.0% 0.8% 6.0% 92.2% 92.2%
Average overall compliance for domain 92.6%
Use of protective device (domain)
15. I remove Personal Protective Equipment (PPE) in a
designated area.
1.2% 0.4% 3.5% 95.0% 95.0%
16. I wear gloves when I am exposed to body fluids, blood
products and any excretion of patients.
0.2% 0.4% 1.7% 97.7% 97.7%
17. I wear a surgical mask alone or in combination with
goggles, face shield and apron whenever there is a
possibility of a splash or splatter.
4.5% 2.3% 9.9% 83.3% 83.3%
18. My mouth and nose are covered when I wear a mask. 0.4% 0.2% 1.6% 97.9% 97.9%
19. I reuse a surgical mask or disposable Personal
Protective Equipment (PPE).
73.0% 5.8% 2.9% 18.3% 73.0%
20. I wear a gown or apron when exposed to blood, body
fluids or any patient excretions.
1.0% 0.4% 9.3% 89.3% 89.3%
Average overall compliance for domain 89.4%
Average overall compliance for the total CSPS 78.2%
Abbreviation: CSPS, Compliance with Standard Precautions Scale.
BERDIDA 5
3.4 | Mean scores on FIASPS factors according to
participants' role designation
Mean scores for the FIASPS five factors, Justification, Leadership,
Contextual cues, Culture/practice, and Judgment, are presented in
Table 4. Participants strongly endorsed the influence of Contextual
cues on their adherence to SPs (factor mean = 4.53, SD = 0.66). Simi-
larly, Leadership and Judgment were also found to have an influence
on their adherence to SPs (Leadership factor mean = 4.05, SD = 0.80;
Judgment factor mean = 4.09, SD = 0.90), followed by Culture/
TABLE 3 Mean scores on CSPS domains according to participants' role designation (n = 515)
Domains
Mean (SD)
p-valuesNurses (n = 293) Nursing assistants (n = 199) Midwives (n = 23)
Prevention of cross infection from person to person 2.66 (0.30) 2.65 (0.29) 2.61 (0.18) 0.7360
Disposal of sharps 1.66 (0.65) 1.27 (0.50) 1.17 (0.36) <0.0001*,a,b
Disposal of waste 1.44 (1.34) 2.11 (1.28) 1.91 (1.31) <0.0001*,c
Decontamination of spills and used articles 2.90 (0.26) 2.92 (0.30) 2.83 (0.37) 0.3150
Useof protective device 2.81 (0.28) 2.77 (0.29) 2.86 (0.19) 0.1946
Total score 0.0947
Abbreviation: CSPS, Compliance with Standard Precautions Scale.
aPost hoc tests, difference between nurses and nursing assistants (0.39, Hedges’ G = 0.66).
bPost hoc tests, difference between nurses and midwives (0.49, Hedges’ G = 0.77).
cPost hoc tests, difference between nurses and nursing assistants (0.67, Hedges’ G = 0.71).
*p <0.05.
TABLE 4 Mean scores on FIASPS factors according to participants' role designation (n = 515)
FIASP factors maximum
range (1–5)
Mean items (standardized) (SD)
p-values
Total M (SD)
response range
Nurses (n = 293)
M (SD)
Nursing assistants
(n = 199) M (SD)
Midwives (n = 23)
M (SD)
Justification 2.02 (0.89) 2.30 (1.33) 2.25 (1.12) 0.0172*,a 2.14 (1.10) range (1–5)
Leadership 4.12 (0.72) 3.97 (0.91) 3.93 (0.78) 0.0986 4.05 (0.80) range (1–5)
Contextual cues 4.56 (0.60) 4.51 (0.73) 4.36 (0.72) 0.2627 4.53 (0.66) range (1–5)
Culture/practice 3.32 (0.71) 3.62 (0.95) 3.44 (0.76) 0.0003*,b 3.44 (0.82) range (1–5)
Judgment 4.12 (0.87) 4.04 (0.97) 4.2 (0.75) 0.4940 4.09 (0.90) range (1–5)
Abbreviation: FIASPS, Factors Influencing Adherence to Standard Precautions Scale.
aPost hoc tests, difference between nurses and nursing assistants (0.28, Hedges’ G = 0.26).
bPost hoc tests, difference between nurses and nursing assistants (0.3, Hedges’ G = 0.37).
*p <0.05.
TABLE 5 Correlation between FIASPS factors and CSPS domains (n = 515)
CSPS
FIASPS
Prevention of cross infection
from person to person
Disposal of
sharps
Disposal of
waste
Decontamination of spills
and used articles
Use of protective
device
Justification �0.1361
<0.0001*
�0.1533
0.0005*
0.2492
<0.0001*
0.0337
0.4450
�0.2223
<0.0001*
Leadership 0.1673
0.0001*
0.0103
0.8156
0.1084
0.0139*
0.2236
<0.0001*
0.1234
0.0050*
Contextual
cues
0.2122
<0.0001*
�0.0944
0.0323*
0.1222
0.0055*
0.2685
<0.0001*
0.2482
<0.0001*
Culture/
practice
0.0098
0.8237
�0.2696
<0.0001*
0.2926
<0.0001*
0.1809
<0.0001*
�0.0964
0.0284*
Judgment 0.1466
0.0008*
�0.0922
0.0365*
0.2188
<0.0001*
0.2076
<0.0001*
0.0488
0.2686
Note: Pearson correlation analysis.
Abbreviations: CSPS, Compliance with Standard Precautions Scale; FIASPS, Factors Influencing Adherence to Standard Precautions Scale.
*p <0.05.
6 BERDIDA
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BERDIDA 7
practice (mean = 3.44, SD = 0.82). In contrast, participants had
lower levels of endorsement for the influence of Justification on
adherence (factor mean = 2.14, SD = 1.10). All three designations
presented the highest mean item scores for Contextual cues,
whereas they all presented the lowest factor mean for Justification.
Significant differences were found between nurses and nursing
assistants for both Justification (0.28, Hedges' G = 0.26) and Cul-
ture/practice (0.3, Hedges' G = 0.37).
3.5 | Correlation between FIASPS factors
and CSPS domains
Pearson's correlation coefficient was used to analyze the correlations
between the dimensions of the CSPS and FIASPS (Table 5). The Justi-
fication factor of the FIASPS was significantly correlated with most of
the domains of the CSPS. Specifically, Justification was found to have
a weak inverse correlation with Prevention of cross infection from
person to person (r = �0.1361, p = <0.0001), Disposal of sharps
(r = �0.155, p = 0.0005), and Use of protective device (r = �0.2223,
p = <0.0001), while Disposal of waste (r = 0.2492, p = <0.0001) had
a weak direct correlation.
Leadership, the second factor of the FIASPS, was also signifi-
cantly correlated with most of the domains of the CSPS. Specifically,
Leadership was weakly associated with Prevention of cross infection
from person to person (r = 0.1673, p = <0.0001), Disposal of waste
(r = 0.1084, p = 0.0139), Decontamination of spills and used articles
(r = 0.2236, p = <0.0001), and Use of protective device (r = 0.1234,
p = 0.0050).
Contextual cues were significantly correlated with all of the
domains of the CSPS. Specifically, the factor of Contextual cues was
found to have a weak positive correlation with Prevention of cross
infection from person to person (r = 0.2122, p = <0.0001), Disposal
of waste (r = 0.1222, p = 0.0055), and Decontamination of spills and
used articles (r = 0.2685, p = <0.0001). A weak negative correlation
was also noted with Disposal of sharps (r = �0.0944, p = 0.0323) and
Use of protective device (r = 0.2482, p = <0.0001).
The factor of Culture/practice was significantly correlated with
four of the domains of the CSPS. Specifically, Culture/practice was
found to have a weak negative correlation with Disposal of sharps
(r = �0.2696, p = <0.0001) and Use of protective device
(r = 0.0964, = 0.0284). Conversely, a weak direct correlation existed
with Disposal of waste (r = 0.2926, p = 0.0001) and Decontamination
of spills and used articles (r = 0.1809, p = <0.0001).
Lastly, the fifth factor of the FIASPS, Judgment, was significantly
correlated with four of the domains of the CSPS. Specifically, Judg-
ment was found to have a weak positive correlation with Prevention
of cross infection from person to person (r = 0.1466, p = 0.0008),
Disposal of waste (r = 0.2188, p = <0.0001), and Decontamination of
spills and used articles (r = 0.2076, p = <0.0001). Only Disposal of
sharps (r = �0.0922, p = 0.0365) was seen to have a weak negative
correlation.
3.6 | Predictors of CSPS and FIASPS outcomes
Table 6 shows the regression model employed to examine further the
predictive role of demographic variables for outcomes of the CSPS
and FIASPS. None of the variables were significantly associated with
the CSPS outcomes. However, years of service (p = 0.043) and educa-
tional attainment (p = 0.010) were significant predictors for outcomes
of the FIASPS.
4 | DISCUSSION
This study investigated the compliance and adherence of nurses, nurs-
ing assistants, and midwives to infection prevention and control prac-
tices duringthe COVID-19 pandemic. The following are the study's
main findings. First, most participants were suboptimally compliant
with SPs (78.2%), and participants' role designation showed a statisti-
cal difference in the Disposal of sharps and Disposal of waste domains
of the CSPS. Second, adherence to SPs was strongly influenced by the
Contextual cues factor and significantly predicted by participants' ser-
vice years and educational attainment. Third, numerous significant but
weak correlations existed between the FIASPS factors and CSPS
domains; however, the FIASPS factor of Contextual cues was signifi-
cantly correlated with all CSPS domains.
The overall average compliance of the participants was 78.2%.
This finding denotes suboptimal SPs compliance of nursing staff
(nurses, nursing assistants, midwives) in the clinical setting
(Lam, 2014). Our result supports prior findings of suboptimal compli-
ance with SPs among nurses in Brazil (69.4%), Hong Kong (57.45%)
(Pereira et al., 2015), and Singapore nurses (76.68%) (Lim et al., 2021).
Compliance with SPs is the foundation of preventing hospital-
acquired infections (CDC, 2018; WHO, 2005). Globally, healthcare
worker and nursing staff compliance with SPs has remained poor and
suboptimal. Accordingly, healthcare workers in Jordan (Al-Faouri
et al., 2021), Tanzania (Bahegwa et al., 2022), Ethiopia (Beyamo
et al., 2019), and Hong Kong (Wong et al., 2021) have reported poor
compliance with SPs. These global reports support the study's findings
in the Philippines. Filipino nursing staff need organizational support to
improve their compliance with SPs to prevent hospital-acquired infec-
tions and enhance patient outcomes.
Worldwide, the COVID-19 pandemic uncovered issues and chal-
lenges with compliance and adherence to SPs. The current data about
compliance and adherence to SPs were collected when the pandemic
was still a threat. These findings, specifically suboptimal compliance,
were supported by previous studies (Mohamad et al., 2022; Wong
et al., 2021). Compliance level with SPs was directedly related to
nurses' satisfaction with infection control and prevention policy dur-
ing COVID-19 (Wong et al., 2021). Healthcare workers' compliance
with SPs protocols during the pandemic varied by department,
employment category, and service years (Mohamad et al., 2022). SPs
are the most critical aspect of limiting cross-transmission among
healthcare workers and patients, and policy satisfaction increases
8 BERDIDA
high-risk group compliance. Suboptimal compliance and inadequate
views on infection prevention and control guidelines should alarm the
healthcare system, especially during pandemics.
This study revealed that the CSPS domains of Decontamination
of spills and used articles and Disposal of sharps domains received the
highest and lowest levels of SPs compliance, respectively. Similarly,
Lim et al. (2021) reported that nurses had high compliance on blood
spills and used articles decontamination. Needles and sharps disposal
received the lowest compliance among Hong Kong nurses (Wong
et al., 2021). Conversely, Tanzanian nurses had high compliance with
discarding needles and sharp equipment in a hospital setting (Bahegwa
et al., 2022). Needle stick injuries are caused by improper disposal of
used needles and sharps (CDC, 2021). Needle stick injuries pose serious
health risks and transmit blood-borne diseases (e.g., hepatitis B,
hepatitis C, human immunodeficiency virus) from the patient to the
nursing staff (CDC, 2021). Moreover, increasing awareness and reinfor-
cing compliance with SPs significantly improve overall compliance and
reduce needle-stick-related injuries (Hussain et al., 2020). Although the
overall compliance rate was sub-optimal, there are discrepancies among
the different CSPS domains and items, indicating that nurses were
selective in their compliance, reflecting a pattern similar to that
observed in various studies (Lim et al., 2021; Pereira et al., 2015).
Results showed a significant difference among nurses, nursing
assistants, and midwives in their compliance with the disposal of sharps
and waste. This study found that nurses are more compliant in dispos-
ing of sharps while nursing assistants are more compliant in disposing
of waste. Nurses' compliance with the disposal of sharp instruments
was higher due to reinforced hospital SPs protocols and staff education
(Luo et al., 2010). Also, Beyamo et al. (2019) reported that nurses have
good practice handling sharp equipment. Conversely, nursing staff and
students in Hong Kong had low compliance rates regarding sharps dis-
posal (48.4%; Lam, 2014). In the Philippines, nurses use needles and
sharps to prepare and administer parenteral medications, while nursing
assistants are tasked with discarding hospital wastes properly. This find-
ing may raise concerns for nursing assistants and other nursing staff,
since disposing of waste containing sharps is one of their responsibili-
ties. They are at high risk for blood-borne biological hazards that may
cause physical injuries and psychological trauma.
It is interesting to note that nursing staff perceived Contextual
cues as the most influential factor in their adherence to SPs. The
Contextual cues factor reflects visual and environmental cues
(i.e., positioning of hand basins, sharps containers, and hand sanitizer in
the ward setting) that might be interpreted as action cues. For instance,
workers are more likely to comply with SPs when dealing with needles
or a blood-borne infection if they are close to patients while wearing
PPE (Bouchoucha & Moore, 2019). This study's data suggest that mea-
sures that consistently motivate nursing staff to adhere to SPs include
conspicuous visual signs and contextual cues. For instance, face masks
and hand sanitizer should be readily available throughout the clinical
areas (Pengpid et al., 2022). Clear signage should alert personnel when
further PPE and transmission-based precautions are required (Panayi
et al., 2020). Thus, contextual cues could improve SPs adherence by
directly stimulating an individual's sensory awareness.
This study found that years of service and educational attainment
were significant predictors of SPs adherence. These findings suggest
on the one hand that increasing the years of experience will raise the
degree of SPs compliance and enhance the clinical competence of
nurses and nursing staff. This result was anticipated and supported by
previous studies (Al-Faouri et al., 2021; Luo et al., 2010; Wong
et al., 2021). However, when the nursing staff's educational attain-
ment increases, they are seen to be less SPs adherent. This situation
could be a cause for alarm among nurse managers. Most studies
establish that education increases an individual's knowledge and
health outcomes (Raghupathi & Raghupathi, 2020); hence it increases
their adherent behavior (Alikari et al., 2019). Therefore, healthcare
facilities must organize training sessions for all nurses and other
healthcare professionals to increase knowledge and compliance.
It is worth noting that the correlations between FIASPS factors
and CSPS domains were significant. There was a negative correlation
between the FIASPS factor of Contextual cues and the CSPS domains
Disposal of sharps and Use of protective device. This finding implies
that even when the nursing staff is reinforced with an abundance of
sensory, environmental, and physical cues, they may ignore these
action cues and are more likely to break the SPs protocols. Filipino
nursing staff have the lowest compliance on sharps disposal.
Compared with previous studies where nurses are highly compliant
with discarding sharps (Bahegwa et al., 2022; Beyamo et al., 2019),
the present findings imply that the participants were more likely to
commit improper sharp disposal and protective device usage. The
study's findings should be regarded with prudence, as deviating fromthe guidelines based on the nurses' assessment of the situation or the
patient may increase the risk of exposure to infectious diseases.
The FIASPS Justification factor was inversely correlated with
the domains of Prevention of cross infection from person to person,
Disposal of sharps, and Use of protective device. The justification
factor is the individual's rationale for not adhering to SPs. Justifica-
tion indicates participants' confidence in judging patients and clinical
risk practice (Bouchoucha & Moore, 2018). Thus, a negative relation-
ship with CSPS domains is expected. The findings imply that nurses
with high clinical judgment may less likely follow guidelines and SPs
protocols. Nursing staff scored lowest on the Justification factor,
validating Bouchoucha and Moore's (2019) results that they were
less likely to rationalize or excuse non-adherence to SPs guidelines.
Hence, Filipino nurse managers will face difficulty convincing nursing
staff of the implications for themselves and their clients if SPs are
not followed.
The Leadership factor was positively correlated with the domains
of Prevention of cross infection from person to person, Disposal of
waste, Decontamination of spills and used articles, and Use of protec-
tive device. The Leadership factor reflects an individual's active super-
vision and informal leadership to influence coworkers to follow SP
(Bouchoucha & Moore, 2019). Leadership and supervision promote a
workplace safety culture. According to this study's nurses, personal
leadership is key to boosting SPs adherence. Thus, nurse managers
must tackle poor infection control procedures and model efficient SPs
adherence for inexperienced nursing staff (Lim et al., 2021).
BERDIDA 9
The factor of Culture/practice was indirectly correlated with the
domains of Disposal of sharps and Use of protective device. The
Culture/practice factor refers to an organization's environment, which
could support or hinder SPs utilization (Bouchoucha & Moore, 2019).
Creating a safety culture and safe environment in an organization
reinforces strong infection control practices (Lim et al., 2021). In this
study, nursing staff claimed their organization's SPs practice culture
did not influence adherence and compliance practices. Therefore,
nursing staff should recognize their organization's efforts to promote
SPs guidelines in the workplace with clear guidance.
4.1 | Limitations and recommendations
This study included some limitations that affect the generalizability
of the results. First, the study's cross-sectional methodology does
not allow establishing causal relationships between study variables.
Second, participants could have overestimated or underestimated
their responses because this study employed two self-reported sur-
vey scales. Third, the clinical areas of assignment of the nursing staff
were not included. Based on their work assignments, the nursing
staff may report diverse experiences about adherence and compli-
ance with SPs. Fourth, selection bias may have compromised exter-
nal validity by choosing a convenience sample instead of using a
random sampling technique. This Philippine investigation was also
conducted at a single site. As a result, the study's findings should be
cautiously interpreted.
Based on these limitations, it is recommended to develop an SPs
compliance and adherence model using a larger sample size and across
several sites (e.g., different hospital specialty areas, or multiple sites
and countries). An experimental or longitudinal design may be
required to ascertain the relationship between variables and generate
reliable results. Finally, qualitative research will deepen the nursing
staff's narratives about SPs compliance and adherence.
5 | CONCLUSION
This study reports Filipino nursing staff's compliance and adherence
to SPs during the COVID-19 pandemic. The overall average compli-
ance was suboptimal, with the lowest compliance on the disposal of
sharps domain. Nurses are more compliant with sharps disposal, while
nursing assistants are more compliant with waste disposal. Contextual
cues were the vital factor that strongly influenced participants' adher-
ence to SPs. The Contextual cues factor of the FIASPS was signifi-
cantly correlated to all CSPS domains. Participants' service years and
educational attainment significantly predicted their adherence to SPs.
These findings highlight the organization's vital role of continuing to
enforce policies rigorously, with monitoring programs and good visual
reminders in the workplace to ensure staff adherence to SPs. Further,
to strengthen hospital infection prevention and control, the nursing
staff's compliant and adherent behaviors with SPs should be equally
supported.
6 | RELEVANCE FOR CLINICAL PRACTICE
More than ever, the COVID-19 pandemic demands that healthcare
workers conscientiously adhere to and comply with SPs to halt its
transmission completely. The results from this study underscore the
necessity for nurse managers to provide nursing staff with the follow-
ing: (i) thorough theoretical and practical training in infection preven-
tion and control, and opportunities to improve their contextual cue
recognition skills, clinical rationale skills, and safe practice culture;
(ii) increased organizational support that could aid in encouraging
nursing staff working in clinical practice environments to follow
patient safety standards; and (iii) encouragement for nurses to serve
as role models for implementing SPs in their work environments to
increase their colleagues' adherence to SPs.
ACKNOWLEDGMENTS
I would like to thank the nursing staff who participated in this study.
Also, I am indebted to Kathleen Chelsea Togño, MSPH, for her exper-
tise in statistics.
FUNDING INFORMATION
This research did not receive any specific grant from funding agencies
in the public, commercial, or not-for-profit sectors.
CONFLICT OF INTEREST
The author declares that there are no conflicts of interest.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the
corresponding author upon reasonable request.
ETHICS STATEMENT
Ethics Review Committee of the Universidad de Manila granted
approval to conduct this study (approval number UdM-ERC-2021-36;
approved on October 22, 2021).
ORCID
Daniel Joseph E. Berdida https://orcid.org/0000-0002-5001-6946
TWITTER
Daniel Joseph E. Berdida @DJBerdidaPhD
REFERENCES
Adams, J. G., & Walls, R. M. (2020). Supporting the healthcare workforce
during the COVID-19 global epidemic. JAMA, 323(15), 1439–1440.
Adebimpe, W. O., & Ibirongbe, D. O. (2019). Exploring the knowledge and
preventive practices on isolation precaution and quarantine among
health care workers in Ondo state, Nigeria. Annals of Global Health,
85(1), 72.
Al-Faouri, I., Okour, S. H., Alakour, N. A., & Alrabadi, N. (2021). Knowledge
and compliance with standard precautions among registered nurses: A
cross-sectional study. Annals of Medicine and Surgery, 2012(62),
419–424.
Alhumaid, S., Al Mutair, A., Al Alawi, Z., Alsuliman, M., Ahmed, G. Y.,
Rabaan, A. A., Al-Tawfiq, J. A., & Al-Omari, A. (2021). Knowledge of
10 BERDIDA
https://orcid.org/0000-0002-5001-6946
https://orcid.org/0000-0002-5001-6946
https://twitter.com/DJBerdidaPhD
https://twitter.com/DJBerdidaPhD
infection prevention and control among healthcare workers and fac-
tors influencing compliance: A systematic review. Antimicrobial Resis-
tance and Infection Control, 10(1), 86.
Alikari, V., Tsironi, M., Matziou, V., Tzavella, F., Stathoulis, J.,
Babatsikou, F., Fradelos, E., & Zyga, S. (2019). The impact of education
on knowledge, adherence and quality of life among patients on hae-
modialysis. Quality of Life Research, 28(1), 73–83.
Bahegwa, R. P., Hussein, A. K., Kishimba, R., Hokororo, J., German, C.,
Ngowi, R., Eliakimu, E., & Ngasala, B. (2022). Factors affecting compli-
ance with infection prevention and control standardprecautions
among healthcare workers in Songwe region, Tanzania. Infection Pre-
vention in Practice, 4(4), 100236.
Bani-Issa, W. A., Al Nusair, H., Altamimi, A., Hatahet, S., Deyab, F.,
Fakhry, R., Saqan, R., Ahmad, S., & Almazem, F. (2021). Self-report
assessment of nurses' risk for infection after exposure to patients with
coronavirus disease (COVID-19) in The United Arab Emirates. Journal
of Nursing Scholarship, 53(2), 171–179.
Beyamo, A., Dodicho, T., & Facha, W. (2019). Compliance with standard
precaution practices and associated factors among health care workers
in Dawuro zone, south West Ethiopia, cross-sectional study. BMC
Health Services Research, 19(1), 381.
Bouchoucha, S. L., & Moore, K. A. (2018). Infection prevention and control:
Who is the judge, you or the guidelines? Journal of Infection Prevention,
19(3), 131–137.
Bouchoucha, S. L., & Moore, K. A. (2019). Factors influencing adherence to
standard precautions scale: A psychometric validation. Nursing &
Health Sciences, 21(2), 178–185.
Centers for Disease Control and Prevention, CDC. (2018). Standard Pre-
cautions. Retrieved March 4, 2022, from https://www.cdc.gov/
oralhealth/infectioncontrol/summary-infection-prevention-practices/
standard-precautions.html
Centers for Disease Control and Prevention, CDC. (2021). Needlestick inju-
ries are preventable. Retrieved September 8, 2022, from https://www.
cdc.gov/niosh/newsroom/feature/needlestick_disposal.html
De Vera, P., & Nero, D. L. (2020). Compliance with the standard precau-
tions: An infection control measure of nurses in ilocos sur. Surabaya
Internasional Health Conference 2019, 1(1), 87–98. https://
conferences.unusa.ac.id/index.php/SIHC19/article/view/506
Donati, D., Biagioli, V., Cianfrocca, C., Marano, T., Tartaglini, D., & De
Marinis, M. G. (2019). Experiences of compliance with standard pre-
cautions during emergencies: A qualitative study of nurses working in
intensive care units. Applied Nursing Research, 49, 35–40.
Etafa, W., Gadisa, G., Jabessa, S., & Takele, T. (2021). Healthcare workers'
compliance and its potential determinants to prevent COVID-19 in pub-
lic hospitals in Western Ethiopia. BMC Infectious Diseases, 21(1), 454.
Gammon, J., & Hunt, J. (2018). A review of isolation practices and proce-
dures in healthcare settings. British Journal of Nursing, 27(3), 137–140.
Hussain, A., Shah, Y., Raval, P., & Deroeck, N. (2020). Awareness about
sharps disposal leads to significant improvement in healthcare safety:
An audit of compliance in the National Health Service during the
COVID-19 pandemic. SN Comprehensive Clinical Medicine, 2(12),
2550–2553.
Jin, Y. H., Huang, Q., Wang, Y. Y., Zeng, X. T., Luo, L. S., Pan, Z. Y.,
Yuan, Y. F., Chen, Z. M., Cheng, Z. S., Huang, X., Wang, N., Li, B. H.,
Zi, H., Zhao, M. J., Ma, L. L., Deng, T., Wang, Y., & Wang, X. H. (2020).
Perceived infection transmission routes, infection control practices,
psychosocial changes, and management of COVID-19 infected health-
care workers in a tertiary acute care hospital in Wuhan: A cross-
sectional survey. Military Medical Research, 7(1), 24.
Kim, J. S., & Lee, E. (2022). Difference between self-reported adherence to
standard precautions and surveillance and factors influencing observed
adherence: A quantile regression approach. BMC Nursing, 21(1), 199.
Lam, S. C. (2011). Universal to standard precautions in disease prevention:
Preliminary development of compliance scale for clinical nursing. Inter-
national Journal of Nursing Studies, 48(12), 1533–1539.
Lam, S. C. (2014). Validation and cross-cultural pilot testing of compliance
with standard precautions scale: Self-administered instrument for clini-
cal nurses. Infection Control & Hospital Epidemiology, 35(5), 547–555.
Lim, S. H., Bouchoucha, S. L., Aloweni, F., & Bte Suhari, N. (2021). Evalua-
tion of infection prevention and control preparedness in acute care
nurses: Factors influencing adherence to standard precautions. Infec-
tion, Disease & Health, 26(2), 132–138.
Luo, Y., He, G. P., Zhou, J. W., & Luo, Y. (2010). Factors impacting compli-
ance with standard precautions in nursing, China. International Journal
of Infectious Diseases, 14(12), e1106–e1114.
McCauley, L., Kirwan, M., & Matthews, A. (2021). The factors contributing
to missed care and non-compliance in infection prevention and control
practices of nurses: A scoping review. International Journal of Nursing
Studies Advances, 3, 100039.
Mitchell, K. F., Barker, A. K., Abad, C. L., & Safdar, N. (2017). Infection con-
trol at an urban hospital in Manila, Philippines: A systems engineering
assessment of barriers and facilitators. Antimicrobial Resistance and
Infection Control, 6, 90.
Mohamad, N., Pahrol, M. A., Shaharudin, R., Md Yazin, N., Osman, Y.,
Toha, H. R., Mustapa, N., Mohamed, Z., Mohammad, A., & Ismail, R.
(2022). Compliance to infection prevention and control practices
among healthcare workers during COVID-19 pandemic in Malaysia.
Frontiers in Public Health, 10, 878396.
Mohapatra, R. K., Pintilie, L., Kandi, V., Sarangi, A. K., Das, D., Sahu, R., &
Perekhoda, L. (2020). The recent challenges of highly contagious
COVID-19, causing respiratory infections: Symptoms, diagnosis, trans-
mission, possible vaccines, animal models, and immunotherapy. Chemi-
cal Biology & Drug Design, 96(5), 1187–1208.
Nofal, M., Subih, M., Al-Kalaldeh, M., & Al Hussami, M. (2017). Factors
influencing compliance to the infection control precautions among
nurses and physicians in Jordan: A cross-sectional study. Journal of
Infection Prevention, 18(4), 182–188.
Oldland, E., Botti, M., Hutchinson, A. M., & Redley, B. (2020). A framework
of nurses' responsibilities for quality healthcare—Exploration of con-
tent validity. Collegian, 27(2), 150–163.
Panayi, A. C., Flores-Huidobro, A., Wu, M., Endo, Y., Hamaguchi, R.,
Haug, V., Ma, C., & Orgill, D. P. (2020). Adherence to personal protec-
tive equipment guidelines during the COVID-19 pandemic: A world-
wide survey study. The British Journal of Surgery, 107(11), e526–e528.
Pasay, J. M. C., Enguito, M. R. C., Robles, C. J., & Awa, A. L. (2015). Compli-
ance with standard precautions among hospital nurses in Ozamiz City,
Philippines. Journal of Multidisciplinary Studies, 4(1), 108–138.
Pengpid, S., Peltzer, K., Sathirapanya, C., Thitichai, P., de Moura, F.,
Villela, E., Rodrigues Zanuzzi, T., de Andrade Bandeira, F., Bono, S. A.,
Siau, C. S., Chen, W. S., Hasan, M. T., Sessou, P., Ditekemena, J. D.,
Hosseinipour, M. C., Dolo, H., Wanyenze, R. K., F. J., N. S., &
Colebunders, R. (2022). Psychosocial factors associated with adher-
ence to COVID-19 preventive measures in low-middle-income coun-
tries, December 2020 to February 2021. International Journal of Public
Health, 67, 1604398.
Pereira, F. M., Lam, S. C., Chan, J. H., Malaguti-Toffano, S. E., & Gir, E.
(2015). Difference in compliance with standard precautions by nursing
staff in Brazil versus Hong Kong. American Journal of Infection Control,
43(7), 769–772.
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing
evidence for nursing practice (10th ed.). Wolters Kluwer Health.
Raghupathi, V., & Raghupathi, W. (2020). The influence of education on
health: An empirical assessment of OECD countries for the period
1995–2015. Archives of Public Health, 78, 20.
Soper, D. S. (2021). A-priori sample size calculator for multiple regression
[Software]. https://www.danielsoper.com/statcalc. Accessed on
December 8, 2021
Taber, K. S. (2018). The use of Cronbach's alpha when developing and
reporting research instruments in science education. Research in Sci-
ence Education, 48(6), 1273–1296.
BERDIDA 11
https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/standard-precautions.html
https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/standard-precautions.html
https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/standard-precautions.htmlhttps://www.cdc.gov/niosh/newsroom/feature/needlestick_disposal.html
https://www.cdc.gov/niosh/newsroom/feature/needlestick_disposal.html
https://conferences.unusa.ac.id/index.php/SIHC19/article/view/506
https://conferences.unusa.ac.id/index.php/SIHC19/article/view/506
https://www.danielsoper.com/statcalc
Wong, E. L., Ho, K. F., Dong, D., Cheung, A. W., Yau, P. S., Chan, E. Y.,
Yeoh, E. K., Chien, W. T., Chen, F. Y., Poon, S., Zhang, Q., &
Wong, S. Y. (2021). Compliance with standard precautions and
its relationship with views on infection control and prevention
policy among healthcare workers during COVID-19 pandemic.
International Journal of Environmental Research and Public Health,
18(7), 3420.
World Health Organization. (2005). Practical guidelines for infection control
in health care facilities. Retrieved March 4, 2022 from https://stacks.
cdc.gov/view/cdc/11303
World Health Organization. (2003). Adherence to long-term therapies:
Evidence for action. World Health Organization. Retrieved September
8, 2022, from. https://apps.who.int/iris/bitstream/handle/10665/42682/
9241545992.pdf;jsessionid=824DF12D67BE3494B07A7CA3659E40F
5?sequence=1
How to cite this article: Berdida, D. J. E. (2022). Nursing staff
compliance and adherence to standard precautions during the
COVID-19 pandemic: A cross-sectional study. Nursing &
Health Sciences, 1–12. https://doi.org/10.1111/nhs.12998
12 BERDIDA
https://stacks.cdc.gov/view/cdc/11303
https://stacks.cdc.gov/view/cdc/11303
https://apps.who.int/iris/bitstream/handle/10665/42682/9241545992.pdf;jsessionid=824DF12D67BE3494B07A7CA3659E40F5?sequence=1
https://apps.who.int/iris/bitstream/handle/10665/42682/9241545992.pdf;jsessionid=824DF12D67BE3494B07A7CA3659E40F5?sequence=1
https://apps.who.int/iris/bitstream/handle/10665/42682/9241545992.pdf;jsessionid=824DF12D67BE3494B07A7CA3659E40F5?sequence=1
https://doi.org/10.1111/nhs.12998
	Nursing staff compliance and adherence to standard precautions during the COVID-19 pandemic: A cross-sectional study
	1 INTRODUCTION
	2 METHODS
	2.1 Aim
	2.2 Research design
	2.3 Study setting, participants, and sampling
	2.4 Ethical consideration
	2.5 Instrument
	2.6 Data collection
	2.7 Data analysis
	2.8 Validity and rigor
	3 RESULTS
	3.1 Participants' demographic profiles
	3.2 Participants' self-reported CSPS practice
	3.3 Mean scores on the CSPS domains according to participants' role designation
	3.4 Mean scores on FIASPS factors according to participants' role designation
	3.5 Correlation between FIASPS factors and CSPS domains
	3.6 Predictors of CSPS and FIASPS outcomes
	4 DISCUSSION
	4.1 Limitations and recommendations
	5 CONCLUSION
	6 RELEVANCE FOR CLINICAL PRACTICE
	ACKNOWLEDGMENTS
	FUNDING INFORMATION
	CONFLICT OF INTEREST
	DATA AVAILABILITY STATEMENT
	ETHICS STATEMENT
	REFERENCES