Review article:

Nurses’ Behavior in Preventing Healthcare Association Infections (HAIs) as an Effort of

Prevention and Infection Control Programs in Hospitals: A Structured Review

Emerita

Abstract
Background: Some evidences related to the Healthcare Association Infections (HAIs) influence
the need for infection control in hospitals. Prevention and infection control programs are the
compulsory services which must be implemented in the hospital. Those services are carried out by
applying universal precautions that aimed to protect the patients and healthcare workers from
infection. The compliance behavior of healthcare workers in the infection control programs can
reduce the number of HAIs up to 40% in the hospitals. Methods: The purpose of this structured
review is to identify, assess, and synthesize the best evidence on the compliance of infection
control implementation in hospitals. The Pubmed, EBSCO and Google Scholar databases were
accessed to find out the evidence about nurses’ behavior and HAIs using "infection" AND
"prevention" AND "control" AND “healthcare association infection” keywords. Result: In first
step, by using the following keywords ‘infection’ AND ‘prevention’ AND ‘control’ AND ‘healthcare
association infection’ from Pubmed (NCBI) databases, we found 601 articles. While Emerald Insight
revealed 926 articles, EBSCO HOST 395 articles, Indonesian Publication Index (IPI) 10 articles, and
Google Scholar 123 articles. The second step is by filtering the articles that have been obtained in the
first step with some filters' criteria such as “publication date 5 years”, “abstract”, and “full text
availability”. In the Pubmed database we found 587 articles, while Emerald Insight revealed 891
articles, EBSCO HOST 83 articles, Indonesian Publication Index (IPI) 0 articles, and google
scholar was revealed 17 articles. In the third step was summarizing those articles by filtering some
attributes (open access, retracted, peer reviewed), then we found 51 articles in Pubmed database,
while 7 articles were found in the Emerald Insight database, 19 articles in EBSCO HOST, 0
articles in the Indonesian Publication Index (IPI), and 5 articles in the Google Scholar database.
Finally, according to inclusion criteria such as behavior, perception, and performance, and
exclusion criteria such as intervention and implementation, we found 6 articles in Pubmed, 0
article in Emerald Insight, 2 articles in EBSCO HOST, 0 article in the IPI, and 4 articles in the
google scholar database.

Keywords: infection, prevention, control, Healthcare Association Infection

Introduction
This study describes how behavior could affect the incidence of HAIs in hospitals. In this study
also provides steps or strategies in searching journals in accordance with the research title. The
purpose of this study was to identify whether behavior could affect the incidence of HAIs in
hospitals. The incidence of HAIs is considered as the successful indicator of the prevention and
infection control implementation in hospitals. (Sarani et al., 2015)

Search strategy
There are many various of databases of journals, both in Indonesia and worldwide. Some journal
databases in Indonesia such as google scholar (http://www.google.scholar.com), and Indonesian
Publication Index (IPI). While international journal databases i.e. Pubmed
(http://www.NCBI.nih.gov), EBSCO HOST, and Emerald Insight.

Study selection
Basically, the aim of this study method is to find out whether behavior could affect the incidence
of HAIs in hospitals or not. Firstly, we have to be able to determine the keywords to get journals
that suitable for our research. After that, we filtering the last five years publications, both in
abstract and full-text format. Then we proceed by filtering based on the access, retracted, and peer
reviewed criteria. Finally, we determine the articles by determining the inclusion and exclusion
criteria. The inclusion criteria were behavior, perception and performance of nurses. For exclusion
criteria such as intervention and implementation. We may use Sci-Hub access through this
following link (http:www.sci-hub) by copying the DOI code in the journal and then pasting it into
sci-hub, then the whole journal will be displayed.

Search strategy

Table 1.1: Search Strategy

Pubmed (PMC) Emerald Insight EBSCO HOST Indonesian GOOGLE

NCBI Publication SCHOLAR
Index (IPI)
First Keyword Keyword Keyword Keyword Keyword
step ‘infection’ AND ‘infection’ AND ‘infection’ AND ‘infection’ AND ‘infection’ AND
‘prevention’ AND ‘prevention’ AND ‘prevention’ AND ‘prevention’ ‘prevention’
‘control’ AND ‘control’ AND ‘control’ AND AND ‘control’ AND ‘control’
‘healthcare ‘healthcare ‘healthcare AND ‘healthcare AND ‘healthcare
association association association association association
infection’ infection’ infection’ infection’ infection’

601 articles 926 articles 395 articles 10 articles 123 articles

Second Terms fillters Terms fillters Terms fillters Terms fillters Terms fillters
step ‘publication date ‘publication date ‘publication date ‘publication date ‘publication date
5 years’ , 5 years’ , 5 years’ , 5 years’ , 5 years’ ,
‘abstract, full text ‘abstract, full text ‘abstract, full text ‘abstract, full text ‘abstract, full
availability’ availability’ availability’ availability’ text availability’

587 articles 891 articles 83 articles 0 articles 17 articles

Third Article attributes Article attributes Article attributes Article attributes Article
step (open access, (open access, (open access, (open access, attributes (open
retracted, peer retracted, peer retracted, peer retracted, peer access, retracted,
reviewed’) reviewed’) reviewed’) reviewed’) peer reviewed’)

51 articles 7 articles 19 articles 0 articles 5 articles

Fourth Inclusion criteria Inclusion criteria Inclusion criteria Inclusion criteria Inclusion criteria
step (behaviour,percep (behaviour,percep (behaviour,percep (behaviour,perce (behaviour,perce
tions,performance tions,performance tions,performance ptions,performan ptions,performan
)of nurse and )of nurse and )of nurse and ce)of nurse and ce)of nurse and
exclusion criteria exclusion criteria exclusion criteria exclusion criteria exclusion criteria
(intervention, (intervention, (intervention, (intervention, (intervention,
implementation) implementation) implementation) implementation) implementation)

6 articles 0 articles 2 articles 0 articles 4 articles

Results of the search

There are 12 articles that supported the research title in our study. Six of 12 articles show that the
knowledge, attitudes, and behavior could affect the incidence of HAIs in hospitals in terms of
prevention and infection control implementation. While 5 articles suggested that nurses’
perceptions on prevention and infection control affected the incidence of HAIs in hospitals.
(Honarbakhsh et al., 2018). Furthermore, an article stated that the prevention and infection control
in hospitals is a manipulation by that hospital.

Appraisal of the Methodological Approaches

This study has 5 descriptive articles using a qualitative approach, to understand more about
prevention and control of HAIs in hospitals. In a qualitative approach more often used in case
studies in the prevention and control of infection by interview and observation methods. (Jackson
et al., 2014), while 7 articles used quantitative methods, which analyzed by descriptive and cross-
sectional approach I order to assess the relationship between independent and dependent variables
(MOON and JANG, 2018). Quantitative research using a cross sectional study approach. This
approach was aimed to assess the relationship of knowledge, attitudes and behaviors of nurses in
preventing and controlling the infection in hospitals which used questionnaires and observations.
A Chi-Square test was used to analyze the univarite data, while the multivariate data was analyzed
by using multiple linear regression test (Wiseman, 2006).

Qualitative methods
Qualitative methods are often used in research, because of their realistic or interpretive nature.
This trait implies the perspective of individuals in expressing phenomena and the context of events
in these individuals, one of them is interview (Satiti et al., 2017). The interview is a method of a
particular approach such as using FGD (Focus Group Disscusion), individual interviews, and
phenomenology.
Interviews are useful to determine the behavior of nurses in preventing infection in hospitals. FGD
is an approach in the discussion group to find out the perceptions, knowledge, and attitudes of
nurses in preventing infection in hospitals.
In this case, there are articles in the title Infection as "a show": a qualitative study of nurses
infection prevention behavior using in-depth interviews with respondents to the study, and the
results of the interviews produce verbatim which is then analyzed using the framework method.
(Jackson et al., 2014)

Quantitave methods
Analytical descriptive with cross sectional approach is a kind of quantitative methods that are
often used in many studies. ("IPI ANALYSIS OF APPLICATION OF STANDARD
PRECAUTIONS IN PREVENTION AND CONTROL OF HAIs (HEALTHCARE
ASSOCIATED INFECTIONS) IN RAA SOEWONDO HOSPITAL PATI: View Article," nd).
A journal article which obtained in this study is about analyzing the relationship of nurses’
behavior in preventing phlebitis infection in the in-patient department. The result revealed that
there was a relationship between nurses’ behavior and prevention of infection. Processing of the
data using SPSS in the form of narratives and tables shows the relationship between variables.

Advantages and disadvantages of quantitative approaches

The quantitative methods prioritize a systematic and theoretical advantage. More researchers run
objectively and specifically. This quantitative method requires large samples. As an article about
the Performance of Healthcare Infection Control Guidelines among Hospital Nurse: A Structural
Equation Model that recruited 388 nurses. Those all 388 nurses were given questionnaires and
then the data obtained were analyzed using descriptive statistical analysis, reliability and a
Pearson's coefficient. (MOON and JANG, 2018)
As a qualitative study, a quantitative method also has disadvantages because researchers are not
subjective, their orientation is limited to values and numbers. Researchers are also having
limitation in the quality of data collection devices.

Summary
Nurses’ behavior includes knowledge, attitude, behavior, compliance and performance affect in
the prevention and infection control in health care facilities, which is very important when the
healthcare providers and policy makers are understand on the basic concepts of infectious diseases
in hospitals (Sopirala et al., 2014). The HAIs are infections that are acquired and develop in the
patients during their hospitalization, and being considered as a major problem in the hospitals. The
implementation of universal precaution is very important in the prevention and infection control
program in hospitals. The implementation of a prevention and infection control program must be
evaluated monthly, so that nurses are able to prevent and control infections in the hospital. (Zhou
et al., 2014).

References

Honarbakhsh, M., Jahangiri, M., Ghaem, H., 2018. Knowledge, perceptions and practices of
healthcare workers regarding the use of respiratory protection equipment at Iran hospitals. J.
Infect. Prev. 19, 29–36. https://doi.org/10.1177/1757177417724880
IPI ANALISIS PENERAPAN STANDARD PRECAUTIONS DALAM PENCEGAHAN DAN
PENGENDALIAN HAIs (HEALTHCARE ASSOCIATED INFECTIONS) DI RSUD RAA
SOEWONDO PATI : View Article [WWW Document], n.d. URL
http://id.portalgaruda.org/?ref=browse&mod=viewarticle&article=474413 (accessed 10.20.18).
Jackson, C., Lowton, K., Griffiths, P., 2014. Infection prevention as “a show”: A qualitative study
of nurses’ infection prevention behaviours. Int. J. Nurs. Stud. 51, 400–408.
https://doi.org/10.1016/j.ijnurstu.2013.07.002
MOON, J.E., JANG, K.S., 2018. The Performance of Healthcare-associated Infection Control
Guideline among Hospital Nurses: A Structural Equation Model. Iran. J. Public Health 47, 648–
657.
Sarani, H., Balouchi, A., Masinaeinezhad, N., Ebrahimitabas, E., 2015. Knowledge, Attitude and
Practice of Nurses about Standard Precautions for Hospital-Acquired Infection in Teaching
Hospitals Affiliated to Zabol University of Medical Sciences (2014). Glob. J. Health Sci. 8, 193.
https://doi.org/10.5539/gjhs.v8n3p193
Satiti, A.B., Wigati, P.A., Fatmasari, E.Y., 2017. ANALISIS PENERAPAN STANDARD
PRECAUTIONS DALAM PENCEGAHAN DAN PENGENDALIAN HAIs (HEALTHCARE
ASSOCIATED INFECTIONS). J. Kesehat. Masy. 5, 10.
Sopirala, M.M., Yahle-Dunbar, L., Smyer, J., Wellington, L., Dickman, J., Zikri, N., Martin, J.,
Kulich, P., Taylor, D., Mekhjian, H., Nash, M., Mansfield, J., Pancholi, P., Howard, M., Chase, L.,
Brown, S., Kipp, K., Lefeld, K., Myers, A., Pan, X., Mangino, J.E., 2014. Infection Control Link
Nurse Program: An interdisciplinary approach in targeting health care-acquired infection. Am. J.
Infect. Control 42, 353–359. https://doi.org/10.1016/j.ajic.2013.10.007
Wiseman, S., 2006. Prevention and control of healthcare-associated infection. Nurs. Stand. 20, 41–
45.
Zhou, Y., Zhang, D., Chen, Y., Zhou, S., Pan, S., Huang, Y., Ba-Thein, W., 2014. Healthcare-
Associated Infections and Shanghai Clinicians: A Multicenter Cross-Sectional Study. PLoS ONE
9, 1–9. https://doi.org/10.1371/journal.pone.0105838