الفهرس 
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Abstract
Introduction
Infection prevention and control is a key pillar in the realm of patient safety due to the threats posed by HCAIs to hospitalized patients. Patients admitted in surgical units are particularly at increased risks of contracting all types of HCAIs with majority contracting SSIs. Such infections among surgical patients are some of the most adverse yet preventable events in surgical care delivery causing significant morbidity and mortality. Strict compliance with recommended IPC practices has been documented to significantly reduce the burden of HCAIs and especially SSIs.
Nurses working in the surgical units have a unique opportunity to reduce the potential for development of HCAIs. Utilizing their skills and knowledge of nursing practice, they can facilitate patient recovery while reducing complications related to infections by utilizing CDC and hospital recommended IPC practices during patient care. The nurse is an important collaborator of healthcare team who leads in practicing prevention strategies to protect the patient from infection. Consequently, this study aimed at investigating the extent of nurses’ compliance with IPC practices and related barriers to compliance at the surgical units of the Moi Teaching and Referral Hospital.
Materials and Method
A descriptive cross sectional study design was used in the current study to collect data at the in-patient surgical units of Moi Teaching and Referral Hospital, in Eldoret Kenya. A random sample of 100 nurses, proportionately allocated to six surgical wards of the Moi Teaching and Referral Hospital, and fulfilling the inclusion criteria were included in the study.
Tools:
Two tools were utilized in conducting this study for data collection.
Tool I: Surgical Nurses’ Compliance with IPC Practices Questionnaire
This tool was developed by the researcher after extensive review of related literature. The tool’s aim was to assess the nurses’ compliance to IPC practices while carrying out nursing procedures. It comprised of three parts as follows;
Part 1: Nurses Biosocio-demographic Data
This part consisted of questions that elicited information on nurses’ characteristics such as age, gender, education level, ranking, employment, hepatitis B vaccination status, years of work experience, history of sharps injury and attendance of courses relevant to IPC practices as well as a serial code identifier of the questionnaire.
Part 2: Nurses’ Compliance with IPC Practices
This part consisted of 43 statements relating to the assessment of nurses’ frequency of compliance with IPC practices on a 3 point likert scale. The compliance practices included: Hand hygiene, personal protective devices, safe injection practices, linen management, waste disposal and surgical dressing aseptic technique.
Part 3: Nurses’ Perceived Barriers to Compliance with IPC Practices.
This part included 16 statements that prompted the nurses’ agreement or disagreement on a 3 point likert scale, about perceived barriers to compliance relating to individual, organizational, supplies, patient as well as environmental barriers to compliance.
Part 4: Open ended questions on suggestions for improvement.
This part included an open ended question on nurses’ suggestions for improvement as regards to IPC practice in the hospital.
Tool II: Infection Prevention and Control Compliance Observation checklist
The tool was derived and developed with permission from the authors. This tool was used to record the nurses’ observed compliance with IPC practices as they perform nursing procedures. The tool had the following practice domains; Hand hygiene, personal protective devices, safe injection practices, linen management, waste disposal and surgical dressing aseptic technique.
Data collection process
Simple random sampling using proportionate allocation method from all surgical wards was used to obtain the total sample size of 100 surgical nurses. Randomly selected nurse participants were observed for 2-3 hours using concealed observations for opportunities during nursing interventions requiring application of IPC practices. Individual nurses were only observed once for the specified IPC practice application. After completing all the observations, the observed nurses were interviewed using tool (I).
Main results of the current study were as follows
• A total of 100 nurses consented and participated in this study, 76.0 % were females, 65% were within the age group of 30 – 39 years. On nursing education level, 64% of the studied nurses had a diploma in nursing; with 35% having a bachelor’s degree. Half of the nurses (50%) had 5-10 years of clinical experience. Seventy nine percent had been vaccinated against Hepatitis B, of those who were vaccinated, 65.8% had received all the three doses recommended for protection, 30.4% did not complete the recommended doses of vaccination while 4.8% were not sure if they completed. None of the nurses’ characteristics were statistically significant with compliance with IPC practices.
• Sixty nine percent of the nurses were compliant with recommended HH practices; the least complied moment was when nurses were in contact with different patients at 47%. Nearly all the nurses (98%) when in contact with any body fluids (blood, excretions or secretions) indicated that they “always” washed their hands.
• The results revealed a near total compliance in PPE (gloving use) with 99% of the nurses being compliant as compared to use of goggles (25%) and gowns (37%)
• Slightly more than two thirds of the participants (68%) reported that they did not recap used syringes. Seventy percent of the nurses were compliant with safe injection. During wound dressing, 86% of the participants’ utilized prescribed IPC practices adequately.
• Comparison between observed and self-reported compliance shows statistically significant difference (p =0.001) implying that nurses tend to overestimate their compliance with recommended IPC practices more than they actually do under observations.
• In regards to the perceived barriers to compliance, the study findings show that the majority of nurses believed that high workload (70%), lack of PPEs (70%), and emergency situations (64%), are the main contributors to non-compliance.
• There was a significant negative correlation between patient related factors (P value=0.004) and supplies related factors (P value=0.04) with compliance. This implied the higher the perception of barriers the lower the compliance with IPC practices.
Conclusions and Recommendations
Based on the findings of this study; it can be concluded that most of the nurses complied with the recommended IPC practices. However, compliance varied widely across different domains of IPC practice indications. There was near total compliance with IPC practice indications for; use of PPEs -gloving, waste management and linen management. On the other hand, hand hygiene, injection safety and wound aseptic techniques recorded the least compliance. These can imply that the hospital has succeeded in engendering the safety culture shift in use of gloves, waste and linen management.
There was no significant association between any of the nurses’ social demographics or work related characteristics with their compliance with IPC practices. Self-reported compliance with IPC practices was statistically significantly higher in hand hygiene practices and use of PPEs.
High workload, lack of PPEs, and emergency situations were the main contributors to non-compliance with IPC practices. High perception of patient related factors and supplies related factors showed a significant negative relationship with compliance.
Recommendations
• The hospital should increase the duration of Infection prevention and control trainings and Continuous Medical Education programs to disseminate latest evidence based IPC practices.
• Regular monitoring of IPC practice implementation through random infection control spot checks of the hospitals.
• The hospital should ensure adequate supply of PPEs, ABHRs and equipments to support effective implementation of IPC practices.
• Nurses should be encouraged to be vaccinated against Hepatitis B
• Further studies on nurses and other health care workers compliance with IPC practices should be considered.