الفهرس 
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Abstract
Nosocomial infection (NI) is considered the most frequent adverse event threatening patients’ safety worldwide and presents a challenge for all health personnel. It may involve not only patients but also any one comes in contact with the hospital including staff members, visitors, workers…etc. The risk of acquiring NI is especially significant in the intensive care units (ICUs) where the most critical patients are clustered together. As a result, isolation precautions are developed to identify and reduce the risks of acquiring and transmitting NIs among individuals.
Nurses, who are providing consistent, around the clock care for ICU patients are of a great importance and they are the front line staff in infection prevention and control. They should rely on the nursing process to assess the possibility of infections and apply the appropriate precautions. It is expected of them to comply with the recommended precautions in the clinical settings. But unfortunately compliance of nurses to infection control practices is scanty, therefore studies to describe the practice of infection control guidelines by nurses is essential. Specifically, this study was done to identify the compliance of nurses with isolation precautions and determine factors hindering their compliance with these precautions.
The design of the study was a descriptive correlational. This study was carried out in seven ICUs (General ICU ”unit I”, General ICU ”unit II”, General ICU ”unit III”, Medical ICU, Respiratory ICU, Neurosurgery ICU and Emergency anesthesia ICU) at the Alexandria Main University Hospital. The sample of the study was a convenient of 100 nurses working in the previously mentioned settings and providing a direct care to isolated patients.
Tools of the study:
Two tools were developed by the researcher and used to collect the data:-
Tool I: Nurses’ Isolation Precautions Compliance Checklist to assess the compliance of critical care nurses with isolation precautions. It consists of a list of isolation precautions that was observed twice by the researcher. In addition, socio-demographic data of the nurses was obtained.
Tool II: Factors Hindering Critical Care Nurses Compliance with Isolation Precautions Structured Interview Schedule which was based on Health Belief Model (HBM) to study factors that hinder compliance of critical care nurses with isolation precautions. It consists of questions about HBM six constructs (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy) to be answered by the studied nurses.
` The tools were tested for content validity by 5 experts in the fields of Critical Care Nursing and Critical Care Medicine. A pilot study was conducted on 10 nurses in order to test the clarity and applicability of the tools and necessary modifications were done.
Nurses’ practice of isolation precautions were observed by the researcher twice in two shifts (morning and evening) while they are providing care for patients in need for isolation using tool one (appendix III). Nurses who achieved a score of 70% or more of the available opportunities to practice a single precaution were considered compliant with that precaution, while nurses who achieved a score of less than 70% were considered non-compliant.
Upon completion of nurses’ observation, each observed nurse was interviewed individually during the break time using the Arabic form of tool two (appendix V) for about 15 minutes to respond to HBM constructs’ statements in order to determine factors that hinder their compliance with isolation precautions.
The main findings of the present study were that more than half of the studied nurses were in the age group 30 years to less than 40 years old and the majority were female. Concerning their qualifications, more than half of them had diplomat in nursing and only 13.3% had a bachelor degree in nursing. As regard to working experience in the ICU, 37.8% of nurses had 10 years to less than 15 years of experience while only 7.8% had more than 20 years of experience. On the other hand, 20% of the nurses attended lectures in infection control and 73.3% was vaccinated against HBV. It was also found that 65.6% of the nurses reported a history of previous exposure to an infection.
Observation of nurses’ compliance with isolation precautions revealed that nurses were non-compliant with precautions of hand washing, hand disinfection, donning/ doffing mask and gown, safe patient placement, safe handling of linen and laundry, safe reprocessing of patient care equipment and instruments, safe disposal of sharps and precautions specific to family visits.
On the other hand, they were found compliant with donning/ doffing gloves, safe injection practices and precautions specific to disposable patient-care items.
Concerning factors hindering nurses’ compliance with isolation precautions, this study revealed that that 100% of the study nurses agree that understaffing and unavailability of places for patient isolation were the most hindering factors followed by lack of knowledge, lack of training and lack of managerial support by 93.3%. Moreover, 78% of them agree that lack of subjective norms and unavailability and inadequacy of equipment and supplies were considered among their factors for non-compliance with isolation precautions.
Furthermore, 80%, 73.3%, 40%, 33.3% and 33.3% of nurses respectively agree that emergency situations, workload, time constraints, forgetfulness and psychological factors were also reasons for non-compliance with isolation precautions. In addition, intention, belief, attitude and self-efficacy were considered hindering factors by 13.3% of nurses as well as perceiving susceptibility, severity and cues to action by 6.7% of nurses.
A significant positive correlation was found between the isolation precautions that nurses were non-compliant with and factors of intention, belief, attitude, psychological factors, psychological factors, knowledge, training, workload, managerial support, subjective norms and availability of equipment and supplies.
This study also revealed that nurses’ compliance with isolation precautions was high between female and older nurses who were holding a bachelor degree and having more than 20 years of experience in the ICU. Furthermore, nurses who attended an infection control lectures were more compliant than who didn’t while nurses who were previously infected were less compliant.
It can be concluded that critical care nurses are to some extent compliant with donning and doffing gloves, safe injection practices and safe management of disposable patient-care items, but they are non-compliant with the rest of the precautions. On the other hand, Nurses viewed that understaffing, unavailability of supplies, workload, lack of knowledge, lack of training, lack of managerial support were the most hindering factors. Furthermore, compliance of nurses increases if they were female, older, experienced, holding a bachelor degree and attending to an infection control lectures.
Finally, it can be recommended that:
• Provision of continuous supervision of nurses during their practice with motivation and positive feedback on performance must be done.
• Reasons for non-compliance should be considered by an infection control committee, supervisors and administrators.
• A written form of isolation precautions should be available all the time for critical care nurses at all ICUs in both Arabic and English language.
• Proper distribution of the ICU nurses between different units and different shifts to maintain reasonable nurse-patient ratio must be ensured.
• Hospital policy should be directed to provide adequate resources all the times.
• Educational programs should be conducted to raise critical care nurses awareness of nosocomial infection and isolation precautions.
• The position of infection control link nurse should be created in all units with adequate preparation, clear job description and authority.