Knowledge, attitudes, and practices of Jamaican healthcare workers on nosocomial infection control

Abstract

Objectives

The emergence of deadly infections such as methicillin-resistant Staphylococcus aureus and COVID-19 (SARS-CoV-2) highlights the need for effective infection control (IC) procedures in healthcare facilities. The aim of the study was to assess the knowledge, attitudes, and practices (KAP) of healthcare workers (HCWs) on IC procedures.

Methods

A cross-sectional survey was conducted among HCWs in western Jamaica from May to August 2015. A questionnaire based on the Jamaican Health Facilities Infection and Control Policies and Procedures Manual was used to collect data on staff training in IC, and their KAP of IC. Summary statistics, ANOVA, and multiple linear regression were applied for data analyses.

Results

Among 227 participants, the mean knowledge scores were statistically higher among the younger HCWs, Physicians/Nurses, and those in clinical units. Older HCWs, non-physicians/nurses, non-clinical unit workers, HCWs at Western Regional Hospital A, and those who received ongoing IC training scored higher on attitude. The practice scores were significantly correlated with the attitude scores but not the knowledge scores. The attitude score was a significant predictor for IC practices.

Conclusions

Six knowledge and three attitude variables were significant predictors of IC practices that the Western Regional Health Authority Officials can use to implement measures to improve IC practices among HCWs.

Highlights

• • Limited data exist on infection control practices of healthcare workers in Jamaica.

• • 60% of healthcare workers received infection control training in the last 3 years.

• • Only 22.5% of healthcare workers received ongoing infection control training.

• • Knowledge scores ranged from 49% to 99% and were significantly higher in younger workers.

• • Attitude score was a significant predictor of infection control practices.

Background

The emergence of deadly infections such as severe acute respiratory syndrome-associated coronaviruses SARS-CoV-1 and SARS-CoV-2 (COVID-19) highlight the need for effective infection control (IC) programs and proper training of healthcare workers (HCWs) to prevent infection transmission in healthcare facilities (Mehta et al., 2014).

Hospital-acquired infections (HAIs) are associated with significant morbidity, mortality, and cost. The World Health Organization (WHO) estimates that 1.4 million infections occur in hospitals daily worldwide (World Health Organization, 2011). HAIs occur at a rate of 3.5–12% among patients in developed countries but at a higher percentage (15–40%) among patients in critical care units (Lazzari et al., 2004; Nagao, 2013; World Health Organization, 2011). In the United States, 1/136 patients acquire an infection in a hospital, resulting in 90,000 deaths annually. The rates of HAIs can be greater than 20% in developing countries (Pittet, 2005). Data on HAIs in the Caribbean are not readily available. A review of reports on gram-negative bacterial infections in adult ICUs in Latin America and the Caribbean indicates a high rate of infections (24% in Argentina and 57% in Brazil) (Luna et al., 2014). In Mexico, 450,000 HAIs were estimated to occur annually, with 35 deaths/100,000 neonatal admissions (Zaidi et al., 2005).

Healthcare workers (HCWs) are constantly exposed to infectious agents. They are susceptible to occupational exposures to agents such as hepatitis B and C viruses (HBV and HCV) and human immunodeficiency virus (HIV) from needle stick injuries, blood, and other bodily fluids (Foster et al., 2010a; Nienhaus et al., 2012; Schmid et al., 2007). Data from the epidemiology (EPI)-Net system show that hospital workers acquire approximately 30 needle stick injuries per 100 beds per year (National Infection Prevention (IP) and Patient Safety (PS) Advisory Technical Working Group (ATWG), 2012). The WHO estimates that about 2.5% of HIV cases and 40% of HBV and HCV cases among HCWs worldwide result from bloodborne exposures and nosocomial infections (World Health Organization, 2011). In developing countries, these risks are amplified, and the protection of HCWs is challenging to maintain (Sagoe-Moses et al., 2001; Sepkowitz and Eisenberg, 2005). Since it is impossible to identify all patients with these infections, universal precautions should be followed with every patient (Occupational Safety and Health Administration).

In Jamaica, 1.3% of the adult population is affected by HIV; 0.29% and 1.71% are chronically infected with HBV and HCV, respectively (Coalition for Global Hepatitis Elimination, 2020; World Health Organization, 2021). An HBV survey conducted in Jamaica reported that 60% of 1537 HCWs presenting for HBV vaccinations reported needle stick injuries, and 48% reported that during the delivery of babies, blood or amniotic fluid splashed on their faces (Figueroa et al., 1994). HCWs are expected to follow universal precautions. However, studies that assessed Jamaican HCWs’ compliance with universal precautions found that IC compliance was insufficient (Foster et al., 2010a; McGaw et al., 2012; Watson et al., 2014). To improve IC practices, it is essential to assess the knowledge, attitudes, and practices (KAP) of HCWs, identify barriers to compliance, and implement strategies to overcome the deficiencies.

Material and methods

Ethical approval

Ethical approval for the study was obtained from the University of Alabama at Birmingham Institutional Review Board, the Advisory Panel of Ethics and Medico-Legal Affairs, the Jamaican Ministry of Health, and the Western Regional Health Authority (WRHA).

Study site and participants

A cross-sectional survey was conducted among doctors, nurses, ward assistants, orderlies, and technicians from the WRHA of Jamaica from May to August 2015. The WRHA serves a population of approximately 600,581 people at 84 healthcare centers. Four hospitals participated in the study (Regional Hospital A, a Type A hospital in St. James, General Hospital B, a Type B hospital in Westmoreland, and General Hospitals C and D, Type C hospitals in Trelawny and Hanover, respectively). Type A hospitals provide comprehensive secondary and tertiary services. Type B and Type C hospitals provide primary and essential secondary services.

At the time of the study, a total of 533 HCWs (105 doctors of all categories, 241 nurses, 141 ward assistants, orderlies, attendants, and 46 technicians and technician assistants) were working in the four hospitals, and 374 were available and agreed to participate. Participation in the study was voluntary, and no incentive was given.

Inclusion and exclusion criteria

All doctors, nurses, ward assistants, orderlies, and technicians employed by the health agency were invited to participate and were included in the study based on their willingness to participate. HCWs outside of the categories listed above and who were not employed by the health agency were excluded from the study.

Questionnaire

The questionnaire consisted of questions on sociodemographic information, IC training experiences, and KAP of IC (18 questions each assessed participants’ knowledge and attitudes toward IC, and 27 questions evaluated participants’ IC practices) based on materials covered in the Jamaican Health Facilities Infection and Control Policies and Procedures (ICPP) Manual used to train HCWs (Jamaican Ministry of Health, revised 2000). The content of the ICPP manual is extensive and comprehensive and covers information on Universal Precautions, isolation procedures, monitoring and surveillance, and reporting infection transmission events.

The responses to the KAP questions were presented on a five-point Likert scale (Supplemental Material 1). The questionnaire was reviewed by Jamaican health officials responsible for infection control and revised for clarity and cultural sensitivity. It was then pilot tested among 5 doctors/nurses, 5 ward assistants/orderlies, and 2 technicians like those recruited for the study and then revised before use.

Statistical analyses

Statistical analysis was conducted using the Stata statistical program (V16.1. StataCorp LLC, College Station, Texas). Summary descriptive statistics were applied to all variables. Chi-square and Fisher’s exact tests were used to compare the response rates among categorical variables. The Knowledge Scores were the sum of all correct responses to the 18 knowledge questions. The Attitudes Scores and the Practice Scores were the sums of responses based on the five-point Likert scale. Spearman’s correlation and one-way analysis of variance (ANOVA) were used to compare the mean scores among targeted categorical variables. Multiple linear regression was used to assess the contribution of the sociodemographic status, IC training, and potential explanatory variables to the KAP scores. All tests were two-tailed, and p-values <0.05 were considered significant.

Results

Participants and characteristics

Of the 374 HCWs contacted, 227 (60.7%) gave signed informed consent and completed the questionnaire. Distributions of the HCW sociodemographic characteristics and IC training experiences are illustrated in Supplemental Tables 1. The professional groups were further combined into two categories: the “Physicians/Nurses” versus “All others.” Overall, 85.6% of the participants were females, 54.2% were physicians or nurses, 59.6% were working in clinical units, 61.4% received IC training within the last 3 years, 59.0% reported having an ICPP manual in their department, and 22.5% reported they had recently received ongoing IC training. The “Physicians/Nurses” group was significantly different from the “All others” group in terms of sociodemographic variables and IC training experiences (Table 1). Physicians/Nurses were younger than the “All others.” More Physicians/Nurses (90.8%) were in “Clinical units” versus 76.0% in “Other units” among the “All others.” The type of infection control training (Formal, Informal, Both, Neither) was evenly distributed for Physicians/Nurses, but 50% of “All others” answered “Neither.” Almost 80% of Physicians/Nurses reported that an ICPP manual was present in their unit, compared to only 34% of the “All others.” Two-thirds of Physicians/Nurses and 90% of “All others” reported receiving IC training at Hospital A; more than 70% of Physicians/Nurses and 86% of “All others” reported that they did not receive ongoing IC training (Table 1).

Table 1.

Study participants’ sociodemographic and clinical characteristics by professional group.

Variable	Professional Group			p-Value
	N (%) a	Physicians/Nurses	All others b
Hospital, N = 227
Regional Hospital A	179 (78.8)	87 (70.7)	92 (88.5)	0.001
Other General Hospitals c	48 (21.2)	36 (29.3)	12 (11.5)
Age (years), N = 204
<30	56 (27.5)	41 (38.7)	15 (15.3)	<0.001
30–39	61 (29.9)	44 (41.5)	17 (17.4)
40–49	39 (19.1)	14 (13.2)	25 (25.5)
≥50	48 (23.5)	7 (6.6)	41 (41.8)
Gender, N = 222
Female	190 (85.6)	109 (90.8)	81 (79.4)	0.016
Male	32 (14.4)	11 (9.2)	21 (20.6)
Current work units, N = 223
Clinical units d	133 (59.6)	108 (90.8)	25 (24.0)	<0.001
Other units e	90 (40.4)	11 (9.2)	79 (76.0)
Experience (year), N = 220
<2 years	56 (25.4)	31 (26.1)	25 (24.8)	0.010
2 to <5 years	38 (17.3)	22 (18.5)	16 (15.8)
5 to <10 years	46 (20.9)	33 (27.7)	13 (12.9)
≥10 years	80 (36.4)	33 (27.7)	47 (46.5)
Type of infection control training, N = 220
Formal	49 (22.2)	27 (22.1)	22 (22.5)	0.006
Informal	43 (19.6)	31 (25.4)	12 (12.2)
Both	43 (19.6)	28 (23.0)	15 (15.3)
Neither	85 (38.6)	36 (29.5)	49 (50.0)
Training sites, N = 129
Regional hospital A	96 (74.4)	53 (65.4)	43 (89.6)	0.002
Others General Hospitals f	33 (25.6)	28 (34.6)	5 (10.4)
Have a Jamaican ICPP manual g , N = 222
Yes	131 (59.0)	97 (79.5)	34 (34.0)	<0.001
No	38 (17.1)	6 (4.9)	32 (32.0)
Not sure	53 (23.9)	19 (15.6)	34 (34.0)
Received ongoing training, N = 222
Yes	50 (22.4)	36 (29.7)	14 (13.9)	0.005
No	172 (77.6)	85 (70.3)	87 (86.1)

^aNumbers do not always add up to total due to missing responses.

^bAll other profession: ward assistant, lab technician, porters, sanitation, and housekeeping.

^cOther General Hospitals include Public General Hospitals B, C, and D.

^dClinical work units: Internal medicine, surgery, pediatric, obstetrics and gynecology, accident and emergency, ICU, psychiatry, renal, maternity, radiotherapy, dietary, hemodialysis, otorhinolaryngology, and orthopedic.

^eOther work units: Milestone, operation theater, lab, sterilization, administration, transport, and general areas.

^fOther training sites include Public General Hospitals B, C, and D.

^gICPP manual: Infection Control Policies and Procedures Manual.

Knowledge assessment

The corrected response rate for the 18 knowledge questions ranged from 49.3% to 98.7%. The mean knowledge scores (maximum score was 26) were statistically higher among the younger age groups (p < .01), the Physicians/Nurses group (p < .001), and those in the clinical units (p < .05) (Table 2A). Significant differences in the knowledge scores were also observed in the Physicians/Nurses group compared to “All other” participants. Additionally, the hospital sites, sex, working experience length, and IC training type did not appear to influence the mean knowledge scores significantly.

Table 2.

Comparisons of the mean scores of the infection control knowledge, attitudes, and practice against selected explanatory variables.

Category	N	Mean	Standard Deviation	Median	Min, Max	Range
A. Knowledge scores
Hospital
Regional Hospital A	155	21.83	3.3	23	9, 26	17
Other General Hospitals a	42	22.1	2.7	22	13, 26	13
Age (year)**
<30	50	22.8	2.6	23	15, 26	11
30–39	58	21.7	3.0	22	14, 26	12
40–49	39	21.9	3.1	23	15, 26	11
≥50	39	20.4	3.2	20	13, 26	13
Professional group***
Physicians/Nurses	106	22.8	2.8	23	9, 26	17
All others b	91	20.8	3.3	21	13, 26	13
Work units*
Clinical units	121	22.2	3.2	23	9, 26	17
Other units c	78	21.2	3.1	21	14, 26	12
B. Attitude scores
Hospital**
Regional Hospital A	148	59.8	6.0	60	38, 72	34
Other Regional Hospitals a	43	55.6	7.0	57	38, 67	29
Age (year)*
<30	51	56.8	7.45	58	38, 71	33
30–39	52	59.3	5.7	59.5	42, 70	28
40–49	37	60.5	6.2	62	45, 72	27
≥50	40	60.6	6.0	60	50, 71	21
Professional group*
Physicians/Nurses	111	58.1	6.2	59	38, 71	33
All others b	80	60.0	6.7	60.5	38, 72	34
Work unit*
Clinic units	121	58.6	6.1	59	38, 72	34
Other units c	70	59.7	7.2	60.5	38, 71	33
Training sites*
Regional Hospital A	82	60.6	5.3	61	48, 72	24
Other General Hospitals a	28	57.6	6.0	58	44, 66	22
Received ongoing training***
Yes	45	61.9	4.5	59	52, 71	19
No	149	58.1	6.7	60	38, 72	34
C. Practice scores
Hospital**
Regional Hospital A	137	41.0	3.4	60	38, 72	34
Other General Hospitals a	43	39.2	3.3	57	38, 67	29
Age (year)
<30	51	39.6	3.9	58	38, 71	33
30–39	52	40.7	3.6	59.5	42, 70	28
40–49	37	41.1	2.8	62	45, 72	27
≥50	40	41.5	2.4	60	50, 71	21
Professional group**
Physicians/Nurses	111	40.0	3.5	59	38, 71	33
All others b	80	41.6	3.2	60.5	38, 72	34
Work unit**
Clinic units	124	40.0	3.5	59	38, 72	34
Other units c	53	41.8	3.1	60.5	38, 71	33

^aOther General Hospitals: Public General Hospitals A, B, and C in the region.

^bAll other Profession: ward assistant, lab technician, porters, sanitation, and housekeeping.

^cClinical Work Unit: Milestone, operation theater, lab, sterilization, administration, transport, and general areas.

*One-way ANOVA. *p-value < .05; **p-value < .01; ***p-value < .001.

Attitude assessment

Three of the eighteen attitude questions had more than 30% missing responses and were excluded from the final analysis. A value of 72 was the maximum score for the attitude assessment. The study found that 8 of the 18 Attitude response rates significantly differed between the Physicians/Nurses and the “All others” (Figure 1). Participants scored higher if they were older (p < .05), in the “All other” group (p < .05), worked in the “Other units” (p < .05), or Hospital A (p < .05), and received ongoing IC training (p < .001) (Table 2B).

Figure 1.

Comparisons of the infection control attitude assessment among the study participants. The assessment was based on the participants’ responses to 18 survey questions in the Attitudes of Infection Control category (Supplemental Materials 1, Questions Q29–Q46). The figure illustrates eight responses that are significantly different between the “Physicians/Nurses” group and the “All others” group.

Practice assessment

A total of 17 practice questions with less than 200 responses were excluded. The final statistical analysis was based on a maximum number of 192 participants. Significant differences were observed between the Physicians/Nurses and other participants for questions related to hand washing, use of PPE, and patient care (Figure 2). The mean practice scores were statistically higher for participants from Hospital A (p < .01). Participants in non-clinical units scored higher than those in the clinical units (p < .01) (Table 2C). Additionally, the practice scores were significantly correlated with the attitude scores (r = 0.409, p < .001) but not with the knowledge scores (r = 0.075, p = .966).

Figure 2.

Comparisons of the infection control practice assessment among the study participants. The assessment was based on the participants’ responses to 27 survey questions in the Practice of Infection Control category (Supplemental Materials 1, Questions Q47–Q73). The figure illustrates eight responses that are significantly different between the “Physicians/Nurses” group and the “All others” group.

Practice prediction

Multiple linear regression was used to determine what exploratory factors could influence HCWs’ practices to prevent infection transmission in health facilities. Using the practice score as the outcome variable against the sociodemographic and IC training variables, only the hospital and the work units significantly correlated to the practice scores when controlling for the age and sex factors (Table 3A, Model 1). However, the model could explain only 9.7% of the variations contributing to the practice score.

Table 3.

Multiple linear regression models to predict the mean scores of infection control practices.

Outcome Variable: Practice score	Coef.	SE	p-Value	Model Statistics
				Adj R-squared	p-Value
A. Model 1.	Variables: Sociodemographic and infection control training (Q1 to Q10)
				0.0966	0.0002
Q2. Hospitals (other hospitals)	−1.62	0.64	0.012
Q7. Work units (all other units)	1.57	0.59	0.009
Model constant	40.54	0.38	0.000
B. Model 2.	Variables: Knowledge (Q11 to Q28) selected 12 variables based on univariate regression + hospital + work units + professional group
				0.2575	<0.001
Q15. Wash hands using antiseptic soap solution	−2.07	0.89	0.021
Q17. Patient hand washing	−12.35	3.26	0.000
Q18b. Sources of infection: active disease	−1.38	0.66	0.040
Q18d. Source of infection: colonized by agent	1.11	0.54	0.042
Q19e. All PPE to be used in isolation units	−1.22	0.57	0.035
Q21. Disinfection for cleaning environment	−1.63	0.68	0.017
Q23. Disposal of body wastes from patients	1.19	0.51	0.021
Q28. Patients never leave isolation area	−1.46	0.54	0.059
Q2. Hospital: Others	−1.23	0.59	0.040
Model constant	61.35	3.80	0.000
C. Model 3.	Variables: Attitudes (Q29 to Q46) selected 12 variables based on univariate regress + hospitals + work units + professional group
				0.2838	<0.001
Q29. Regular infection control training	0.63	0.22	0.005
Q34. Importance of hand hygiene to institution	1.34	0.62	0.032
Q38. Effectiveness of hand hygiene training	1.02	0.33	0.002
Q39. Effectiveness of patients reminding	−0.36	0.20	0.081
Q40. Importance of PPE use	0.92	0.35	0.009
Q42. Gloves protection from needles	1.08	0.26	0.000
Model constant	21.53	3.44	0.000
D. Model 4.	Variables: selected 7 knowledge variables, 5 attitudes variables + knowledge score + attitudes score + hospitals + work units + professional group
				0.3764	<0.001
Mean of the attitude scores	0.14	0.04	0.001
Q15. Wash hands with antiseptic soap solution	−1.87	0.86	0.031
Q17. Patient hand washing	−9.63	3.04	0.002
Q18b. Sources of infection: active disease	−1.77	0.66	0.008
Q18d. Source of infection: colonized by agent	1.15	0.53	0.033
Q19e. All PPE to be used in isolation units	−1.25	0.56	0.027
Q21. Disinfection for cleaning environment	−1.50	0.66	0.025
Q34. Importance of hand hygiene to institution	0.99	0.59	0.097
Q40. Importance of PPE use	0.69	0.31	0.027
Q42. Gloves protection from needles	0.41	0.21	0.050
Model constant	40.10	5.01	0.000

Twelve knowledge responses that were significantly associated with the practice scores, based on univariate regression analysis, were included in multiple regression analysis. In the model, knowledge related to washing hands, patients should wash their hands before eating, identify persons as sources of infection, use all types of PPE and disinfectants for cleaning the environment, proper dispose of body wastes, and keep patients in isolation until significantly influence the practice scores. This model can explain approximately 25.75% of the variations in the practice score when controlling for the hospital, working units, and professional group (Table 3B, Model 2).

Model 3 included 11 attitude responses that were significantly associated with the practice scores based on univariate regression analysis. The importance of regular IC training, training in hand hygiene, and PPE use by HCWs significantly affected the practice score when controlling for the hospital, working units, and professional group (Table 3C, Model 3).

In the final multivariate regression model (Table 3D, Model 4), eleven knowledge variables, five attitude variables, and three sociodemographic variables were selected, resulting from the previous three regression analyses. The mean knowledge and attitude scores were also included in the final model. The study found that (1) the attitude score was a significant predictor for IC practices; (2) six knowledge-related variables and three attitude-related variables remained significant factors; (3) the hospital site, professional group, and working units were no longer significant exploratory factors in predicting the mean IC practice score. The ten variables in the final model can explain approximately 37.64% of the variations in predicting the practice score (Adjusted R ² = 0.3764, p < .001) when controlling for hospitals, working units, and professional groups.

Discussion

Training in IC differed significantly between Physicians/Nurses and “All other” HCWs. Nearly 30% of Physicians/Nurses, compared to 50% of “All others,” reported receiving no IC training. This lack of IC training by such substantial proportions of HCWs should be investigated by IC health officials and deficiencies that are found remedied. Copies of the ICPP manual should be placed in all units of the hospitals with full knowledge of each HCW regardless of the work unit and shift worked. Most of the IC training in the region was conducted at Hospital A. IC training should be conducted in all hospitals to ensure that all HCWs are IC compliant. Ongoing IC training should also be undertaken in each hospital to reinforce previous training and address unique IC aspects as infectious agents emerge or re-emerge. Previous studies have shown that IC knowledge among HCWs decreases over time, such that continuous training is essential to reduce the incidence of nosocomial infections (Suchitra and Lakshmi Devi, 2007).

Younger age groups, Physicians/Nurses, and Clinical units scored higher on IC knowledge. This may reflect more recent training of younger HCWs and the more intensive education of Physicians/Nurses and those in clinical units. Other studies have shown that educational level impacts IC knowledge scores (Aiken et al., 2003; Gruda and Sopjani, 2017). HCWs who were older from Regional Hospital A and those who received IC training from Regional Hospital A and ongoing IC training scored higher on the attitude scale. This indicates that experience, training, and environment largely influenced HCWs’ attitudes to IC. Thus, WRHA officials can plan to conduct more frequent IC training at each hospital site, gear training toward the different age groups of HCWs, and develop training geared toward changing attitudes. Participants other than Physicians/Nurses and those in non-clinical units scored slightly higher on attitude. Previous studies conducted in Jamaica show less than adequate compliance of HCWs with IC practices such as hand washing, use of all PPE including gloves, and not re-sheathing needles (Figueroa et al., 1994; Foster et al., 2010b; McGaw et al., 2012; Watson et al., 2014). Another study on IC compliance reported poor compliance among doctors with IC procedures such as hand washing, wearing gloves when taking blood from patients, and not re-sheathing used needles manually (Stein et al., 2003). Doctors also consistently de-emphasized the importance of complying with these guidelines, giving time constraints, emergencies, decreased dexterity with gloves, and inconvenient location of sharp disposal bins as reasons for non-compliance. WRHA officials need to look more closely into the attitudes of different types of HCWs and conduct IC training to improve their IC practices. Interestingly, the practice scores were significantly correlated with the attitude scores but not the knowledge scores. It is known that although necessary, knowledge is not enough to change behavior (Arlinghaus and Johnston, 2018). Personal awareness of why a particular behavior needs to be changed and training on how to make the change are essential.

The study identified six knowledge variables that can influence the IC practice score, including knowledge of hand hygiene of both HCWs and patients, identification of patients who are possible sources of infection, knowledge of proper PPE use in isolation areas, and disinfection for cleaning the environment. This knowledge is critical in controlling nosocomial infections and should be emphasized in training HCWs. Three attitude variables related to HCWs’ perception of the importance of hand hygiene to the institution, the necessity of using PPE, and whether HCWs felt that gloves protect from needle sticks or other puncture wounds significantly correlated with IC practice. WRHA officials should ensure that PPE, gloves, and sharp-disposal containers are readily available and train and require HCWs to use them appropriately. Ensuring institutional supplies such as hand hygiene materials, constant water supply, disinfecting agents, and training HCWs should improve safe infection prevention practices. A hand hygiene intervention that focuses on changing the WRHA hand hygiene policy may offer the best chance of improving hand hygiene and reducing infection in health facilities (Swoboda et al., 2004; Zerr et al., 2005).

Study limitations

Certain limitations should be considered in interpreting the results of this study. First, the small sample size and incomplete responses to some questions could have prevented other significant findings in the study. Second, the study sample represents only HCWs in the four parishes of western Jamaica; therefore, the results may not be generalizable to HCWs in other clinics, healthcare facilities, or other regions of Jamaica. Third, the data were self-reported and might be subject to social desirability bias. It was not possible to directly link reported with actual practices in this study. However, ongoing data collected by the Infection Control Committee should allow this to be done.

Conclusions

Younger HCWs, Physicians/Nurses, and those in the clinical units had significantly better IC knowledge. Ongoing IC training enhanced IC attitude scores among most HCWs. Discrepancies were seen in IC practice between participants from different hospitals and among different professional groups. Since the practice scores were significantly correlated with the attitude scores and at least six knowledge factors can influence IC practice, the findings can be used to guide future implementation of IC training among HCWs in the WRHA to provide knowledge, strongly influence attitude, and increase IC practices.

Appendix.

Abbreviations

HCWs

Healthcare workers

HAIs

Hospital-acquired infections

HBV

Hepatitis B virus

HCV

Hepatitis C virus

HIV

Human immunodeficiency virus

IC

Infection control

ICU

Intensive care unit

ICPP

Infection and Control Policies and Procedures

KAP

Knowledge, attitudes, and practices

PPE

Personal protective equipment

WHO

World Health Organization

WRHA

Western Regional Health Authority of Jamaica.

ORCID iD

Pauline E Jolly https://orcid.org/0000-0003-1718-6908