Abstract
Nurses are essential in the upkeep, maintenance, and implementation of infection control standards and guidelines by ensuring that their practices reflect the current evidence in the prevention of infectious diseases. The study performed to measure the level of infection control practices compliance among nurses. A cross-sectional design, was performed among nurses in 3 governmental hospitals. Infection control practices Tool were shared between August 2023 and October 2023, made up of 29 questions scored using a 5-point Likert scale. Overall mean levels of infection control practices were rated weak compliance (raw score = 105, mean = 3.64, standard deviation [SD] = 0.9). The items with the highest rated scores were Item 1 (“I wash my hands before and after giving care to patient”) (raw score = 110, mean = 3.79, SD = 1.0) and Item 25 (“I inform other units before transferring patients who are under contact precautions”) (raw score = 110, mean = 3.79, SD = 1.1). None of the sociodemographic variables analyzed show a statistically significant relationship with infection control practices, as all P-values are >.05. Nurse, managers, and hospital administrators should ensure that policies reflect the critical significance of infection control practices in preventing further morbidity and mortality among hospitalized patients and protecting the health and well-being of nurses and other healthcare staff.
Keywords: compliance, healthcare, infection control practices, infectious diseases, nurses
1. Introduction
Infectious diseases are and continue to be the primary source of morbidity and mortality around the world.[1] While the impact of infectious diseases is equally felt in high-income and developed countries, developing and low-income countries are more susceptible to the political, social, economic, and health consequences of communicable diseases both in community and hospital settings.[2,3]
In hospitals, healthcare-associated infections (HAIs), add to the burden of infectious diseases already present in patients admitted with those diseases and in patients who are admitted with no prior infection.[4] Rosenthal et al[5] performed a multinational, multicenter, prospective cohort study involving 312 hospitals in 147 cities in 37 countries from Latin America, Asia, Africa, the Middle East results showed that 21,371 HAIs were recorded for 300,827 patients followed up through a period of 4 years, and that being diagnosed with a central-line associated bloodstream infection increased mortality by up to 1.84 times, ventilator-associated pneumonia increased mortality by up to 1.48 times, and catheter-associated urinary tract infection increased mortality by up to 1.18 times.
However, HAIs are preventable with the implementation of multifaceted and multidisciplinary strategies that span the entirety of the healthcare system.[6] In a systematic review and meta-analysis of all studies published between 2005 and 2016, Schreiber et al[7] found that when the sustained implementation of infection control practices and strict adherence to infection control guidelines are followed, hospitals can potentially achieve a 54.3% reduction of catheter-associated urinary tract infections, 45.9% reduction of central-line associated bloodstream infections, and 55.3% reduction of ventilator-associated pneumonia. In a narrative review, found that the most effective strategies include hand hygiene, maintaining a safe, clean, hygienic hospital environment, screening and categorizing patients into cohorts, public health surveillance, antibiotic stewardship, and following patient safety guidelines.[8] Smiddy et al, explored the compliance of healthcare workers with hand hygiene guidelines, being the strategy that remains the most efficient and cost-effective intervention to reduce the transmission of disease.[9]
As part of the healthcare team, nurses are essential in the upkeep, maintenance, and implementation of infection control standards and guidelines by ensuring that their practices reflect the current evidence in the prevention of infectious diseases.[10] In a systematic review, Nasiri et al[11] examined the evidence on the knowledge, attitude, practice, and clinical recommendation toward infection control and prevention standards among nurses. Results of the review that included 18 studies showed that while nurses had adequate levels of knowledge and positive attitudes toward infection control and prevention, nurses displayed poor levels of practice about controlling HAIs. A study involved 384 nurses from 9 different hospitals in Jordan. Results of the study showed that within the context of 835 observed injections, nurses did not perform proper handwashing 74% of the time, nurses did not wear appropriate gloves 65% of the time, and nurses performed needle recapping 28% of the time,[12] in another study, results showed that nurses and doctors had low knowledge scores on infection control practices, but had similarly high levels of positive attitude Nofal et al.[13] Implementing strategies that can improve infection control practices of staff nurses, and to guide audits and quality improvement efforts to monitor and evaluate key performance indicators are important. This is study preformed to measure the level of infection control practices among Jordanian nurses.
2. Methods
2.1. Research design
A secondary data analysis of the original correlative descriptive cross-sectional study[14] was carried out in this paper.
2.2. Research setting and sample
The study was performed in 3 governmental hospitals in Jordan, which provide medical care and health protection to the largest portion of Jordanians. The exclusion criteria must not occupy a managerial position. Only nurses who have been employed for 6 months or more are eligible to join the study because only nurses who have been employed for some time would have had adequate work experience to develop a sense of the hospital and the unit’s organizational culture. Sample size calculation was calculated based on a Pearson correlation coefficient test to ensure that the study has a power of 0.95, alpha = 0.05, and a medium effect size of 0.3. The minimum target sample size is 134.
2.3. Infection control practices tool
The participant information sheet collects data on the sociodemographic and professional characteristics of nurse participants. Infection control practice was measured using the questionnaire developed by Al-Rawajfah et al.[15] The tool is made up of 29 questions scored using a 5-point Likert scale. Hence, the overall minimum total score is 29 and the overall maximum total score is 145. Scores were interpreted as low compliance if between 29 and 87, weak compliance if between 88 and 116, and high compliance if between 117 and 145. The reliability of the tool was measured using internal consistency with a Cronbach alpha value of 0.83. Validity was established using content validity provided by infection control experts.
2.4. Data collection
Once relevant ethical approvals are obtained, data collection can commence. The researcher then visited each department in the selected hospitals and coordinated with the nurse manager or head of the research department (whichever applies to the participating hospital) to carry out the research. A master list of nurses with their email addresses was obtained from the nurse managers. From this list, the researcher along with the nurse managers identified nurses who meet the inclusion-exclusion criteria. Nurses who meet the sampling criteria are invited to participate in the study. Letters of invitation are sent via their emails or contact via WhatsApp. If a respondent completes and returns a survey form, it is implicitly giving their consent to participate in the survey. Participants who provided informed consent to join the study were asked to fill out electronic survey forms designed using Google Forms (August 2023–October 2023).
2.5. Data analysis
The Statistical Package for the Social Sciences (SPSS, Chicago) version 23 was used to perform statistical analysis. All survey data were transcribed from Google Forms onto SPSS. Descriptive statistics were performed to obtain means and standard deviations (SDs). Independent t-tests were used to test for differences between sociodemographic characteristics and infection control practices. Statistical significance set at P < .05.
The average age of participants is 37 years (SD = 7.0), and the majority of staff were females 68.6% (n = 118). Participants primarily work in Medical-Surgical units (32.6%), followed by intensive care unit/critical care unit/neonatal intensive care unit (ICU/CCU/NICU) settings (23.8%). A majority of participants have over 10 years of experience (61.0%). Most participants (72.1%) have undergone previous training in infection control (Table 1).
Table 1.
Sociodemographic characteristics.
| Mean | SD | |
|---|---|---|
| Age | 37 | 7.0 |
| Frequency (n) | Percentage (%) | |
| Gender | ||
| Male | 54 | 31.4 |
| Female | 118 | 68.6 |
| Area of work | ||
| Medical-surgical | 56 | 32.6 |
| ICU/CCU/NICU | 41 | 23.8 |
| Emergency | 13 | 7.6 |
| Maternity | 6 | 3.5 |
| Operating room | 8 | 4.7 |
| Pediatrics | 3 | 1.7 |
| Others | 42 | 24.4 |
| Years of experience | ||
| <2 yr | 2 | 1.2 |
| 2 to 5 yr | 20 | 11.6 |
| 5 to 10 yr | 41 | 23.8 |
| More than 10 yr | 105 | 61.0 |
| Length of experience in the current department | ||
| <2 yr | 2 | 0.01 |
| 2 to 5 yr | 20 | 11.9 |
| 5 to 10 yr | 41 | 24.4 |
| More than 10 yr | 105 | 62.5 |
| Previous training in infection control | ||
| Yes | 124 | 72.1 |
| No | 39 | 22.7 |
| Unsure | 8 | 4.7 |
CCU = critical care unit, ICU = intensive care unit, NICU = neonatal intensive care unit, SD = standard deviation.
Overall mean levels of infection control practices were rated weak compliance (raw score = 105, mean = 3.64, SD = 0.9). The items with the highest rated scores were Item 1 (“I wash my hands before and after giving care to patient”) (raw score = 110, mean = 3.79, SD = 1.0) and Item 25 (“I inform other units before transferring patients who are under contact precautions”) (raw score = 110, mean = 3.79, SD = 1.1). However, raw score conversions still suggest weak compliance in these items. On the other hand, the item with the lowest rated score was Item 28 (“I perform needle recapping for needles and blade before discarding it”) (raw score = 83, mean = 2.87, SD = 1.5). For item 28, raw score conversion suggests low compliance (Table 2).
Table 2.
Infection control practices.
| Item | Score | Mean | SD | |
|---|---|---|---|---|
| 1 | I wash my hands before and after giving care to the patient. | 109.9 | 3.79 | 1.0 |
| 2 | I wash my hands before and after using gloves. | 108.8 | 3.75 | 1.1 |
| 3 | I wash my hands after dealing with blood, body fluid, body secretions, and contaminated tools. | 107.9 | 3.72 | 0.9 |
| 4 | I wash my hands with an antiseptic solution containing Iodine after performing nursing interventions that may lead to the spread of blood or body fluids. | 105.0 | 3.62 | 1.2 |
| 5 | I wash my hands with an antiseptic solution after removing gloves and giving nursing care to patients who are under contact precautions. | 109.6 | 3.78 | 1.1 |
| 6 | I use eye protection to protect my eyes when I perform activities or nursing care that may lead to the spout of blood and body fluids. | 94.0 | 3.24 | 1.4 |
| 7 | I use a surgical mask when I perform activities or nurse a car which may lead to the spray of blood and body fluid. | 107.0 | 3.69 | 1.1 |
| 8 | I use a surgical mask when giving care to patients who are under droplet precaution with a distance of not more than 90 cm. | 109.3 | 3.77 | 1.1 |
| 9 | I use a surgical mask when I enter patients’ rooms who are infected with chickenpox and measles. | 107.3 | 3.70 | 1.1 |
| 10 | I use an isolation gown when giving care or performing activities that may lead to a spout of blood and body fluid. | 107.0 | 3.69 | 1.1 |
| 11 | I use an isolation gown when entering patients’ rooms who are under contact precautions. | 104.7 | 3.61 | 1.1 |
| 12 | I use 2 pairs of gloves (double gloving) when doing procedures and nursing activities for patients infected with contagious diseases through the blood such as hepatitis type “B” and AIDS. | 105.9 | 3.65 | 1.1 |
| 13 | I use gloves when I enter isolation rooms for patients who need contact precautions and take the gloves off before leaving the room. | 107.3 | 3.70 | 1.0 |
| 14 | I use gloves before touching any different body wounds of patients. | 107.6 | 3.71 | 1.0 |
| 15 | I use gloves before contact with any mucus membrane. | 109.0 | 3.76 | 0.9 |
| 16 | I inform other departments before transferring patients who need droplet precautions. | 108.5 | 3.74 | 1.0 |
| 17 | I put on face masks for patients with diseases spread by droplets or spray during the process of their movement or transfer. | 108.2 | 3.73 | 1.0 |
| 18 | I separate patients with diseases spread by droplets or aerosols away from each other at a distance of not <1·5 m. | 106.7 | 3.68 | 1.1 |
| 19 | I isolate patients with diseases spread by droplets or spray in private rooms. | 108.5 | 3.74 | 1.1 |
| 20 | I isolate patients with diseases transmitted through the air (airborne spread disease) in private rooms equipped with a negative pressure system. | 105.9 | 3.65 | 1.1 |
| 21 | Permanently, I close the doors of rooms of patients with diseases transmitted through the air. | 107.0 | 3.69 | 1.0 |
| 22 | I inform other departments before transferring patients who need Airborne precautions. | 108.2 | 3.73 | 1.0 |
| 23 | I put on face masks for patients with diseases spread by air during the process of their movement or transfer. | 109.0 | 3.76 | 1.0 |
| 24 | I isolate patients who are under contact isolation in a special isolation room. | 108.2 | 3.73 | 1.1 |
| 25 | I inform other units before transferring patients who are under contact precautions. | 110.0 | 3.79 | 1.1 |
| 26 | I use patients’ tools and equipment with other patients who need contact precautions. | 87.6 | 3.02 | 1.5 |
| 27 | I sterilize all shared equipment that is used among patients who need contact precautions. | 105.9 | 3.65 | 1.1 |
| 28 | I perform needle recapping for needles and blades before discarding them. | 83.2 | 2.87 | 1.5 |
| 29 | I protect myself with the Hepatitis B virus vaccine if it is available free of charge at the hospital. | 105.9 | 3.65 | 1.1 |
| Overall | 105 | 3.64 | 0.9 |
SD = standard deviation.
None of the sociodemographic variables analyzed show a statistically significant relationship with infection control practices, as all P-values are >.05 (Table 3).
Table 3.
Relationship between sociodemographic characteristics and infection control practices.
| Variable | Category | Infection control |
|---|---|---|
| Area of work | F | 1.537 |
| P-value | .169 | |
| Yr of experience as RN | F | 0.620 |
| P-value | .60 | |
| Previous training in infection control | F | 0.961 |
| P-value | .385 | |
| Length of experience in current area of work | F | 1.013 |
| P-value | .39 |
RN = registered nurse.
3. Discussion
Results of the study showed that Jordanian nurses working in healthcare settings had weak compliance with infection precaution practices. Such a result was similar to other studies that measured the level of compliance among nurses.[16–18] Several factors have been proposed to elucidate this widespread issue of poor compliance. Among them, a lack of knowledge and skills regarding infection control practices is a major concern. This could be due to inadequate training or a lack of continuous education programs aimed at updating nursing staff about new trends and protocols in infection control. This gap in knowledge and skills can be detrimental, leading to unsafe practices and potentially contributing to the spread of infections.[17] In addition, insufficient availability of personal protective equipment (PPE) was identified as another crucial factor.[16] A shortage of PPE leaves nurses ill-equipped to adhere to infection control guidelines, thereby increasing the risk of disease transmission, Moreover, the study found that poor hospital infrastructure, especially regarding patient isolation or cohorting facilities, exacerbated the issue.[16]
Without adequate isolation rooms, the risk of cross-contamination increases significantly.[19] Another key problem that emerged from the studies was the lack of quality monitoring and managerial support. Without a robust system to monitor and provide feedback on infection control practices, nurses may not be aware of lapses in their compliance. Furthermore, a lack of managerial support could lead to low morale and reduced motivation to adhere to infection control protocols.[16]
Weak compliance with infection precaution practices amongst nurses has far-reaching implications. When healthcare professionals do not strictly adhere to safe and effective infection control policies and guidelines, patient care can be compromised. This could result in increased patient morbidity and mortality rates. From a hospital management perspective, noncompliance can lead to operational difficulties, including increased costs associated with treating hospital-acquired infections and potential legal issues. Furthermore, this could negatively affect organizational outcomes, such as hospital reputation and patient satisfaction.[20]
Studies have also shown that poor infection control practices can lead to poor patient outcomes such as increased morbidity, increased mortality, longer duration of mechanical ventilation, longer duration of hospital stay, increased rates of readmission, and higher levels of technological and pharmaceutical dependence, and poor organizational outcomes such as increased costs with antibiotics, increased usage of PPE, higher need for temporary and agency nursing staff to replace permanent nursing staff who have gone off sick, poor job performance, poor job satisfaction, higher reports of sickness episodes, and overall lower quality of patient and family care.[21,22]
When it comes to item responses, participants had the highest compliance with handwashing and informing other units of contact precautions. This is significant since hand washing is the single most effective intervention to prevent the spread of infectious diseases.[23] Informing other units of infection precautions specific to patients will prevent cross-infection of other patients between hospital departments.[24] On the other hand, avoidance of needle recapping was the item with the lowest compliance. This will need to be addressed because there is a risk for nurses to have needlestick injuries which, in itself, carries significant workforce implications (i.e., nurses who have needlestick injuries might require post-exposure prophylaxis, be prevented from undertaking work requiring needles or be taken off work entirely depending on the nature and severity of the injury).[25,26]
No sociodemographic characteristics were found to be significantly related to infection control practices. This finding aligns with the conclusions of various integrative reviews and analyses conducted by researchers such as Nasiri et al,[11] Smiddy et al,[9] and Durant[10] who similarly found no significant variations in infection control practices based on these demographic variables. This implies that infection precaution practices should not be contingent upon the individual characteristics of healthcare professionals. Rather, adherence to these procedures should be standardized, regular, and consistent for all nurses. This is because maintaining robust infection control is not an optional undertaking, but a fundamental expectation in the field of nursing.[27] Upholding infection control policies and guidelines is a fundamental responsibility for nurses, regardless of their age, gender, workplace, or length of professional experience, as emphasized by Alp and Damani.[28]
4. Limitations
The study has several limitations. First, the cross-sectional design captured key variables at a single point in time, rather than through repeated measures over an extended period. Second, the recruitment process was research conducted at selected hospital sites, limiting the generalizability of findings to nurses and hospitals with comparable characteristics. Third, data collection relied on self-report questionnaires, which depend on respondents’ recall accuracy.
5. Conclusion
Weak compliance of nurses to infection control practices suggests that either existing infection control policies are not followed and poorly implemented or there are no infection control policies at all. Nurse managers and hospital administrators should ensure that policies reflect the critical significance of infection control practices in preventing further morbidity and mortality among hospitalized patients and protecting the health and well-being of nurses and other healthcare staff. In addition, policies should be embedded within hospital organizational culture – this ensures that infection control policies become a way of life for healthcare practitioners.
Acknowledgments
The authors extend their appreciation to Princess Nourah bint Abdulrahman University Researchers Supporting Project number (PNURSP2025R844) and Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
Author contributions
Conceptualization: Khalid Al-Mugheed, Sally Mohammed Farghaly Abdelaliem.
Data curation: Suzan Harb.
Funding acquisition: Sally Mohammed Farghaly Abdelaliem.
Investigation: Ghada Abu Shosha.
Methodology: Islam Ali Oweidat, Majdi M. Alzoubi.
Writing – original draft: Islam Ali Oweidat.
Writing – review & editing: Majdi M. Alzoubi.
Abbreviations:
- CCU
- critical care unit
- HAIs
- healthcare-associated infections
- ICU
- intensive care unit
- NICU
- neonatal intensive care unit
- PPE
- personal protective equipment
- SPSS
- Statistical Package for the Social Sciences
Princess Nourah bint Abdulrahman University Researchers Supporting Project number (PNURSP2025R844), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
Appropriate ethical approvals will be obtained from the institutional review board committee of the Faculty of Nursing of Zarqa University (2023/144). The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review at all sites. Written informed consent was obtained from all participants.
The authors have no conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
How to cite this article: Harb S, Abu Shosha G, Oweidat IA, Al-Mugheed K, Alzoubi MM, Abdelaliem SMF. Compliance of infection control practices among registered nurses: A cross-sectional study. Medicine 2025;104:14(e42062).
Contributor Information
Suzan Harb, Email: desert.rose2020@hotmail.com.
Ghada Abu Shosha, Email: Ghada_abushosha@zu.edu.jo.
Majdi M. Alzoubi, Email: mujdi.alzoubi@zuj.edu.jo.
Sally Mohammed Farghaly Abdelaliem, Email: smfarghaly@pnu.edu.sa.
References
- [1].Cassini A, Colzani E, Pini A, et al. ; BCoDE consortium. Impact of infectious diseases on population health using incidence-based disability-adjusted life years (DALYs): results from the Burden of Communicable Diseases in Europe study, European Union and European Economic Area countries, 2009 to 2013. Euro Surveill. 2018;23:17–00454. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [2].Hearn P, Miliya T, Seng S, et al. Prospective surveillance of healthcare associated infections in a Cambodian pediatric hospital. Antimicrob Resist Infect Control. 2017;6:16. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [3].Ali S, Birhane M, Bekele S, et al. Healthcare-associated infection and its risk factors among patients admitted to a tertiary hospital in Ethiopia: a longitudinal study. Antimicrob Resist Infect Control. 2018;7:1–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [4].Legeay C, Bourigault C, Lepelletier D, Zahar JR. Prevention of healthcare-associated infections in neonates: room for improvement. J Hosp Infect. 2015;89:319–23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [5].Rosenthal VD, Yin R, Lu Y, et al. The impact of healthcare-associated infections on mortality in ICU: a prospective study in Asia, Africa, Eastern Europe, Latin America, and the Middle East. Am J Infect Control. 2022;51:675–82. [DOI] [PubMed] [Google Scholar]
- [6].Castro-Sánchez E, Holmes AH. Impact of organizations on healthcare-associated infections. J Hosp Infect. 2015;89:346–50. [DOI] [PubMed] [Google Scholar]
- [7].Schreiber PW, Sax H, Wolfensberger A, Clack L, Kuster SP; Swissnoso. The preventable proportion of healthcare-associated infections 2005–2016: systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2018;39:1277–95. [DOI] [PubMed] [Google Scholar]
- [8].Haque M, McKimm J, Sartelli M, et al. Strategies to prevent healthcare-associated infections: a narrative overview. Risk Manag Healthc Policy. 2020;13:1765–80. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [9].Smiddy MP, O’Connell R, Creedon S. Systematic qualitative literature review of health care workers’ compliance with hand hygiene guidelines. Am J Infect Control. 2015;43:269–74. [DOI] [PubMed] [Google Scholar]
- [10].Durant DJ. Nurse-driven protocols and the prevention of catheter-associated urinary tract infections: a systematic review. Am J Infect Control. 2017;45:1331–41. [DOI] [PubMed] [Google Scholar]
- [11].Nasiri A, Balouchi A, Rezaie-Keikhaie K, Bouya S, Sheyback M, Rawajfah OA. Knowledge, attitude, practice, and clinical recommendation toward infection control and prevention standards among nurses: a systematic review. Am J Infect Control. 2019;47:827–33. [DOI] [PubMed] [Google Scholar]
- [12].Al-Rawajfah OM, Tubaishat A. A concealed observational study of infection control and safe injection practices in Jordanian governmental hospitals. Am J Infect Control. 2017;45:1127–32. [DOI] [PubMed] [Google Scholar]
- [13].Nofal M, Subih M, Al-Kalaldeh M, Al Hussami M. Factors influencing compliance to the infection control precautions among nurses and physicians in Jordan: a cross-sectional study. J Infect Prev. 2017;18:182–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [14].Al-Rawajfah OM, Hweidi IM, Alkhalaileh M, Khader YS, Alshboul SA. Compliance of Jordanian registered nurses with infection control guidelines: a national population-based study. Am J Infect Control. 2013;41:1065–8. [DOI] [PubMed] [Google Scholar]
- [15].Suzan H, Ghada A, Oweidat I, et al. Exploring organizational culture and its association with standard precaution practices among nurses. BMC Nurs. 2025;24:260. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [16].Powers D, Armellino D, Dolansky M, Fitzpatrick J. Factors influencing nurse compliance with standard precautions. Am J Infect Control. 2016;44:4–7. [DOI] [PubMed] [Google Scholar]
- [17].Powell BJ, Mettert KD, Dorsey CN, et al. Measures of organizational culture, organizational climate, and implementation climate in behavioral health: a systematic review. Implement Res Pract. 2021;2:26334895211018862. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [18].Dekker M, Van Mansfeld R, Vandenbroucke-Grauls C, De Bruijne M, Jongerden I. Infection control link nurse programs in Dutch acute care hospitals; a mixed-methods study. Antimicrob Resist Infect Control. 2020;9:1–10. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [19].Wong ELY, Ho KF, Dong D, et al. Compliance with standard precautions and its relationship with views on infection control and prevention policy among healthcare workers during COVID-19 pandemic. Int J Environ Res Public Health. 2021;18:3420. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [20].Hansen S, Schwab F, Zingg W, Gastmeier P; PROHIBIT Study Group. Process and outcome indicators for infection control and prevention in European acute care hospitals in 2011 to 2012 – results of the PROHIBIT study. Euro Surveill. 2018;23:1700513. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [21].Grayson ML, Stewardson AJ, Russo PL, et al. ; Hand Hygiene Australia and the National Hand Hygiene Initiative. Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study. Lancet Infect Dis. 2018;18:1269–77. [DOI] [PubMed] [Google Scholar]
- [22].Mitchell BG, Hall L, MacBeth D, Gardner A, Halton K. Hospital infection control units: staffing, costs, and priorities. Am J Infect Control. 2015;43:612–6. [DOI] [PubMed] [Google Scholar]
- [23].Damilare OK. Hand washing: an essential infection control practice. Int J Caring Sci. 2020;13:776–80. [Google Scholar]
- [24].Hadaway A. Handwashing: clean hands save lives. J Consum Health Internet. 2020;24:43–9. [Google Scholar]
- [25].Oweidat I, Al-Mugheed K, Alsenany SA, Abdelaliem SMF, Alzoubi MM. Awareness of reporting practices and barriers to incident reporting among nurses. BMC Nurs. 2023;22:231. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [26].Al-Mugheed K, Farghaly SM, Baghdadi NA, Oweidat I, Alzoubi MM. Incidence, knowledge, attitude and practice toward needle stick injury among nursing students in Saudi Arabia. Front Public Health. 2023;11:1160680. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [27].Al-Mugheed K, Bayraktar N, Al-Bsheish M, et al. Effectiveness of game-based virtual reality phone application and online education on knowledge, attitude and compliance of standard precautions among nursing students. PLoS One. 2022;17:e0275130. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [28].Alp E, Damani N. Healthcare-associated infections in intensive care units: epidemiology and infection control in low-to-middle income countries. J Infect Dev Ctries. 2015;9:1040–5. [DOI] [PubMed] [Google Scholar]