Table I.

Summary of select study characteristics

Source	Objective	Study design	Sample	Setting	PSC measure: components, type of measure, psychometric properties	Primary outcome: SP adherence components, type of measure, psychometric properties	Secondary outcomes: HCAI or HCW exposure	Results	Quality rating
Anderson et al.39	Evaluate the validity and reliability of a measure of organizational safety climate in association with HCW compliance with SP.	Secondary analysis of cross- sectional data.	1746 HCWs (four categories: RN, MD, laboratory and miscellaneous) with direct patient contact or specimen contact.	Three large acute care hospitals in the Mid- Atlantic, Southwest and Midwest USA.	Survey, nine-item 4-point Likert scale measuring leadership, management, non- punitive environment, organizational structure, summated as mean score across all items. Five-item 5- point Likert survey on availability of PPE. Cronbach’s alpha = 0.85, construct validity established by hypothesis testing of relationships between variables.	Survey (Gershon et al.21), measured frequency of 11 behaviours using 5-point Likert scale. Includes PPE, HH, sharps environmental cleaning and food in work area. Mean of items comprised a SP score. Content validity reported, derived from CDC guidelines and Gershon et al. 21 tool.	Neither	Statistically significant relationship between PSC and SP adherence. Measure of PSC found reliable and valid.	10
Brevidelli et al.37	To analyse the influence of psychosocial and organizational factors on compliance with SP for preventing exposure to biologic materials.	Cross- sectional survey	Random sampling, 270 HCWs (213 nurses and 57 MDs). 370 sample aim.	University hospital in São Paulo, Brazil.	65-item survey, adapted from Gershon et al.21 and DeJoy et al.40 transculturally adapted and includes psychosocial and organizational factors: management support, knowledge about risk of transmission, risk- taking personality, organizational barriers, availability of equipment, workload and training. Cronbach’s alpha between 0.67 and 0.82 for scales, construct validity established by exploratory factor analysis.	13-item survey, ‘standard precaution compliance’ composed as a global index and grouped by adherence to PPE or disposal of sharps. Content validity reported as derived from Gershon et al. (1995)21 and DeJoy et al.40 tools.	Neither.	Safety climate scale statistically significant between management support for safe work practices and safety performance feedback and SP adherence. As single dimensional construct statistically significant relationship between training, less perceived barriers, feedback and support for safe practices and SP adherence.	8
Clarke et al.41	To examine relationships between nurse characteristics , types of protective equipment, organizational climate, and risk of needlestick injuries and near misses.	Cross- sectional study	2287 RNs with direct care responsibility who worked at least 16 h per week on medical surgical units and surveys from management, infection control and purchasing officials.	22 US hospitals described as Magnet certified or reputations for excellence	Questionnaire of safety officials at hospitals regarding presence and availability of safety intravenous insertion equipment. Five- item scale, items from the 49-item Nursing Work Index Revised survey of nurses using a 4-point Likert scale to rate the presence of administrative and management support, leadership and responsiveness. Cronbach’s alpha = 0.85.	Questionnaire survey that asked frequency of wearing gloves when performing venepuncture and other procedures with a risk of contact with body fluids. No psychometrics properties reported.	HCW outcome: needlestick injuries of nurses.	Statistically significant relationship between poor safety climate and needlestick injuries. Nurse self-report compliance with SPs was analysed separately descriptively.	7
DeJoy et al.35	To examine the individual, job-task and environment organizational factors related to SP compliance.	Cross- sectional analysis of data from a larger study examining nurses.	889 nurses.	Three large (~1000 beds) regionally distinct acute care hospitals in the USA	17 items from a larger survey measuring safety climate dimensions: priority assigned to safety, formal and informal feedback, management actions and commitment to safety. Cronbach’s alpha range 0.57–0.84 for scales. Construct validity established by confirmatory factor analysis.	11-item survey measuring compliance with sharps and waste disposal, needle recapping, hand hygiene, cleaning spills and use of PPE/barriers. Cronbach’s alpha = 0.73 for compliance with PPE (three items) and 0.53 for general compliance (8 items). Construct validity established by exploratory factor analysis.	HCW exposure analysed as predict or: exposure to blood or body fluids including splashes, needlesticks, cuts with sharp objects and contact with open wounds.	Statistically significant relationships between knowledge of transmission risks, absence of job hindrances, formal and informal feedback, availability of supplies, and priority assigned to safety with compliance with PPE and general compliance.	7
Gershon et al.42	To develop a measure of safety climate that is specific for bloodborne pathogen management, and assesses relationship with safe behaviour and workplace exposures.	Cross- sectional design.	Stratified sample of those considered highest risk for blood and body fluid exposure; 789 nurses, physicians and technicians.	One urban, 1000-bed research medical centre.	46-item 5-point Likert survey measuring presence of safety climate dimensions: senior management support, absence of workplace barriers, worksite cleanliness and orderliness, minimal conflict and good communication, frequent safety monitoring feedback and training and availability of engineering controls. Original 46-item tool psychometric properties referenced but not reported. Construct validity and reliability established through factor analysis in 6 factors (20 items). Cronbach’s alpha range 0.71–0.84 for scales.	14-item survey of SP compliance using 5-point Likert scale ‘strict compliance’ defined as score above ≥80%). Prior tool development and testing referenced though psychometric properties not reported.	HCW outcome: workplace exposures to blood and body fluids over preceding 6 months.	Statistically significant relationship between senior management support, absence of workplace barriers, and worksite cleanliness and orderliness and SP adherence. Senior management support and frequent safety monitoring feedback and training were significantly related with workplace exposures.	10
Kermode et al.43	Describe the knowledge and understanding of SPs and predictors of compliance among HCWs in rural north India. Assess extent of occupational exposure, identify factors associated with exposure, quantify the risk of bloodborne pathogens, assess compliance with SPs and identify factors associated with non-compliance.	Cross- sectional survey of HCWs.	266 HCWs including nurses, midwives, student nurses, laboratory workers, doctors dentists and others.	Seven hospitals in rural north India.	13-item, 5-point Likert scale of items related to patient safety climate including availability of PPE, cleanliness of environment, management support and leadership, organizational commitment to patient safety and training. Nine-item 5-point Likert scale used to measure barriers was a separate scale. Tool reliability and validity testing referenced to Gershon et al.21, though psychometric properties not reported.	12 item, 5- point Likert scale measures behaviours related to SP. An overall compliance score calculated by summing the scores across participants. Tool reliability and validity testing referenced to Gershon et al.21, though psychometric properties not reported.	HCW outcome: occupational blood exposure. No patient outcome.	Statistically significant relationship between PSC and SP compliance and perceived barriers and SP compliance.	9
Vaughn et al.44	To examine organizational factors and occupational characteristics associated with adherence to occupational safety guidelines to avoid needle recapping.	A cross- sectional study linking three data sources	The sample comprised 1454 physicians, nurses and laboratory workers who self- identified as likely to routinely handle needles and 99 IPs from 99 hospitals.	Analytic sample included nurses and IPs from 84 hospitals drawn from a stratified random sample to represent each county in Iowa.	17 items drawn from HCW survey (management support, job demands, feedback, and availability of PPE) and IP survey (structural support, key leadership support and equipment availability). Construct validity and reliability established through factor analysis in four factors (17 items). Cronbach’s alpha range 0.70–0.90 for scales.	One-item survey measure using a visual scale to mark respondents’ level of compliance between 0 and 100% and then treated as a dichotomous measure of never recapping or ever recapping a needle. Psychometric properties not reported.	Neither.	Statistically significant relationships were found between organizational IP staffing, HCW education, availability of PPE, management support for safety, and consistent adherence to needle recapping guidance.	9

PSC, patient safety climate; SP, standard precaution; HCAI, healthcare-associated infection; HCW, healthcare worker; RN, registered nurse; MD, medical doctor; PPE, personal protective equipment; HH, hand hygiene; IP, infection prevention.