Identifying Barriers to Compliance with Infection Prevention and Control

In healthcare, the term compliance refers to that accuracy and consistency with which practitioners follow pre-determined procedures of executing their job tasks, as regards the treatment of patients. Healthcare practitioners are required to observe operational standards, rules they can only adhere to if they know they exist. Thus, in the case of complying with the standard precautions for preventing and controlling infections, healthcare practitioners, both nurses, and physicians, must be aware of the measures they must take to facilitate preventive and control actions that mitigate exposure to infection (Asadollahi et al., 2015). An infection is considered an invasion of the body tissue by disease-causing agents resulting in their multiplication and toxic reaction with the body of the host, thereby causing illness (Lawitz et al., 2013).

So, this study seeks to identify the barriers that may hinder practitioner compliance with infection prevention and control and establish measures through which the said barriers can be eliminated to foster better care services. The obstacles that will be explored will represent the study’s independent variables whereas the prevention and control of infections will characterize the dependent variable for this study. The questions that the study seeks to answer are:

In nursing, how does knowledge compared to experience influence infection control prevention compliance?

In physicians, how does knowledge compared to experience influence infection control prevention compliance?

Theoretical Framework

The theoretical framework that will be applied for this study will guide the approach the researcher takes on the subject matter. It will facilitate the establishment of the logic behind methodology choices, clarify epistemological dispositions, create a theory based on research findings, and guide the study framework (Collins & Stockton, 2018). This study will be based on the ground theory framework, which is expected to facilitate the establishment of theories on the barriers to compliance with infection prevention and control among medical practitioners, through the methodological collection and analysis of data. The said theory is expected to support and direct the inductive approach that the researcher has chosen to take on the study, to allow them to base their research on the questions stated above (Morse et al., 2016). The ground theory framework will facilitate the exploration of the difference between knowledge-based and experience based operations and the effect (s) of each on infection prevention and control. This is expected to allow the realization of the barriers to compliance with controlling and preventing infections among medical care practitioners. The said framework is the most appropriate for the study because the research findings acquired will have a high possibility of accurately representing real-life situations, and warranting the ecological validity of the research. The ground theory framework will also allow the study to possess novelty and parsimony, making it easy for readers to deduce meaning from the findings (Charmz, 2014).

Literature Review

According to Meyers et al. (2018), education is crucial to the Infection Prevention and Control (IPAC) practice. Therefore, Infection Control Professionals (ICPs) who play the role of educators are essential to healthcare practices as their consultative role has a direct impact on the prevention and control of infections as well as the safety of patients. Regardless, owing to the limited research on IPAC education and practices, the role of education in IPAC is undervalued. Thus, the researchers acknowledge that training is meant to provide learning experiences which result in the acquisition of knowledge that can be transferred from the learning context to an applied one. However, owing to the dynamism and complexity of the learning process, it is essential that instructors clarify the expected outcome of the education, explicitly highlight assumptions and ground their research on theoretical frameworks.

Moreover, in another research conducted by Nofal et al. (2017), the researchers aimed at determining the attitudes, compliance, and knowledge of Infection Control Professionals depicted by both nurses and physicians in Jordan. The researchers, therefore, used a cross-sectional survey to collect data from physicians and nurses that were recruited from three different hospitals located in various sectors in Jordan. From their findings, the researchers established that the physician and nurse study participants had little knowledge of ICPs, as indicated by previous studies. Regardless, the authors recorded that both physicians and nurses exhibited positive attitudes towards ICPs, but nurses exhibited higher Infection Prevention and Control practice compliance compared to physicians. Hence, the researchers concluded that high compliance with infection control and prevention practices is affected by both the knowledge and attitudes of practitioners, with experience playing a less relevant role to the same. 

Furthermore, in the case of home healthcare patients, infection has been deemed to be a leading cause of hospitalization. Nurses play a crucial role in the reduction of infection rates among such patients, making their levels of compliance to procedures for infection control critical. From the findings of a study that involved 359 home healthcare practitioners, which was conducted to determine IPAC practice compliance levels among the said professionals, the attitudes, demographics and knowledge correlations of the practitioners were also explored. Hence, it became evident that the efforts required to improve compliance to IPAC practices would entail focusing on the establishment of strategies that alter the perception of nurses about the risk of infection and other attitude based factors (Russell et al., 2018). Moreover, in Australia, following the increasing rate of healthcare-associated infections (HAIs), researchers conducted a study to determine the knowledge, beliefs, and intentions of Australian nursing students on the critical concepts of preventing and controlling infection. The cross-sectional study conducted across six universities in Australia showed that knowledge on the transmission based precautions that nurses can take was substandard. So, seeing that transference based precautions form the foundation of infection prevention and control (IPAC) practices, the researchers deemed it crucial for educational institutions to refine the delivery of educational content on the said subject (Mitchell et al., 2014). 

Also, in the case of physicians, research conducted in Japan indicated that despite the requirement for dentists in the said region to comply with IPAC practices, high compliance levels are not recorded among most dentists in Japan. It became evident that the knowledge of the meaning of standard precautions of infection prevention and control were the most significant predictors of compliance among Japanese dentists. Like other researchers, previously discussed, the authors of this study also pointed out the complementary role of attitudes and knowledge in the prevention of infections, factors they propose must be highlighted in the dental educational curriculum (Tada et al., 2014). 

Methodology 

This study will take a qualitative approach which will allow the authors to explore the subject matter. The qualitative nature of the study will also enable the researchers to fully understand the reasons and motivations underlying successful infection control and prevention among healthcare practitioners. It will also facilitate the uncovering of knowledge-based trends that will facilitate the more in-depth exploration of the barriers to compliance with IPAC practices among both physicians and nurses. The qualitative research design will be appropriate for the study because it will enable the analysis of the topic in detail and allow the fluidity of the study framework, such that the outcome is dictated by data collected. Moreover, the qualitative data collected will have predictive qualities, and the data complexities can be incorporated in the conclusions that the authors make (Silverman, 2016). 

The study will involve a total of 120 participants (60 nurses and 60 physicians). The said participants will be selected randomly from the pool of staff members working in both public and private hospitals in California. Participant qualifications for the study will require the healthcare practitioners to have at least minimal academic certification in their areas of expertise, at least a degree. The study will lean towards allowing the participants to engage in the research while in their natural setting, the hospitals they work in. The data collection instrument will be a questionnaire, with both open and closed-ended questions. Data collection will involve the administration of surveys via email. The participants will be expected to submit filled in questionnaires within 14 days after their administration. Before starting the study, all participants will be required to read and sign consent forms, informing them of the exact scope and nature of the review. 

Data Analysis 

Since the study will employ the ground theory framework, data analysis will take an inductive approach. The data analysis process will be characterized by the transcription of data using a computer-assisted qualitative data analysis software (CAQDAS). Secondly, the data will be organized, after which it will be coded. Coding the data will compress its quantity and allow easy understanding of the underlying concepts. The researcher will use descriptive coding to summarize the principal themes of the data, in-vivo coding to code data based in the participant language and pattern coding, to establish essential data patterns. Additionally, the validity and reliability of the data will be analyzed after which conclusions from the data analysis process will be made. Finally, the data will be presented in tables and graphs, visual representations that will make it easier for readers to see the difference between research data sets ( Chowdhury, 2015) . 

Applicability to Nursing 

The research will focus on compliance with infection prevention and control, critical aspects of healthcare. Nursing focuses on patient care and the betterment of patient well-being. Thus, understanding the barriers to compliance with infection prevention and control is critical to establishing the measures that can be taken to eliminate the said barriers and implement the best care practices. Since the nursing department is highly affiliated to patient care regardless of the various healthcare departments, the findings of this study are likely to impact most, if not all, aspects of healthcare. It is crucial that all health care practitioners comply with infection prevention and control, as it is the surest means of enhancing patient health and well-being. Nonetheless, this research proposal is complete and can be used by another researcher to replicate the study. 

References

Asadollahi, M., Bostanabad, M. A., Jebraili, M., Mahallei, M., Rasooli, A. S., & Abdolalipour, M. (2015). Nurses' knowledge regarding hand hygiene and its individual and organizational predictors.  Journal of caring sciences ,  4 (1), 45.

Charmaz, K. (2014).  Constructing grounded theory . Sage.

Chowdhury, M. F. (2015). Coding, sorting and sifting of qualitative data analysis: Debates and discussion.  Quality & Quantity ,  49 (3), 1135-1143.

Collins, C. S., & Stockton, C. M. (2018). The Central Role of Theory in Qualitative Research.  International Journal of Qualitative Methods ,  17 (1), 1609406918797475.

Lawitz, E., Mangia, A., Wyles, D., Rodriguez-Torres, M., Hassanein, T., Gordon, S. C., ... & Jacobson, I. M. (2013). Sofosbuvir for previously untreated chronic hepatitis C infection.  New England Journal of Medicine ,  368 (20), 1878-1887.

Meyers, G., Jacobsen, M., & Henderson, E. (2018). An exploration of IPAC educational intervention research: What do we mean by education?

Mitchell, B. G., Say, R., Wells, A., Wilson, F., Cloete, L., & Matheson, L. (2014). Australian graduating nurses’ knowledge, intentions, and beliefs on infection prevention and control: a cross-sectional study.  BMCNursing ,  13 (1), 43.

Morse, J. M., Stern, P. N., Corbin, J., Bowers, B., Charmaz, K., & Clarke, A. E. (2016).  Developing grounded theory: The second generation . Routledge.

Nofal, M., Subih, M., & Al-Kalaldeh, M. (2017). Factors influencing compliance with the infection control precautions among nurses and physicians in Jordan: A cross-sectional study.  Journal of infection prevention ,  18 (4), 182-188.

Russell, D., Dowding, D. W., McDonald, M. V., Adams, V., Rosati, R. J., Larson, E. L., & Shang, J. (2018). Factors for compliance with infection control practices in home healthcare: findings from a survey of nurses' knowledge and attitudes toward infection control.  American journal of infection control ,  46 (11), 1211-1217.

Silverman, D. (Ed.). (2016).  Qualitative research . Sage.

Tada, A. K. I. O., Watanabe, M., & Senpuku, H. (2014). Factors influencing compliance with infection control practice in Japanese dentists.  Int J Occup Environ Med (The IJOEM) ,  5 (1 January), 298-24.

Appendices

Consent Form 

Introduction

I am (Student’s Name) from (Institution Name). I am researching, “Identifying Barriers to compliance with infection prevention and control.” I will provide you some information about my study and invite you to participate in it. However, before deciding whether you will participate, you may talk to anyone you deem fit about this research. Also, if this consent form contains words that you are not familiar with, please feel free to ask me to explain them. Additionally, if you happen to have further questions in the course of the research, I will be open to addressing them.

Purpose of the Research

Healthcare related infections are on the rise. I am looking to establish the barriers that hinder compliance to infection control and prevention measures, hoping that an understanding of the same will provide insights on the actions that healthcare departments can take to reduce the prevalence rates of healthcare associated infections (HAIs). The reduction in the prevalence of HAIs is crucial because it will lead to the provision of better care services and enhanced patients well-being.

Type of Research Intervention

This research will involve your participation in a survey, through which you will be required to respond to the questions presented in the questionnaire truthfully and honestly.

Participation Selection

You are being involved as a participant because you work as a nurse or physician in one of the hospitals in California, and your expertise will be crucial to the study findings.

Voluntary Participation

Your participation in this research is optional, and you can choose to participate or not. The choice that you make will not affect your job or any job evaluations and reports. You can change your mind on participation in the study without any repercussions, at any time.

Procedures

I am requesting you to help me learn more about the barriers to compliance with infection control and prevention. If you accept, you will be asked to fill in a questionnaire that will require you to provide some demographic information plus opinion on your professional practice and the procedures, thereof.

Duration

The entire study will take about two months to complete, but your participation will be required only for the period of filling the questionnaire. After getting the survey, you will have 14 days to fill it and send it back to me via email.

Confidentiality

The research I am undertaking may draw attention, and if you participate, you may be asked questions by non-participants. Nonetheless, no information about you will be shared with anyone that is not part of the research team. All the information we collect will be kept private, and the questionnaires will be submitted anonymously.

Name of Participant__________________ 

Signature of Participant ___________________ 

Date ________dd/mm/yy___________________ 

Name of Witness__________________ 

Signature of Witness ___________________ 

Date ________dd/mm/yy___________________ 

Questionnaire 

(Tick where appropriate and type answers where necessary) 

What is your gender?

Male

Female

Which age bracket do you fall in?

18-25

26-35

36-45

45-54

55+

Do you work as a nurse or physician?

Nurse

Physician

How long have you been working in your profession?

1-3 years

4-7years

7-10 years

10-15 years

15+ years

Do you think that your experience in your profession has influenced your compliance with infection prevention and control practices?

Yes

No

Why? _____________________________________________________________________________________________________________________________________________________________________________________________________

Do you think that your knowledge/education enhances your compliance to infection prevention and control practices?

Yes

No

Why? _____________________________________________________________________________________________________________________________________________________________________________________________

Numerically mark the following in the order of importance in terms of influencing compliance to infection prevention and control practices? (1 represents the most important and three represents the least important)

Education/Knowledge

Experience

Attitudes

What do you think are the barriers of compliance with infection prevention and control practices in your profession and/or institution?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What do you think can be done to eliminate the said barriers?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________