Compliance of Nurses with personal protective equipment


The identification of clients with infectious diseases through the clinical and laboratory assessment is Possible, but not always be effective. Because the most of infectious diseases such as AIDS, hepatitis and other, the Microorganisms needs to the incubation period before appearance the signs and symptoms of disease on the clients, however, the probability of transmission of infection are possible in these is period. Therefore, any patient should be regarded as a potential source of infection (Hinkin and Gammon, 2008). Use of personal protective equipment is very important to prevent infectious pathogens transmitted from patient to nurse and the versa is true. Furthermore, correctly select and use of personal protective equipment is very effective to prevent transmission of infection, in addition to reduce the risks of exposure for infectious agents (Hon et al 2008). However, the health environment filled with hazards and pathogens because of that nurses should be use effective barrier equipment to break down any probability to contamination by infectious agent (Hinkin and Gammon, 2008).

The personal protective equipments in all contents aprons, gloves, gowns, eye protection (goggles, glasses), caps, laboratory coats, resuscitation bags and face shields/mask all of this and other, are use frequently in general care settings as very important part of standard precaution (Clark et al 2002; Pratt et al 2007).

The standard precautions developed gradually from the universal precautions (Hinkin and Gammon, 2008), which began as prevention agent to prevent transmission of blood borne pathogens to healthcare workers (Wilson 2001). Standard precautions are evidence-based guidance designed to reduce incidence of healthcare associated infection and transmission of infections in healthcare environment (Pellow et al. 2004). Also all intervention and precautions must be applied by all healthcare workers to provide professional care and safety to all health worker and patients in health environment (Pratt et al. 2007).

The Standard precautions it aim to prevent transmission of infection or at least reduce probability of transmission any infected pathogens to the lowest level between nurses and patients , also to protect the patients and healthcare workers at the same time by use standardized precautions such as personal protective equipments (Cullen et al, 2006). Damani (2003) did clarify the standard infection precautions guideline, health worker education are playing effective role to minimize major problems in the UK such as the antibiotic resistant and health care associated infections.

Furthermore, the personal protective equipments as the important part of standard precautions and playing very effective role to prevent incident of healthcare associated infections, it was identified as one of the most common complications in the health care environment, recently which affects on approximately 10% of clients admitted to hospitals worldwide (Filetoth 2003), around 4-10% between hospitals in the developed countries (Nazarko 2008). Also the rate varies from 5-15% in the developing countries (Jarvis 2007). Globally, healthcare associated infections infect a patient every two minutes and the world loses one patient every two hours because of healthcare associated infections leading to non-compliance the healthcare workers with personal protective equipments use and anther standard precautions (Chief Medical Officer’s Report 2006).

For instance, harbarth et al (2001) cleared the rate of hand hygiene compliance among healthcare workers nearly 34%, and Golan et al (2006) cleared the compliance for hand hygiene before provide care nearly 10% and 36% after provide care. Therefore, some studies suggest that the use of MMS, images, videos and online education is very effective to education the health care workers and increased level of compliance and application of personal protective equipments during practice (Pullen 2006), such as Hon et al (2008) reported the rate of hand hygiene compliance among healthcare workers post provide course when wear the personal protective equipment nearly 87% and 68% when taking off the personal protective equipments.

The main infectious occupational risks in the healthcare environment such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Also There are some nurses more risk to transmit or received infection for or from patient such as staff nurses in surgical or operations department, because of he or she have high chances to direct contact with blood of patient and make many of specific procedures(Ganczak and Szych, 2007).

Doebbeling et al (2003) did clarify the occupational blood exposure occurred frequently among the healthcare workers , also as stated in his study one-fourth to one-third of the respondents had injured by percutaneous blood exposure in the previous three months. Specifically, more than one-third of nursing had exposure more than one time to mucocutaneous blood in the previous three months. Also the exposure and injury rates to infection in health environment is vary differ according to the occupation, which depending on several factors such as the average of time spent in provide care for patient or treated of specimens, use of standard precautions during provide care, frequency use of certain devices and mostly never recapping needles.

Gershon et al (1995) clarify the compliance rates among healthcare workers related for the eleven items of personal protective equipments, 97% compliance rate for gloves ; 95% for disposal of sharps; and also the compliance rate is low for others items such as 62% for wearing protective outer clothing and 63% for wearing eye protection. Therefore, Gershon et al find strongly relationship between the compliances of healthcare workers and several key factors such as perception of risk; and training on use the standard precautions as the personal protective equipments.

Research questions and aims:

What is the level of compliance of nursing with Personal protective equipments use? The aim for this question is to evaluate the level of compliance with Personal protective equipments use among Jordanian nurses during provides care for patients. Also to identify the level of compliance for each tool of personal protective equipments.

What are the significant factors that lead to non-compliance with personal protection equipments use among Jordanian nurses during provides care? The aim for this question is to identify the significant factors that lead to non-compliance with personal protective equipments use during provides nursing care for patients.

Almost all nursing interventions need to use personal protective equipment frequently during provide care for patients and especially when applying sterilizes nursing procedures for patients, Because of that this study aims to:

1-to identify mainly significant factors that led to non-compliance with personal protection equipment among Jordanian nurses during provides care.

2- To evaluate the level of compliance with Personal protective equipments use among Jordanian nurses during provides care for patients.

3- To enhance the safety for patients and caregivers in hospital in the same time.

4- To explore the gaps between knowledge and practice relater to personal protective equipments among Jordanian nursing.

5- To enhance apply the standard precautions guideline for personal protective equipments among nursing.

6- To prevent transmission of infection between the nurses and patients, also to minimise incident some of major problem in healthcare environments such as health care associated infection and antibiotic resistant.

7- To provide appropriate solutions and suggestions for these is factors.

Rational of the methodology:

This study was proposed to evaluate the level of compliance with Personal protective equipments use and identify the level of compliance for each tool among Jordanian nurses during provides care for patients. Also to explore the significant factors that leads to non-compliance with personal protection equipments use. However, for the above proposed research quantitative design shall be used.

Quantitative researchers do not look to confirm a hypothesis, but looking forward to reject the hypothesis through the analysis of data and therefore development of statements through clarify of causal relationships (Phillips and Burbules, 2000). Moreover quantitative researches often start with a hypothesis related to phenomena to be tested and after the data are collected and analyses, support this is hypothesis or refute by clarify the relationship between the variables (Holt 2009). Furthermore, quantitative research is often used as a method trying to display causal relationships under controlled or standardized condition (Casebeer and Verhoef, 1997).

Quantitative research is described as the numerical representation and processing of observations and data for the purpose of describing and explain phenomena and facts that those observations reflect. On the other hand the qualitative research is defined as the non-numerical representation and analysis of observations and data; for the purpose of determining underlying meanings and discovering the patterns of relationships (Babbie 1992). As a result the quantitative research is apply deductive approach (where data are especially collected for the purpose of hypotheses, analysis and testing ideas) rather than the qualitative research is apply inductive approach (develop the generalizations and ideas Through the data ) (Meadows 2003).

Quantitative research is identified the science as objective fact or truth, different from quantitative research is identified the science depending on previous experience and thus subjectivity determined. Furthermore, quantitative research method is use numerical estimates and statistical analysis from a generalization sample related to a larger number of populations “true” (Casebeer and Verhoef, 1997). And thus the quantitative research involves experiments and surveys, where statistics and data are collected by using standardized methods such as structured interviews and questionnaires (Meadows 2003). On the other hand the qualitative research method is use narrative description and continual comparisons, are more often use to understand the specific sample or situations being studied (Casebeer and Verhoef, 1997).

Quantitative research is an effective and necessary part of healthcare services researches; the most example of this is the controlled randomized experiment research, with its importance on experimentation and large size of sample. However, quantitative researches cover a wide broader spectrum of activity, which can contain some of small-scale descriptive studies, through to more specialization and complication studies by detect and explore the relationships between variables (Meadows 2003).

Quantitative research used many of research designs for example experiments or surveys and correlational studies (Holt 2009). Also Robson (2002) classified the quantitative research to several types under the headings experimental design, quasi-experimental design and non-experimental design; however these designs sometimes are similar in several respects such as patterns of group behaviour, properties and tendencies. But meadows in (2003) classified the quantitative research strategies to two designs experimental and non-experimental designs. Also the experimental designs are characterized by the introduction or management of some variable for example randomized control trials (RCT) (Lanoe 2007). But in the non experimental designs the data are get from existing groups, for example (relational design) to consider at the relationship between a number of variables such as the scores on a pain or depression scale and age; (descriptive design) to identify the frequency and type of problem in a specific group; (analytical design) to determination why a specific group is affected although the another is not (Meadows 2003).

The qualitative studies are more complicated for generalization than the quantitative studies and more controversial. Therefore, Researchers in quantitative research rarely worry for generalizability issue. Also the goal of most qualitative studies is to present a rich of study, contextualized and considerate of human experience through the concentrated study of particular cases (Polit and Beck, 2010).

Related to my aim from this is study the quantitative design is more appropriate than qualitative design. However, the designs of quantitative research are serves the proposed aims for these is study. In addition this study when looking forward to identify the relationship between the nursing compliance and personal protective equipments, identify frequency of non-compliance of nursing for the personal protective equipments and to determine which personal protective equipments more compliance and another are less compliance. And also after analyse the data will be able to identify the significant factors that lead to non-compliance with personal protective equipments use among the nursing.

it was consider that the literature review could put in the picture the select of methodology and method for this study and also according to the objectives and aims of this study; in addition, this study looking forward to analysis of collected data from a largest size of sample from nurses through survey design. Thus quantitative design approach would be the most excellent approach to achieve my aims and objectives.

Research methodologies:

Qualitative methods

The most three data collection methods common in qualitative research are interview participant observation and focus group discussions.

Firstly, participant observation method the data collection in this method when the researcher watching interactions and acts of participants in a natural situation. Also perhaps the researcher has a role or task in the observation site in addition for his observation role (Greenhalgh and Taylor, 1997). Thus involve on the researcher use some of data collection techniques for example observation, interviewing and self-analysis and reflection. In addition the participant observation is aim to create a completely and specifically description of social interaction in a natural situation (Astin and Long, 2009). Also the researcher has more control on the participants especially about credibility issue and more aware about the less tangible aspects for example apathy and good will. But the participant observation the researcher might have complexity to making observe if involved in the location and recording data especially if working in busy situation such as hospital, the researcher lost the accuracy of observation if the participants might see the researcher make spying or threat (Lanoe 2007). In addition the participant observation techniques put the researcher under some particular pressure and ethical challenges (Astin and Long, 2009).

Secondly, interview method is defined as the interaction and effective conversation between the researcher and participant and usually is in the form face-to-face in a natural location such as participant’s home or workplace (Astin and Long, 2009). Moreover the interview can give the interviewee and researcher more flexibility to express opinions, views and make dissection. But the researchers need to have communication skills of interview; Long time to collect data; difficulty in recording, analysing and coding the information; and the interviews non-confidential are not anonymous (Lanoe 2007).

Quantitative methods:

The most common methods to collect data in quantitative researches is the survey, which approximately always uses questionnaires, structured interviews (face-to-face or telephone), or tests and scales (Meadows 2003).

Firstly, structured interview method the researcher an interviewer poses his questions exactly the same question in the same way and order on the respondent and also gives the opportunity for the researcher to filling out the answers of questionnaire (Holt 2009). But the researcher will be exposed to the same problems that face in any interview such as need to have communication skills of interview, long time to collect data and analysis, in addition difficulty to find appropriate place and time of interview especially with nurses are working in hospital (Lanoe 2007).

Secondly, it was consider that the literature review could put in the picture the select of method for this study. Also and according to the objectives and aims of this study, questionnaires method approach would be the best approach to achieve the objectives and aims of this study.

Questionnaires are a most method of data collection in quantitative design, also characterized mostly as relatively inexpensive; can be cover large numbers of sample by given to several participant at the same time; allow the participant a degree of privacy and answered anonymously, Therefore the participants might be more truthful. However, some famous questionnaires don’t require users to get a licence from the author for use (Holt 2009). Also the questionnaires method characterized by more easier to analyse and code of data and. In addition more effectively for time to respondents’ and researcher’s especially if the respondent as the nurses working in busy area (Lanoe 2007). Nieswiadomy (2008) summarized the importance of questionnaire method by ability to provide good accurate data on population, using relatively small size of samples. In addition the advantage of questionnaire researcher can obtained large amount of data, quickly and less cost.

Although, the questionnaires method needs effort to preparation and perhaps time to test validity and reliability, also some persons do not like forms. Moreover, the most limitation of questionnaire is the type of information obtained (Nieswiadomy 2008), because of some respondents might be answer casually “do not bothering about their answers” or trying to provide the correct answer, although the researcher cannot ask the respondent to clarification their answers (Lanoe 2007).

Literature review:

The purpose of the literature review is to explore and clarify the recently study, knowledge, standardise precautions guideline and theory on the compliance of nurses with personal protective equipments use, in other hand to clarify the significant factors that lead to non-compliance for it among nurses. Moreover it was considered that the literature review would inform the select of most appropriate research design and method for this study.

The literature search for this study which will be using computerized databases by Athens log-in: Medline, CINAHL, Ovid, SAGE, Cochrane Database and the Evidence-Based Medicine. In addition, specific online journals as in Science Direct journal, Medscape Nurses, Medpulse Journal, BioMed central articles, Journal of advanced Nursing, BMJ Journals. Furthermore, have been limited set for each data base: date range between1996-2010, related for nursing, full text articles and journals. To provide the recently studies, information and researchers on the compliances of nurses with personal protective equipments ; and to grow deeper in topic of this study more analytically and Informatics, in addition to devise the best methods used for the same of this study; read and analyse some of the used questionnaires, and perhaps use one of their.

Additional reviewing included the WHO, NHS, Jordanian Ministry of Health, and Jordanian Nursing and Midwife Council. A manual search also undertaken by examining the reference list at the end of the articles found and those that were relevant were followed through. So as to get at the latest statistics and numerical and ratio analysis to benefit of their in this study, accordingly, building of some comparative studies and explore some of the causal relations between the personal protective equipment tools and the compliances of nursing and in addition to clarify the significant factors that led to non-compliances with personal protective equipments and support that by statistically rates.

Also and one of literature review strategy is critically read and analyse for text books references about nursing research, standard precaution, personal protective equipment and nursing guideline.

The key words used were “Nursing Personal protective equipment”, “Standard precaution”, “Nursing safety”, “Qualitative and quantitative research”, “qualitative research”, “quantitative research”, “Nursing compliance”, “guideline”, “Jordanian nursing”, “Knowledge”, “practice”, “attitude”

According to the topic, formulated questions, objectives and aims of this study the literature review clarify the picture about select of methodology and method for this study and also after the literature review has been seen on some of the questionnaires used in the same study and how collected and what the questions that used in the questionnaires. In addition, identify the most significant factors effect on the compliances of healthcare workers with personal protective equipments use.