Occupational exposures of healthcare workers tend to occur because of inconsistent compliance with standard precautions. Also, incidence of occupational exposure is underreported among operating room personnel. The purpose of this project was to develop national estimates for compliance with standard precautions and occupational exposure reporting practices among operating room nurses in Australia. Data was obtained utilizing a 96-item self-report survey. The Standard Precautions and Occupational Exposure Reporting survey was distributed anonymously to 500 members of the Australian College of Operating Room Nurses. The Health Belief Model was the theoretical framework used to guide the analysis of data. Data was analysed to examine relationships between specific constructs of the Health Belief Model to identify factors that might influence the operating room nurse to undertake particular health behaviours to comply with standard precautions and occupational exposure reporting. Results of the study revealed compliance rates of 55.6% with double gloving, 59.1% with announcing sharps transfers, 71.9% with using a hands-free sharps pass technique, 81.9% with no needle recapping and 92.0% with adequate eye protection. Although 31.6% of respondents indicated receiving an occupational exposure in the past 12 months, only 82.6% of them reported their exposures. The results of this study provide national estimates of compliance with standard precautions and occupational exposure reporting among operating room nurses in Australia. These estimates can now be used as support for the development and implementation of measures to improve practices in order to reduce occupational exposures and, ultimately, disease transmission rates among this high-risk group.

<p>Everyday thousands of nurses are rendering bedside nursing care in health care settings as a result they are exposed to blood, body fluids and sharp objects that are contaminated with Hepatitis B, Hepatitis C and HIV. Therefore they are at risk of getting infected. In 1996, standard precautions were implemented by the Centre of Disease Control to reduce the risk of transmission of micro-organisms from any source of infection in the hospital. In the year 2008, the three tertiary hospitals together in the Western Cape reported that they had 733 needle prick injuries. Therefore the aim of the study was to determine if nurses comply with and have adequate knowledge of standard precautions. A non-experimental design and a self administered questionnaire were used to collect the data for the study. The study was done at Tygerberg Hospital and the participants (n=143) that were involved in the study were all nursing categories (professional, enrolled nurse and auxiliary nurse). Stratified random sampling was used to ensure that there was a representation of all the nurses working in the different modules at Tygerberg Hospital. Therefore three wards were randomly selected from each module and all the nurses on duty working in the three selected wards were given a questionnaire by the Assistant Director of the specific module. After the data was collected it was analysed through the statistical package for social sciences. The findings of the study showed that nurses have inadequate knowledge regarding standard precautions and the mean score of the nurses overall self reported compliance of standard precautions was 87.5%. The results also showed that when patients are HIV positive nurses intend to over comply the use of personal protective equipment. No association was found between the nurses&rsquo / knowledge and compliance regarding standard precautions. It is therefore important that every nurse should be educated about the basic principles of standard precautions and also the policies and protocols of infection control in order to prevent each nurse from getting infected. Training needs to be implemented starting in the wards through the unit manager to improve all the nurses&rsquo / knowledge and practice.</p>

<p>Everyday thousands of nurses are rendering bedside nursing care in health care settings as a result they are exposed to blood, body fluids and sharp objects that are contaminated with Hepatitis B, Hepatitis C and HIV. Therefore they are at risk of getting infected. In 1996, standard precautions were implemented by the Centre of Disease Control to reduce the risk of transmission of micro-organisms from any source of infection in the hospital. In the year 2008, the three tertiary hospitals together in the Western Cape reported that they had 733 needle prick injuries. Therefore the aim of the study was to determine if nurses comply with and have adequate knowledge of standard precautions. A non-experimental design and a self administered questionnaire were used to collect the data for the study. The study was done at Tygerberg Hospital and the participants (n=143) that were involved in the study were all nursing categories (professional, enrolled nurse and auxiliary nurse). Stratified random sampling was used to ensure that there was a representation of all the nurses working in the different modules at Tygerberg Hospital. Therefore three wards were randomly selected from each module and all the nurses on duty working in the three selected wards were given a questionnaire by the Assistant Director of the specific module. After the data was collected it was analysed through the statistical package for social sciences. The findings of the study showed that nurses have inadequate knowledge regarding standard precautions and the mean score of the nurses overall self reported compliance of standard precautions was 87.5%. The results also showed that when patients are HIV positive nurses intend to over comply the use of personal protective equipment. No association was found between the nurses&rsquo / knowledge and compliance regarding standard precautions. It is therefore important that every nurse should be educated about the basic principles of standard precautions and also the policies and protocols of infection control in order to prevent each nurse from getting infected. Training needs to be implemented starting in the wards through the unit manager to improve all the nurses&rsquo / knowledge and practice.</p>

As Precauções- Padrão (PP) são medidas fundamentais para proteger pacientes e profissionais da área da saúde (PAS) da aquisição de microorganismos patogênicos. Entretanto, a adesão às PP é insatisfatória e vários motivos são descritos para essa baixa adesão. OBJETIVO: Analisar os fatores individuais, laborais e organizacionais associados com a adesão às PP de profissionais de enfermagem de uma instituição privada localizada na cidade de São Paulo. MÉTODO: Estudo transversal realizado com uma amostra de 291 profissionais de enfermagem, distribuídos proporcionalmente entre enfermeiros, técnicos e auxiliares que trabalhavam em setores críticos, semi-críticos e emergência. Os dados foram coletados no período de outubro de 2010 a janeiro de 2011. Para a coleta de dados, utilizou-se um instrumento com questões socio demográficas e escalas de Likert com 5 opções de respostas, segundo o referencial teórico Modelo Explicativo da Adesão às Precauções- Padrão. RESULTADO: 78,0% (226/291) dos profissionais de enfermagem responderam usar as PP na assistência a todos os pacientes. A análise multivariada mostrou que a adesão às PP foi associada a fatores individuais, expressa por profissionais mais jovens; fatores laborais, expressa por menor percepção de obstáculos e ter recebido treinamento; e fatores organizacionais, expressa por maior percepção de clima de segurança institucional. CONCLUSÕES: As intervenções planejadas para a melhoria da adesão às PP devem ser voltadas não somente para treinamentos em serviço, mas também para ações de redução de barreiras e melhoria do clima de segurança institucional. / Standard Precautions (SP) are key measures to protect patients and health professionals (HP) from the acquisition of pathogenic microorganisms. However, adherence to the SP is unsatisfactory and several reasons are described for this low adherence. OBJECTIVE: To analyze individual, organizational and labor factors associated with adherence to the SP of nursing professionals from a private institution located in the city of São Paulo. METHOD: Cross-sectional study carried out with a sample of 291 nursing professionals, proportionally distributed among nurses, nursing technicians and nursing auxiliaries who work in critical, semi-critical and emergency care areas. Data were collected between October 2010 and January 2011. For data collection an instrument with sociodemographic questions and Likert-type scales with 5 response options was used, according to the theoretical framework of the Explanatory Model of Adherence to Standard Precautions. RESULT: 78.0% (226/291) of the nursing professionals answered using the SP in the care to all patients. Multivariate analysis showed that adherence to SP was associated with individual factors, expressed by younger professionals; labor factors, expressed by lower perception of obstacles and having received training; and organizational factors, expressed by a greater perception of institutional safety climate. CONCLUSIONS: Interventions designed to improve the adherence to SP should target not only in-service training, but also actions to reduce barriers and improve the institutional safety climate.

Magister Curationis - MCur / Everyday thousands of nurses are rendering bedside nursing care in health care settings as a result they are exposed to blood, body fluids and sharp objects that are contaminated with Hepatitis B, Hepatitis C and HIV. Therefore they are at risk of getting infected. In 1996, standard precautions were implemented by the Centre of Disease Control to reduce the risk of transmission of micro-organisms from any source of infection in the hospital. In the year 2008, the three tertiary hospitals together in the Western Cape reported that they had 733 needle prick injuries. Therefore the aim of the study was to determine if nurses comply with and have adequate knowledge of standard precautions. A non-experimental design and a self administered questionnaire were used to collect the data for the study. The study was done at Tygerberg Hospital and the participants (n=143) that were involved in the study were all nursing categories (professional, enrolled nurse and auxiliary nurse). Stratified random sampling was used to ensure that there was a representation of all the nurses working in the different modules at Tygerberg Hospital. Therefore three wards were randomly selected from each module and all the nurses on duty working in the three selected wards were given a questionnaire by the Assistant Director of the specific module. After the data was collected it was analysed through the statistical package for social sciences. The findings of the study showed that nurses have inadequate knowledge regarding standard precautions and the mean score of the nurses overall self reported compliance of standard precautions was 87.5%. The results also showed that when patients are HIV positive nurses intend to over comply the use of personal protective equipment. No association was found between the nurses knowledge and compliance regarding standard precautions. It is therefore important that every nurse should be educated about the basic principles of standard precautions and also the policies and protocols of infection control in order to prevent each nurse from getting infected. Training needs to be implemented starting in the wards through the unit manager to improve all the nurses knowledge and practice. / South Africa

Bakgrund Vårdrelaterade infektioner [VRI] är den vanligaste vårdskadan både globalt, i Europa liksom i Sverige. I Sverige får cirka 65 000 patienter årligen en VRI där närmare hälften av dessa beräknas kunna undvikas. De vanligaste typerna av VRI är luftvägsinfektioner, urinvägsinfektioner, infektioner i blodbanan och gastrointestinala infektioner. Vårdrelaterade infektioner är ett utbrett problem som utgör ett hot mot patientsäkerheten genom att orsaka onödigt lidande, förlängda vårdtider, medför stora kostnader för samhället samt utgör en risk för antibiotikaresistens. Följsamhet av basala hygienrutiner för hälso- och sjukvårdspersonal är den främsta åtgärden för att förebygga VRI. Säker vård och evidensbaserad vård är två av sjuksköterskornas sex kärnkompetenser. Tidigare forskning visar på brister gällande följsamhet av vårdhygien Syfte Syftet var att beskriva faktorer som har betydelse för sjuksköterskors följsamhet till vårdhygien i förebyggandet av vårdrelaterade infektioner. Metod Denna litteraturöversikt har en icke systematisk design. Utifrån litteraturöversiktens bärande begrepp gjordes sökningar i databaserna CINAHL och PubMed som resulterade i 15 vetenskapliga originalartiklar vars kvalitet säkrades utifrån Sophiahemmet Högskola granskningsmall. Datainsamlingen integrerades genom en integrerad dataanalys och kategoriserades därefter. Resultat De två identifierade huvudkategorierna i resultatet var Individens betydelse för följsamhet samt Arbetsplatsens betydelse för följsamhet. Resultatet visade att individuell riskbedömning, att bli observerad och att rationalisera, kunskap och erfarenhet, tidspress och arbetsbelastning, lokal och material samt arbetskultur hade betydelse för sjuksköterskors följsamhet till vårdhygien. Slutsats Individuella och organisatoriska faktorer har betydelse för sjuksköterskors följsamhet till vårdhygien. Tidspress, hög arbetsbelastning och otillgängligt material sågs bidra till bristande följsamhet. Individuell riskbedömning som ersatte vårdhygieniska riktlinjer liksom rationalisering av felaktiga beslut sågs ha betydelse för följsamhet av vårdhygien bland sjuksköterskor. Basala hygienrutiner är för hälso- och sjukvårdspersonal den främsta åtgärden för att förebygga vårdrelaterade infektioner. / Background  Cross infections are the most common health care injury globally, in Europe and in Sweden. Every year almost 65 000 patients suffer from a cross infection where almost 50 percent could have been avoided. Respiratory tract infections, urinary tract infections, bloodstream infections and gastrointestinal infections are the most common types of cross infections. Cross infections are a widespread threat against patient safety and causes unnecessary suffering, prolonged health care, high costs and causes risk for antibiotic resistance. Compliance to hygiene routines among healthcare professionals is the main measure to prevent cross infections. Providing safe and evidence-based care are two important aspects of nursing care. Research shows a lack of compliance with hygiene routines. Aim  The aim was to describe factors of importance for nurses’ compliance with hygiene routines in prevention of cross infections. Method This literature review had a non-systematic design. Based on the identified keywords searches were made through the databases CINAHL and PubMed which resulted in 15 scientific articles. The quality of the articles was ensured according to Sophiahemmet Högskola quality review template. The result was analysed and categorized through an integrative data analysis. Results The two main categories identified were Compliance from an individual aspect and Compliance from an organizational aspect. The results showed that individual risk assessment, to be observed and to rationalize, knowledge and experience, time pressure and workload, infrastructure, and personal protective equipment as well as work culture influenced nurses' compliance with hygiene routines. Conclusions Individual and organizational factors influence nurses' compliance with hygiene routines. Time pressure, high workload and unavailable personal protective equipment were seen as main contributors regarding non-compliance. Individual risk assessment replacing hygiene guidelines as well as rationalization of non-compliance were seen to influence the compliance with hygiene routines among nurses. Standard precautions are the primary measure to prevent cross infections.

As precauções-padrão preconizadas pelo Centers for Disease Control and Prevention e ratificadas pelo Ministério da Saúde, são medidas que minimizam a exposição ocupacional a material biológico potencialmente contaminado e previnem as infecções relacionadas à assistência em saúde. No entanto, constata-se que a adesão a essas medidas é problema dentre os profissionais de enfermagem e instrumentos para estudar a adesão de enfermeiros a essas medidas foram construídos para apoiar intervenções. Considerando-se que a adaptação e validação de um instrumento utilizado em diferentes culturas garante a sua maior confiabilidade e validade e que a viabilidade de um instrumento fidedigno, para aferir conhecimento e adesão de enfermeiros às precauções-padrão, se faz necessário no contexto brasileiro, este estudo teve por objetivos adaptar para enfermeiros brasileiros e validar o questionário de adesão às precauções-padrão e o questionário de conhecimento sobre as precauções-padrão (Questionnaires for Knowledge and Compliance with Standard Precaution).Trata-se de estudo metodológico, cujo processo de adaptação dos questionários seguiu as etapas: tradução inicial; síntese e consenso das traduções; realização do comitê de especialistas; retrotradução; validação semântica e pré-teste da versão final. O processo de adaptação contou com uma amostra de 42 enfermeiros de uma unidade de emergência vinculada a um hospital de ensino do interior de São Paulo, sendo que 12 enfermeiros participaram da validação semântica e 30 do pré- teste. O processo de validação foi realizado com uma amostra aleatória de 121 enfermeiros, sendo 91 pertencentes a estabelecimentos de saúde de alta complexidade e 30 enfermeiros pertencentes a estabelecimentos de saúde de média complexidade de outro município do interior de São Paulo (sendo um hospital filantrópico, um hospital privado e uma unidade de pronto atendimento vinculada a um plano de saúde). Para o Questionário de Adesão às Precauções-Padrão, a consistência interna foi calculada pelo alfa de Cronbach e a estabilidade pelo Coeficiente de Correlação Intraclasse. A validade de construto convergente foi calculada pela correlação com a percepção de clima de segurança organizacional e a validade de construto divergente por meio da correlação com a menor percepção de obstáculos, para seguir as precauções-padrão. A validade de construto por grupos conhecidos foi calculada entre enfermeiros que relataram ter recebido e enfermeiros que relataram não ter recebido treinamento e entre as diferentes instituições estudadas. A presença de efeito máximo e mínimo (floor and ceiling) foi avaliada. Para o Questionário de Conhecimento sobre as Precauções-Padrão foi calculada a concordância pelo coeficiente Kappa e a estabilidade foi avaliada pelo Coeficiente de Correlação Intraclasse. A validade de construto entre grupos conhecidos foi calculada entre enfermeiros com maior e menor titulação e enfermeiros que receberam e que não receberam treinamento sobre as precauções-padrão. Os resultados obtidos mostram que os questionários estão compreensíveis, fáceis de responder e adequados ao português do Brasil. O pré-teste confirmou a versão obtida pela validação semântica. O questionário de adesão apresentou consistência interna de 0,80 e estabilidade de 0,97. A validade de construto convergente e divergente evidenciaram forte correlação com a maior percepção de clima de segurança (r=0,614) e com a menor percepção de obstáculos, (r=0-537). A validade de construto entre grupos conhecidos revelou maior adesão entre os enfermeiros que receberam treinamento (p=0,028) e que os participantes pertencentes aos estabelecimentos de alta complexidade apresentaram maior adesão quando comparados aos demais estabelecimentos (p=0,006). Foi verificado efeito máximo e mínimo no Questionário de Adesão às Precauções-Padrão, o que compromete a responsividade do instrumento; porém, auto-relatos de adesão são frequentemente superiores aos índices constatados em estudos observacionais. Com relação ao Questionário de Conhecimento sobre as Precauções-Padrão, as respostas dos enfermeiros se mostraram concordantes e a estabilidade foi de 0,91, o que confirma a capacidade do instrumento de detectar possíveis alterações em características na amostra estudada. A validade por grupos conhecidos não evidenciou diferença estatisticamente significante entre os enfermeiros pela titulação e presença de treinamento (p=0,706 e p=0,209, respectivamente). Os resultados evidenciam que o Questionário de Adesão às Precauções-Padrão obteve índices psicométricos satisfatórios, o que confirma a hipótese de que o instrumento afere o construto adesão. O Questionário de Conhecimento sobre as Precauções-Padrão revelou boa concordância e estabilidade. Conclui-se que os questionários adaptados e validados são fidedignos e podem ser utilizados para medir a adesão e o conhecimento de enfermeiros brasileiros às precauções-padrão e subsidiarão a proposição de medidas intervencionistas, visando a saúde do trabalhador e a segurança do paciente / The standard precautions, established by the Centers for Disease Control and Prevention and ratified by the Brazilian Ministry of Health, are measures that minimize the occupational exposure to potentially contaminated biological material and prevent healthcare-related infections. As verified, however, compliance with these measures is a problem among nursing professionals and tools to study the nurses\' compliance with these measures have been constructed to support interventions. Considering that the adaptation and validation of a tool used in different cultures guarantees its greater reliability and validity and that the feasibility of a reliable tool to verify nurses\' knowledge and compliance with the standard precautions is necessary in the Brazilian context, the objectives in this study were to adapt for Brazilian nurses and validate the Questionnaires for Knowledge and Compliance with Standard Precaution. In this methodological study, the adaptation process of the questionnaires followed a number of phases: initial translation; synthesis and consensus of the translations; expert committee; back translation; semantic validation and pretest of the final version. The adaptation process involved a sample of 42 nurses from the emergency service of a teaching hospital in a city from São Paulo state, 12 of whom participated in the semantic validation and 30 in the pretest. The validation process was accomplished with a random sample of 121 nurses, 91 were located in high complexity healthcare institutions and 30 from intermediate healthcare institutions in another city from São Paulo state (including one non-for-profit hospital, one private hospital and the emergency service of a health insurance). For the Questionnaire for Compliance with Standard Precaution, the internal consistency was calculated using Cronbach\'s alpha and the stability using the Intraclass Correlation Coefficient. The convergent construct validity was calculated through the correlation with the perceived organizational safety climate and the divergent construct validity through the correlation with the lesser perception of obstacles to compliance with the standard precautions. The construct validity using the known-groups method was calculated among nurses who indicated they had received and nurses who indicated they had not received training and among the different institutions under analysis. The presence of floor and ceiling effects was assessed. For the Questionnaire for Knowledge about Standard Precaution, the agreement was calculated using the Kappa coefficient and stability was assessed through the Intraclass Correlation Coeficient. The construct validity among known groups was calculated between nurses with higher and lower degrees and nurses who did and did not receive training about the standard precautions. The obtained results show that the questionnaires are understandable, easy to answer and appropriate to Brazilian Portuguese. The pretest confirmed the version obtained in the semantic validation procedure. The internal consistency of the compliance questionnaire equaled 0.80 and the stability 0.97. The convergent and divergent construct validity showed a strong correlation with a greater perceived safety climate (r=0.614) and a lesser perception of obstacles (r=0-537). The construct validity among known groups revealed greater compliance among the nurses who received training (p=0.028) and that the subjects at the high complexity healthcare institutions showed higher compliance levels when compared to the other institutions (p=0.006). Floor and ceiling effects were found in the Questionnaire for Compliance with Standard Precaution, which compromises the responsiveness of the tool; nevertheless, self-reported compliance levels are frequently higher than the indices found in observation studies. As regards the Questionnaire for Knowledge about Standard Precaution, the nurses\' answers demonstrated agreement and the stability corresponded to 0.91, which confirms that tool\'s ability to detect possible alterations in characteristics of the study sample. The validity among known groups did not show a statistically significant difference among the nurses according to the degree and presence of training (p=0.706 and p=0.209, respectively). The results show that the Questionnaires for Compliance with Standard Precautions obtained satisfactory psychometric coefficients, which confirms the hypothesis that the tool verifies the compliance construct. The Questionnaire for Knowledge about Standard Precaution revealed good agreement and stability coefficients. In conclusion, the adapted and validated questionnaires are reliable and can be used to measure the compliance and knowledge of Brazilian nurses about the standard precaution and will support the proposal of intervention measures directed at occupational health and patient safety

As precauções-padrão preconizadas pelo Centers for Disease Control and Prevention e ratificadas pelo Ministério da Saúde, são medidas que minimizam a exposição ocupacional a material biológico potencialmente contaminado e previnem as infecções relacionadas à assistência em saúde. No entanto, constata-se que a adesão a essas medidas é problema dentre os profissionais de enfermagem e instrumentos para estudar a adesão de enfermeiros a essas medidas foram construídos para apoiar intervenções. Considerando-se que a adaptação e validação de um instrumento utilizado em diferentes culturas garante a sua maior confiabilidade e validade e que a viabilidade de um instrumento fidedigno, para aferir conhecimento e adesão de enfermeiros às precauções-padrão, se faz necessário no contexto brasileiro, este estudo teve por objetivos adaptar para enfermeiros brasileiros e validar o questionário de adesão às precauções-padrão e o questionário de conhecimento sobre as precauções-padrão (Questionnaires for Knowledge and Compliance with Standard Precaution).Trata-se de estudo metodológico, cujo processo de adaptação dos questionários seguiu as etapas: tradução inicial; síntese e consenso das traduções; realização do comitê de especialistas; retrotradução; validação semântica e pré-teste da versão final. O processo de adaptação contou com uma amostra de 42 enfermeiros de uma unidade de emergência vinculada a um hospital de ensino do interior de São Paulo, sendo que 12 enfermeiros participaram da validação semântica e 30 do pré- teste. O processo de validação foi realizado com uma amostra aleatória de 121 enfermeiros, sendo 91 pertencentes a estabelecimentos de saúde de alta complexidade e 30 enfermeiros pertencentes a estabelecimentos de saúde de média complexidade de outro município do interior de São Paulo (sendo um hospital filantrópico, um hospital privado e uma unidade de pronto atendimento vinculada a um plano de saúde). Para o Questionário de Adesão às Precauções-Padrão, a consistência interna foi calculada pelo alfa de Cronbach e a estabilidade pelo Coeficiente de Correlação Intraclasse. A validade de construto convergente foi calculada pela correlação com a percepção de clima de segurança organizacional e a validade de construto divergente por meio da correlação com a menor percepção de obstáculos, para seguir as precauções-padrão. A validade de construto por grupos conhecidos foi calculada entre enfermeiros que relataram ter recebido e enfermeiros que relataram não ter recebido treinamento e entre as diferentes instituições estudadas. A presença de efeito máximo e mínimo (floor and ceiling) foi avaliada. Para o Questionário de Conhecimento sobre as Precauções-Padrão foi calculada a concordância pelo coeficiente Kappa e a estabilidade foi avaliada pelo Coeficiente de Correlação Intraclasse. A validade de construto entre grupos conhecidos foi calculada entre enfermeiros com maior e menor titulação e enfermeiros que receberam e que não receberam treinamento sobre as precauções-padrão. Os resultados obtidos mostram que os questionários estão compreensíveis, fáceis de responder e adequados ao português do Brasil. O pré-teste confirmou a versão obtida pela validação semântica. O questionário de adesão apresentou consistência interna de 0,80 e estabilidade de 0,97. A validade de construto convergente e divergente evidenciaram forte correlação com a maior percepção de clima de segurança (r=0,614) e com a menor percepção de obstáculos, (r=0-537). A validade de construto entre grupos conhecidos revelou maior adesão entre os enfermeiros que receberam treinamento (p=0,028) e que os participantes pertencentes aos estabelecimentos de alta complexidade apresentaram maior adesão quando comparados aos demais estabelecimentos (p=0,006). Foi verificado efeito máximo e mínimo no Questionário de Adesão às Precauções-Padrão, o que compromete a responsividade do instrumento; porém, auto-relatos de adesão são frequentemente superiores aos índices constatados em estudos observacionais. Com relação ao Questionário de Conhecimento sobre as Precauções-Padrão, as respostas dos enfermeiros se mostraram concordantes e a estabilidade foi de 0,91, o que confirma a capacidade do instrumento de detectar possíveis alterações em características na amostra estudada. A validade por grupos conhecidos não evidenciou diferença estatisticamente significante entre os enfermeiros pela titulação e presença de treinamento (p=0,706 e p=0,209, respectivamente). Os resultados evidenciam que o Questionário de Adesão às Precauções-Padrão obteve índices psicométricos satisfatórios, o que confirma a hipótese de que o instrumento afere o construto adesão. O Questionário de Conhecimento sobre as Precauções-Padrão revelou boa concordância e estabilidade. Conclui-se que os questionários adaptados e validados são fidedignos e podem ser utilizados para medir a adesão e o conhecimento de enfermeiros brasileiros às precauções-padrão e subsidiarão a proposição de medidas intervencionistas, visando a saúde do trabalhador e a segurança do paciente / The standard precautions, established by the Centers for Disease Control and Prevention and ratified by the Brazilian Ministry of Health, are measures that minimize the occupational exposure to potentially contaminated biological material and prevent healthcare-related infections. As verified, however, compliance with these measures is a problem among nursing professionals and tools to study the nurses\' compliance with these measures have been constructed to support interventions. Considering that the adaptation and validation of a tool used in different cultures guarantees its greater reliability and validity and that the feasibility of a reliable tool to verify nurses\' knowledge and compliance with the standard precautions is necessary in the Brazilian context, the objectives in this study were to adapt for Brazilian nurses and validate the Questionnaires for Knowledge and Compliance with Standard Precaution. In this methodological study, the adaptation process of the questionnaires followed a number of phases: initial translation; synthesis and consensus of the translations; expert committee; back translation; semantic validation and pretest of the final version. The adaptation process involved a sample of 42 nurses from the emergency service of a teaching hospital in a city from São Paulo state, 12 of whom participated in the semantic validation and 30 in the pretest. The validation process was accomplished with a random sample of 121 nurses, 91 were located in high complexity healthcare institutions and 30 from intermediate healthcare institutions in another city from São Paulo state (including one non-for-profit hospital, one private hospital and the emergency service of a health insurance). For the Questionnaire for Compliance with Standard Precaution, the internal consistency was calculated using Cronbach\'s alpha and the stability using the Intraclass Correlation Coefficient. The convergent construct validity was calculated through the correlation with the perceived organizational safety climate and the divergent construct validity through the correlation with the lesser perception of obstacles to compliance with the standard precautions. The construct validity using the known-groups method was calculated among nurses who indicated they had received and nurses who indicated they had not received training and among the different institutions under analysis. The presence of floor and ceiling effects was assessed. For the Questionnaire for Knowledge about Standard Precaution, the agreement was calculated using the Kappa coefficient and stability was assessed through the Intraclass Correlation Coeficient. The construct validity among known groups was calculated between nurses with higher and lower degrees and nurses who did and did not receive training about the standard precautions. The obtained results show that the questionnaires are understandable, easy to answer and appropriate to Brazilian Portuguese. The pretest confirmed the version obtained in the semantic validation procedure. The internal consistency of the compliance questionnaire equaled 0.80 and the stability 0.97. The convergent and divergent construct validity showed a strong correlation with a greater perceived safety climate (r=0.614) and a lesser perception of obstacles (r=0-537). The construct validity among known groups revealed greater compliance among the nurses who received training (p=0.028) and that the subjects at the high complexity healthcare institutions showed higher compliance levels when compared to the other institutions (p=0.006). Floor and ceiling effects were found in the Questionnaire for Compliance with Standard Precaution, which compromises the responsiveness of the tool; nevertheless, self-reported compliance levels are frequently higher than the indices found in observation studies. As regards the Questionnaire for Knowledge about Standard Precaution, the nurses\' answers demonstrated agreement and the stability corresponded to 0.91, which confirms that tool\'s ability to detect possible alterations in characteristics of the study sample. The validity among known groups did not show a statistically significant difference among the nurses according to the degree and presence of training (p=0.706 and p=0.209, respectively). The results show that the Questionnaires for Compliance with Standard Precautions obtained satisfactory psychometric coefficients, which confirms the hypothesis that the tool verifies the compliance construct. The Questionnaire for Knowledge about Standard Precaution revealed good agreement and stability coefficients. In conclusion, the adapted and validated questionnaires are reliable and can be used to measure the compliance and knowledge of Brazilian nurses about the standard precaution and will support the proposal of intervention measures directed at occupational health and patient safety

The purpose of this study was to describe factors associated with noncompliance to hand hygiene standards among nurses in one public hospital in Windhoek, Namibia. A quantitative, descriptive, cross-sectional research design was employed using a stratified sample comprising three categories of nurses (registered, enrolled and auxiliary nurses). Data collection was done using a structured questionnaire. Based on the results, there were more institutional than individual factors associated with noncompliance to hand hygiene. Compliance to hand hygiene was found to be lowest when nurses provide care for patients in non-isolation rooms, when the perceived risk of acquiring infection from patients was low and following brief encounters with patients. Dryness of the skin caused by hand hygiene agents and lack of active participation in hand hygiene promotion at individual level contributed to noncompliance to hand hygiene among nurses. In addition, the results showed that, institutionally there were no rewards/encouragement for hand hygiene, no sanctions for non-compliers and no workshops, seminars and continuing educational courses on hand hygiene. The study produced interesting insights into the vital role that good leadership plays in the implementation of hand hygiene policy guidelines. The key recommendations for this study included development of good leadership, characterized by dedication for hygiene standards to encourage staff to maintain hygiene practice and to ensure that there are adequate resources for the implementation of hand hygiene policy as well as rewards/incentives for compliers and sanctions for noncompliers / Health Studies / M.A. (Nursing Science)

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No. of bitstreams: 1 Dulcelene Melo.pdf: 680160 bytes, checksum: 55d8a4c2a66fae3c908abe807d75735e (MD5) Previous issue date: 2005-03-31 / This was a qualitative study done in a big-sized general public hospital in the city of Goiânia Goiás The aims was to analyze nurses´ adherence to standard precautions according to Rosenstock´s health belief model (HBM) (1974) Data were collected using a semi-structured interview guide based on principles of Critical Incidence Technique (CIT) The instrument was validated by judges and was then pre-tested The ethical-legal research principles were observed Among 90 nurses selected to participate in the study 82 agreed to take part in this study Inclusion criteria were nurses who were either in direct contact with patients or in supervisory positions in the hospital cleaning, laundry or sterilization services Data were analyzed in accordance with CIT The analysis categories were constructed using the dimensions of the HBM A total of 139 critical incidents were identified of which 66 were considered positive and 73 negative HBM dimensions were identified within 131 situations: 74 (56,5%) related to perceived susceptibility; 17 (13,0%) to perceived benefits and 40 (30,5%) to perceived barriers The majority of the reported critical incidents related to situations of occupational exposure to biological materials Among the Standard Precautions (SP) use of protective barriers was most frequently utilized Denial of susceptibility was indicated by the lack of use of protective barriers improper management of sharp objects and non-adherence to SP related to patients with multi-resistant pathogens Moderate perceived susceptibility was associated with partial adherence to SP in cases of patients requiring more complex levels of care; in situations following occupational exposure; and when patients needs took priority over personal protection High perceived susceptibility was observed in situations of caring for patients suspected or diagnosed with infections due to pathogens of epidemiological importance and those related to nurses responsibility Perceived seriousness was evident in behaviors and consequences related to critical incidences after occupational exposure in moments when nurses expressed feelings experienced psychosomatic symptoms and were diagnosed with an infection. Perceived benefits emerged above all from positive critical incidente with focus on protective barriers understood as protection strategies which lead to safety while procedures are executed Perceived barriers were: lack of personnel preparation lack of material resources insufficient personnel improper physical structure patient emergencies psychosocial factors lack of personnel policies for cases of exposure to biological material These barriers contribute to lower adherence of SP but they could be addressed by the Health Care Facilities since nurses have demonstrated adequate perception of susceptibility and benefits HBM dimensions were associated with nurses adherence to SP suggesting that plans should be developed to improve the nurses actions and decision-making in day-to-day nursing cars prioritizing the safety of those individuals involved in this process / Estudo qualitativo desenvolvido em um hospital público geral de grande porte de Goiânia-Go Teve como objetivo analisar a adesão dos enfermeiros às precauções padrão (PP) à luz do modelo de crenças em saúde (MCS) de Rosenstock (1974) Os dados foram coletados por meio de entrevista com roteiro semi-estruturado e conforme preconizado pela técnica de incidentes críticos (TIC) O instrumento foi validado por juizes seguido do pré-teste Foram observados os aspectos ético-legais da pesquisa Fizeram parte do estudo 82 enfermeiros dos 90 eleitos que estavam em atividade assistencial direta ao paciente ou atuavam nos setores: de higienização hospitalar reprocessamento de roupas e materiais odonto-médico-hospitalares Procedemos a análise de conteúdo dos dados conforme a TIC As dimensões do MCS foram utilizadas como categorias prévias de análise Obtivemos 139 incidentes críticos sendo que 66 foram positivos e 73 negativos de acordo com a polaridade referida Destes 131 situações remetiam às dimensões do modelo de crenças em saúde: 74 (56,5%) eram relacionadas à suscetibilidade percebida; 17 (13,0%) aos benefícios percebidos e 40 (30,5%) às barreiras percebidas Os incidentes críticos relatados predominantemente relacionavam-se às situações de exposição ocupacional a material biológico O uso de barreiras protetoras foi a PP que obteve maior freqüência de indicação A negação da suscetibilidade foi observada pelo não uso das barreiras protetoras no manuseio inadequado de perfurocortante e não adesão às PP relacionadas ao paciente portador de patógeno multi-resistente A moderada suscetibilidade percebida associou-se à adesão parcial às PP no atendimento a pacientes com maior complexidade nos cuidados assistenciais Estes comportamentos adotados sinalizam limitada percepção da necessidade de intervenção nos cuidados pós-exposição ocupacional priorizando o atendimento às necessidades dos pacientes A alta suscetibilidade percebida foi observada nas situações de atendimento ao paciente sob suspeita ou com diagnóstico de infecção por patógenos de importância epidemiológica e àquelas relacionadas à responsabilidade do enfermeiro nesta particularidade da assistência A severidade percebida foi evidenciada somente nos comportamentos e conseqüências dos incidentes críticos relatados nos momentos de pós-exposição ocupacional expressa em sentimentos alterações psicossomáticas e experiência de infecção Os benefícios percebidos emergiram sobretudo dos incidentes críticos positivos com enfoque no uso das barreiras protetoras que foram compreendidas como estratégia de proteção ratificando a segurança na execução dos procedimentos As barreiras percebidas foram: falta de preparo do profissional falta de material de consumo e permanente número insuficiente de profissionais estrutura física inadequada atendimento a pacientes em situações de urgência/emergência fatores psicossociais e falta de fluxo para o atendimento ao profissional em situação de pós-exposição a material biológico; que poderiam ser minimizadas com a organização do Serviço de Assistência à Saúde pois se constituíram em impedimentos para a adesão às precauções padrão embora os enfermeiros apresentassem adequada percepção da suscetibilidade e benefícios Verificamos que as dimensões do modelo de crenças em saúde elucidaram a adesão dos enfermeiros às PP sugerindo que empreendimentos devam ser feitos para melhor instrumentalizá-los para a tomada e modalidade de ação no cotidiano da assistência que priorize a segurança dos sujeitos envolvidos nesse processo