|Year : 2019 | Volume
| Issue : 2 | Page : 156-161
Nurses' competency and their role in prevention and control of hospital infections: A case study in a large military teaching hospital
Ehsan Teymourzadeh1, Mohammadkarim Bahadori1, Hamed Fattahi2, Mahmoud Khodadost3, Azad Shokri4
1 Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
2 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
3 Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran; Gerash University of Medical Sciences, Gerash, Iran
4 Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
|Date of Web Publication||8-May-2019|
Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj
Source of Support: None, Conflict of Interest: None
Aims: The aim of the study was to investigated competencies and the role of nursing team members in managing the nosocomial infections (NIs) in a large military teaching hospital in Iran. Settings and Design: The study data were collected using standard 3-part questionnaire including demographic characteristics, self-rated competency ability rating and role in competency activities. Subjects and Methods: Nurses were selected by stratified random sampling and proportional to size between wards. Statistical Analysis Used: The answers were analysed by Chi-square test and one-way analysis of variance in Stata 14. Results: The results showed that only 12% of nurses were expert and the majority (48.8%) were proficient for each of the 8 core competency activities. Preventing/controlling the transmission of infectious agents had the highest proportion of nurses who self-rated competency level as novice (53%), followed by surveillance and epidemiologic investigations and environment of care (52% and 45%, respectively). Competency differences by sex, age, experience, occupation unit, job category and working hours a week were obtained (P < 0.05). Only, 26% of nurses reported that they did not have role in each competency activity. Conclusions: The results showed that the majority of nurses were involved in different tasks, while their competencies were at the novice level. Considering the vital role of nurses in providing the services and preventing the infection, low levels of competency will be an alert for hospitals about the prevalence of NIs and its consequences, which should be taken into consideration in the future programs seriously.
Keywords: Iran, military hospital, nosocomial infection, nurses' competency, nurses' role
|How to cite this article:|
Teymourzadeh E, Bahadori M, Fattahi H, Khodadost M, Shokri A. Nurses' competency and their role in prevention and control of hospital infections: A case study in a large military teaching hospital. Adv Hum Biol 2019;9:156-61
|How to cite this URL:|
Teymourzadeh E, Bahadori M, Fattahi H, Khodadost M, Shokri A. Nurses' competency and their role in prevention and control of hospital infections: A case study in a large military teaching hospital. Adv Hum Biol [serial online] 2019 [cited 2020 Jan 20];9:156-61. Available from: http://www.aihbonline.com/text.asp?2019/9/2/156/257810
| Introduction|| |
Nosocomial infections (NIs) are straightly related to the hospitalisation of patients and considered a critical menace to patients' health., About 8.7% of hospitalised patients worldwide develop it., This phenomenon increases the cost of health services and reduces access to hospital care due to the prolongation of treatment and, on the other hand, causes mental and psychological problems for the patient and their families. Despite many efforts to control NIs, there are estimated that these infections to be responsible for about 80,000 deaths in the US every year. Given the significant burden of NI with the potential for adverse outcomes in patients, there is much interest in understanding their transmission, prevention and control. The results of the WHO cooperative study show that NI should be considered as an important problem in both developed and developing countries. So far, a subject of controlling infection and its evaluation is addressed from different aspects, one of which is strengthening competencies of the human resources for health to improve the preventing activities to control of infection in health centres. In the opinion of experts, recognition and training of human resource competencies play a very determinative role in the improvement of their performance and, consequently, the survival and life of the healthcare organisations. While all healthcare workers are responsible for applying infection prevention and control practices to prevent NIs, providing daily bedside patient care by nurses has an important role to access these goals. Different countries like Iran still examine the knowledge, attitudes and practices of the nurses, while these studies do not show the importance of the subject well. In addition, international studies have also studied the subject very limited., In May 2012, the Association for Professionals in Infection Control and Epidemiology (APIC) proposed a conceptual model to develop competency of the health workforces involved with NIs. This model allows the staff to identify and access the knowledge, competency and ability of leadership and ultimately provides areas for maturity of career and professional development., To the best of our knowledge, only a single study based on the APIC model in 2017 has examined well the diversity of competency among employees, their roles and various resources needed to improve their competency in departments, which resulted in poor scores for them.,,, Given the emphasis today, we have on disease prevention infection control as a major responsibility should be more considered by the nurses. According to the definition of organisation for economic cooperation and development (OECD), they must have ability to meet the demands or to successfully carry out the defined tasks or duties.
Some studies have shown a number of organisational factors that influence the risk of NIs has been identified, including nurse-to-patient ratio, level of nurse education and job type (that is, temporary or permanent).,, While no comprehensive study was conducted on nurses' competency and their role in prevention and control of hospital infections among military hospitals in Iran, in the first step, we need to know the current status of the nurses' competencies, and in the next step, we should improve them. According to what mentioned above, the present study aims for the first time to investigate competencies and the role of nursing team members in managing the NIs so that it can provide a path to improve their competence.
| Subjects and Methods|| |
This cross-sectional study was conducted in 2018 among nurses of a military hospital in Iran. The sample size was determined using d = 0.05 and P = 0.15 as default sample size formula (by considering loss rate 25%) that has been taken from the results of various previous studies conducted on this subject. Therefore, 245 nurses were selected by stratified random sampling and proportional to size between 20 wards. First, we consider that each ward of the hospital has a category, and then, in each ward, nurses were selected based on random sampling method. The study data were collected using standard questionnaire integrated both the APIC Competency Model guides and the Certification Board of Infection Control and Epidemiology.
The instrument was a 3-part questionnaire: Part I – demographic characteristics include sex, age, job category, full-time employment status, recruitment type and working at different hospitals; Part II – self-rated competency ability rating in 8 core competency activities (identification of infectious disease processes; surveillance and epidemiologic investigation; preventing/controlling the transmission of infectious agents/healthcare-associated infections; employee/occupational health; management and communication; education and research; environment of care and cleaning, sterilisation, disinfection and asepsis) by describing three specific career stages (novice/early, proficient/middle and advanced/expert) and Part III – role in competency activities by describing four specific career stages include not applicable, perform the work, supervise/train the work and both perform and supervise/train the work. Content validity through the opinion of knowledgeable persons and the reliability of each of the sections related in turn based on Cronbach's alpha (α = 0.85) were confirmed.
Descriptive statistics were used to describe the data, and the answers were analysed by Chi-square test and one-way analysis of variance. P < 0.05 was considered statistically significant. All analyses were performed by Stata 14 software (Stata Corp, Texas, USA).
| Results|| |
After eliminating defective and incomplete items, the data of 232 questionnaires were used for further analysis (response rate: 95%). The most of participations were men (53.7%), in the age group of 40–50 years (32.8%) and had work experience of 15–25 years (37.4%). Details can be seen in [Table 1].
Respondents were asked to rate their competency level for each of the 8 core competency activities. The majority of nurses (32.1%–53.7%) were self-assessed their competency as proficient compared with novice (19.9%–53.0%) or expert/advanced (10.4%–30.9%). The competency activity category most commonly self-rated as having expert competency was employee/occupational health, with nearly 31% of nurses identifying as expert. Respondents self-rated as having expert competency in cleaning, sterilisation, disinfection, asepsis at 21.2% and management and communication (leadership) and education and research at 16.4%, respectively [Table 2].
The competency activity categories known as identification of infectious disease processes, preventing/controlling the transmission of infectious agents and environment of care had the fewest per cent of nurses' self-rating competency level as expert (10%, 13% and 15%, respectively).
Of the 8 competency activity categories, preventing/controlling the transmission of infectious agents had the highest proportion of nurses who self-rated competency level as novice (53%), followed by surveillance and epidemiologic investigations and environment of care (52% and 45%, respectively).
According to [Table 3], competency differences by sex, age, experience, occupation unit, job category and working hours a week were obtained (P < 0.05). Male responders rated themselves as expert more often than did female in the infection prevention (15% vs. 6.6%, P = 0.017). The results showed that average age of nurses self-rated as expert was higher than nurses with proficient or novice level (P < 0.05). The average age of nurses with expert level was 44.0 ± 10.8 years, and nurses with proficient or novice level were under 39 years of age. These differences were statistically significant. Similarly, competency differences by job experience were identified; it means that often nurses with expert level had higher job experience (20.3 ± 10.6 vs. 14.5 ± 8.1, P = 0.007). Transplant unit and intensive care unit/critical care unit (ICU/CCU) responders rated themselves as novice more often than did surgery unit and internal unit that the differences were statistically significant (P < 0.05). Although in transplant unit, none of them were in expert level, 13.3% nurses of internal unit were in this level.
|Table 3: General characteristics of nurses across categorise of competency score|
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Furthermore, the results reported that head nurses versus nurses (83% vs. 4.6%) and people higher working hours had significantly better competency in infection control (P < 0.05). For characteristics of recruitment type, full-time status and dual practice status, there was no significant different between competency score (P > 0.05).
Respondents were asked whether they performed specific tasks within each of the 8 competency activity categories. Under the competency activity identification of infectious disease processes, 52.9% of respondents reported that they performed the work, whereas 7.4% of respondents reported that they both performed and supervised/train work [Table 4].
Under the competency activity surveillance and epidemiologic investigations, 38.7% of respondents reported that they performed the work. Under the competency activity category management and communication (leadership) reported they only 5.1 both perform and supervise/train work; 32.6% did not perform or supervise activities related to education and research; and 52.9% performed the work tasks related to employee/occupational health. Under the competency activity category environment of care, 30.1% of respondents reported that they did not perform the work. Finally, under the competency activity category cleaning, sterilisation, disinfection and asepsis, 58.8% of respondents performed tasks.
| Discussion|| |
The first study was performed to examine the understanding of the current state of nurses through competency in military hospitals in Iran and even in the Middle East. Information of 235 nurses in 20 wards of a military hospital in four categories (surgery, ICU/CCU, internal and transplant) is collected by a new tool. It was strengthened by our precise methodology in data extraction. We also were careful in each ward to select randomly participations with a willingness to participate in the study to reduce missing data. This method was used to generate confidence of the respondents.
Overall, the results showed that only 12% of nurses were expert. The competency activity with the highest expert self-rating was employee/occupational health (30.9%), and only 19.9% self-rated competency was less than proficient or expert. In this study the nurses were trained regarding activities of staff screening and immunisation programs, exposure to infectious diseases during work, assess the risk of occupational exposure to infectious diseases, and it seems that the hospital improved the competency of this area in recent years.
However, the competency categories described as preventing/controlling the transmission of infectious agents, surveillance and epidemiologic investigations and environment of care had the highest per cent survey respondents with self-rating of novice (45.1%–51.9%). Education and research and management and communication (leadership) were the next highest categories with novice self-rating (44.0%). Although the majority (72.8%) of survey respondents perform or perform/supervise/train the tasks associated within the management and communication (leadership) category, 83.6% self-rated competency less than expert. Reviewing the instructions indicates the slight role of nurses in the management of infection prevention programs. Most nurses contribute to the clinical observations and diagnostic tests for infections; however, less attention is paid to role of nurses in the management of infection prevention in the hospital education programs. Whereas 70% of survey respondents perform or perform/supervise/train the tasks associated within the environment of care category, only 15% of nurses self-rated as expert in this category. This finding reveals that there is opportunity to improve competency levels in this area. Regarding areas of surveillance and epidemiologic investigations and preventing/controlling the transmission of infectious agents' category, although about 60% of survey respondents stated that they perform or perform/supervise/train the tasks associated this areas, ≥50% of survey respondents were novice and do not necessarily equate to a higher self-rated competency level. Having a high level of expertise in the areas specific for in the latter is a critical component of an effective control infection programs, and nurses or other clinical staff usually are involved with them.,
Competency differences by sex, age, experience, occupation unit, job category and working hours a week were identified. Male responders rated themselves as expert more often than did female in infection prevention. Conversely, previous studies usually indicated that female nurses' knowledge of infection control was greater than male nurses., This might be due to the special features of nurses in a military hospital or according to the study of Ezz Eldeen, and this might be due to more eagerness to learn among male nurses in order to prove themselves in a profession in the hospitals. The competency level of nurses was significantly correlated with age and experience. This means that nurses' ages and experience have a great impact on their competency regarding infection prevention, which might be explained by the higher knowledge, improved attitudes and the implementation of infection control practices., Internal unit responders rated themselves as expert more than other units. Incredibly, among transplant unit, none of them were in expert level and even 86% of survey respondents were novice. It seems that nurses who work in internal wards have more opportunity and time than other nurses to learn in fields of clinical prevention and public health. In wards like transplant, because of high workload, nurses perhaps in the clinical dimensions will have less time for training, while the majority of patients hospitalised in these wards use immunosuppressive drugs and so more infections are reported in these wards than other ones.
The results reported that head nurses had significantly better competency in infection control compared with the other nurses. These findings may reflect that head nurse responders have education and training in competency dimensions. In addition, head nurse responders who are responsible for the direction and organization are highly involved in the strategic planning of the nursing unit within a hospital. They had often cooperated with other sections like public health section or other like. So they deal with activities like disease investigation more than other nurses, whereas nurses are usually trained in activities of clinical observation, test interpretation, or other like. Finally, the results showed that nurses with higher working hours had the highest per cent survey respondents with self-rating of expert. Therefore, the results may reveal that nurses with higher working hours often are experienced nurse and acquired required competency regarding infection prevention during working years.
| Conclusions|| |
The results of the study showed that only 12% of nurses were at the expert level to prevent NIs, and still, 39% were at the novice level. Despite the high importance of the topic of NIs in the transplant ward and ICU/CCU, the number of nurses with low competency was very high. It was in the case that ≥70% of participants played their role in each of the dimensions. Thus, the majority of nurses are involved in different tasks that are related to the spread of infection during the provision of services, while their competencies are at the novice level. One of the reasons is lack of integrity of preventive programs that they do not cover all the mandatory dimensions of obtaining competency for the infection prevention, and the other reason is the lack of coverage of all the nurses in different wards, which leads to different competencies in different wards. Considering the vital role of nurses in providing the services and preventing the infection, low levels of competency will be an alert for hospitals about the prevalence of NIs and its consequences, which should be taken into consideration in the future programs seriously.
This study was supported by Baqiyatallah University of Medical Sciences. The ethical committee approved this research (no = s/340/5/6616, October 24, 2017).
Financial support and sponsorship
This study was supported by Baqiyatallah University of Medical Sciences.
Conflicts of interest
There are no conflicts of interest.
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