||Knowledge, Attitude and Behavior Related To Healthcare-Associated Infections of Nurses Working in Emergency Department In Indonesia
||Department of Nursing
||Hudzaifah Al Fatih
Healthcare Associated Infections (HAIs) are considered as being among the most serious patient safety issues in health care settings. Especially in the Emergency Department (ED), nurses face greater risk of exposure to infectious pathogens. ED nurses’ daily intervention often involve contact with patients’ blood and/or other body fluids. To protect ED nurses from infectious agents, standard precautions are essential and also effective in reducing the number of HAIs. However, knowledge, attitude, behavior towards HAIs and relationships between these three variables among nurses working in EDs in developing countries such as Indonesia, has not yet been studied. Therefore, it is imperative to explore the knowledge, attitude, behavior towards HAIs and their relationships, among nurses working in EDs in Indonesia. In addition, the influence of demographic characteristics on nurses’ knowledge, attitude, and behavior were examined in this study.
A cross-sectional, self-reported survey was conducted and a total of 115 participants were recruited from four hospitals in Bandung City, Indonesia. The Healthcare Associated Infections Survey (HAIS) consisting of four domains: demographic characteristics, knowledge, attitude and behavior related to HAIs was used for the survey.
ED nurses’ overall performance on the knowledge portion was good, with a mean of 21.23±5.173 (range=9-30). They produced better scores on control measures and risk factors for HAIs, but did poorly on some questions about HAI source pathogens. 92.2% had positive attitudes and the mean score for behavior when practicing infection control was 37.7±5.570 (26-50). Marital status (Z = -2.838, p = 0.005) and working hours per week, influenced nurses’ knowledge of HAIs (rs = 0.185, p = 0.048). Work experience was found to have a negative relationship towards attitude (rs = -0.196, p = 0.035). While, type of hospital (F (113) = 5.560, p = 0.005) and working hours per week (r = 0.191, p = 0.04) influenced behavior. However, no significant relationship was found between knowledge, attitude and behavior towards HAIs.
Even though the majority of ED nurses in Indonesia believe that precautionary guidelines can reduce the risk of HAIs, in fact most nurses’ behavior was sub-optimal. Therefore, it is essential for healthcare institutions to conduct surveillance, monitor good behavior of infection control practices and provide continuous education for ED nurses. Furthermore, healthcare managers should consider nurses’ characteristics when developing an education plan.
TABLE OF CONTENTS III
LIST OF TABLES V
CHAPTER ONE INTRODUCTION 1
1.1 Research Background. 1
1.2 Significance of Study 3
1.3 Study Purposes 3
1.4 Operational Definitions 4
1.4.1 Knowledge 4
1.4.2 Attitude 4
1.4.3 Behavior 4
CHAPTER TWO LITERATURE REVIEW 5
2.1 Healthcare-associated infections 5
2.1.1 Sources of Healthcare-Associated Infections 7
2.1.2 Prevention of Healthcare-Associated Infections 9
2.2 Risk of infections for emergency department nurses 10
2.3 Relationship of healthcare-associated infections and nurses' knowledge, attitude and behavior 14
CHAPTER THREE RESEARCH DESIGN AND METHODOLOGY 17
3.1 Research Design 17
3.2 Sample and Setting 17
3.3 Instrument 17
3.3.1 Demographic Questionnaire 19
3.3.2 Knowledge about HAIs 19
3.3.3 Attitudes toward HAIs 19
3.3.4 Behavior toward standard precautions 19
3.4 Data collection procedures 20
3.5 Statistical analysis 20
CHAPTER FOUR RESEARCH RESULTS 22
4.1 Demographic and characteristics of participants 22
4.2 Knowledge, attitude, and behavior 23
4.3 Influence of demographic characteristics of nurses on their knowledge, attitude and behavior of HAIs 27
4.4 Relationship of nurses’ knowledge, attitudes and behavior toward HAIs 28
CHAPTER FIVE DISCUSSION 30
5.1 Demographic and occupational characteristics 30
5.2 Nurses’ knowledge, attitude, and behavior toward HAIs 32
CHAPTER SIX CONCLUSION AND RECOMMENDATION 35
6.1 Conclusion 35
6.2 Recommendations 36
6.3 Limitation 37
Appendix 1 IRB Approval 59
Appendix 2 Permission to use HAIs Survey Instrument 60
Appendix 3 Informed Consent (English Version) 61
Appendix 4 Inform Consent (Indonesia Version) 62
Appendix 5 Research Instrument (English Version) 64
Appendix 6 Research Instrument (Indonesia Version) 68
LIST OF TABLES
Table 4.1 Demographic and occupational characteristics of respondents 22
Table 4.2 Test of normality on variables 23
Table 4.3 Total score of knowledge, attitude and behavior of HAIs 24
Table 4.4 Proportion of correct answers of knowledge of HAIs by nurses 25
Table 4.5 Nurses’ behavior related to HAI 26
Table 4.6 Differences of ED nurses’ knowledge, attitudes and behavior by the demographic and occupational characteristics 27
Table 4.7 Correlation between continuous variables of demographic and occupational characteristics and ED nurses’ knowledge, attitudes and behavior 28
Table 4.8 Relationship of nurses’ knowledge, attitudes and behavior 29
Affonso, D. D., Andrews, G. J., & Jeffs, L. (2004). The urban geography of SARS: paradoxes and dilemmas in Toronto's health care. Journal of Advanced Nursing, 45(6), 568-578.
Agustian, D., Yusnita, S., Susanto, H., Sukandar, H., Schryver, A. D., & Meheus, A. (2009). An estimation of the occupational risk of HBV, HCV and HIV infection among Indonesian healthcare workers. Acta Med Indones-Indones J Intern Med, 41(Supplement 1), 33-37.
Albrich, W. C., & Harbarth, S. (2008). Health-care workers: source, vector, or victim of MRSA? The Lancet infectious diseases, 8(5), 289-301.
Al-Hussami, M., Darawad, M., & Almhairat, I. I. (2011). Predictors of compliance handwashing practice among healthcare professionals. Healthcare Infection, 16(2), 79-84.
Allegranzi, B., & Pittet, D. (2007). Healthcare-associated infection in developing countries: simple solutions to meet complex challenges. Infection Control, 28(12), 1323-1327.
Allegranzi, B., Nejad, S. B., Combescure, C., Graafmans, W., Attar, H., Donaldson, L., & Pittet, D. (2011). Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. The Lancet, 377(9761), 228-241.
Alnoumas, S. R., Enezi, F., Isaeed, M., Makboul, G., & El-Shazly, M.K. (2012). Knowledge, attitude and behavior of primary health care workers regarding health care-associated infections in Kuwait. Greener Journal of Medical Sciences, 2(4), 092-098.
Alwutaib, A. H., Abdulghafour, Y. A., Alfadhl, A. K., Makboul, G., & El-Shazl, M.K. (2012). "Knowledge and attitude of the physicians and nurses regarding blood borne infections in primary health care, Kuwait." Greener Journal of Medical Sciences, 2(4): 107-114.
Askarian, M., & Gooran, N. R. (2003). National nosocomial infection surveillance system–based study in Iran: Additional hospital stay attributable to nosocomial infections. American journal of infection control, 31(8), 465-468.
Askarian, M., Mirzaei, K., Mundy, L. M., & McLaws, M. L. (2005). Assessment of knowledge, attitudes, and practices regarding isolation precautions among Iranian healthcare workers. Infection Control, 26(01), 105-108.
Aynalem Tesfay, F., & Dejenie Habtewold, T. (2014). Assessment of prevalence and determinants of occupational exposure to HIV infection among healthcare workers in selected health institutions in Debre Berhan Town, North Shoa Zone, Amhara Region, Ethiopia, 2014. AIDS research and treatment, 2014.
Baraff, L. J., & Talan, D. A. (1989). Compliance with universal precautions in a university hospital emergency department. Annals of emergency medicine, 18(6), 654-657.
Barnett, T. E. (2007). The not-so-hidden costs of surgical site infections. AORN journal, 86(2), 249-258.
Bauer, P. (1991). Universal precautions in OR practice, Part III: Compliance and knowledge. Nursing management, 22(8), 48Q.
Bhatia, N., Daga, M. K., Garg, S., & Prakash, S. K. (2010). Urinary catheterization in medical wards. Journal of global infectious diseases, 2(2), 83.
Bolyard, E. A., Tablan, O. C., Williams, W. W., Pearson, M. L., Shapiro, C. N., & Deitchman, S. D. (1998). Guideline for infection control in healthcare personnel, 1998. Infection Control, 19(06), 407-463.
Breathnach, A. S. (2013). Nosocomial infections and infection control. Medicine, 41(11), 649-653.
Burke, J. P. (2003). Infection control-a problem for patient safety. New England Journal of Medicine, 348(7), 651-656.
Butsashvili, M., et al. (2010). Knowledge of health care-associated infections among Georgian obstetricians and gynecologists. The Journal of Infection in Developing Countries, 4(05): 329-333.
Camacho-Ortiz, A., Díaz-Rodríguez, X., Rodríguez-López, J. M., Martínez-Palomares, M., Palomares-De la Rosa, A., & Garza-Gonzalez, E. (2013). A 5-year surveillance of occupational exposure to bloodborne pathogens in a university teaching hospital in Monterrey, Mexico. American Journal of Infection Control, 41(9), e85-e88. doi: http://dx.doi.org/10.1016/j.ajic.2013.01.008
Caplan, E. S., Preas, M. A., Kerns, T., Soderstrom, C., Bosse, M., Bansal, J., ... & Caplan, M. (1995). Seroprevalance of Human Immunodeficiency Virus, Hepatitis B Virus, Hepatitis C Virus, and rapid plasma reagin in a trauma population. Journal of Trauma and Acute Care Surgery, 39(3), 533-538.
Cardo, D., Dennehy, P. H., Halverson, P., Fishman, N., Kohn, M., Murphy, C. L., & Whitley, R. J. (2010). Moving toward elimination of healthcare-associated infections: A call to action. American Journal of Infection Control, 38(9), 671-675. doi: http://dx.doi.org/10.1016/j.ajic.2010.09.001
Carlet, J., Jarlier, V., Harbarth, S., Voss, A., Goossens, H., & Pittet, D. (2012). Ready for a world without antibiotics? The pensières antibiotic resistance call to action. Antimicrobial resistance and infection control, 1(1), 1-13.
Center for Disease Control (CDC), (2002). Guideline for hand hygiene in healthcare settings. Morbidity and mortality weekly report. 51 (RR-16), 1-48. Retrieved from http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf
Centers for Disease Control and Prevention (CDC), (2010). National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey: 2010 Emergency department summary tables. Retrieved from http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2010_ed_web_tables.pdf
Chan, M. F., Ho, A., & Day, M. C. (2008). Investigating the knowledge, attitudes and practice patterns of operating room staff towards standard and transmission‐based precautions: Results of a cluster analysis. Journal of clinical nursing, 17(8), 1051-1062.
Chan, R., Molassiotis, A., Eunice, C., Virene, C., Becky, H., Chit-Ying, L., ... & Ivy, Y. (2002). Nurses’ knowledge of and compliance with universal precautions in an acute care hospital. International Journal of Nursing Studies, 39(2), 157-163.
Chiang, W. C., Wang, H. C., Chen, S. Y., Chen, L. M., Yao, Y. C., Wu, G. H. M., ... & Ma, M. H. M. (2008). Lack of compliance with basic infection control measures during cardiopulmonary resuscitation—Are we ready for another epidemic? Resuscitation, 77(3), 356-362.
Chiarello, L. A. (1995). Selection of safer needle devices: A conceptual framework for approaching product evaluation. American Journal of Infection Control, 23(6), 386–395.
Cole, M. (2006). Using a motivational paradigm to improve hand washing compliance. Nurse Education in Practice, 6(3), 156-162.
Cooper, T. (2001). Educational theory into practice: Development of an infection control link nurse programme. Nurse education in practice, 1(1), 35-41.
Creedon, S.A. (2005). Health Care workers’ hand hygiene practices: Compliance with recommended guidelines. Journal of Advanced Nursing, 51(3), 208–216.
Cromer, A. L., Hutsell, S. O., Latham, S. C., Bryant, K. G., Wacker, B. B., Smith, S. A., ... & Carney, M. C. (2004). Impact of implementing a method of feedback and accountability related to contact precautions compliance. American Journal of Infection Control, 32(8), 451-455.
Cruickshank, M., Ferguson, J., & Bull, A. (2009). Reducing harm to patients from health care associated infection: The role of surveillance. Chapter 3: Surgical site infection–an abridged version. Healthcare Infection, 14(3), 109-114.
Dellinger, R. P., Levy, M. M., Carlet, J. M., Bion, J., Parker, M. M., Jaeschke, R., ... & Vincent, J. L. (2008). Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Intensive care medicine, 34(1), 17-60.
Denis, M. A., Ecochard, R., Bernadet, A., Forissier, M. F., Porst, J. M., Robert, O., ... & Bergeret, A. (2003). Risk of occupational blood exposure in a cohort of 24,000 hospital healthcare workers: Position and environment analysis over three years. Journal of occupational and environmental medicine, 45(3), 283-288.
Dharan, S., & Pittet, D. (2002). Environmental controls in operating theatres. Journal of Hospital Infection, 51(2), 79-84.
Dı́az, R. I., & Cabrera, D. D. (1997). Safety climate and attitude as evaluation measures of organizational safety. Accident Analysis & Prevention, 29(5), 643-650.
Digiacomo, J. C., Hoff, W. S., Rotondo, M. F., Martin, K., Kauder, D. R., Anderson, H. L., ... & Schwab, C. W. (1997). Barrier precautions in trauma resuscitation: Real-time analysis utilizing videotape review. The American journal of emergency medicine, 15(1), 34-39.
Drees, M., Snydman, D. R., Schmid, C. H., Barefoot, L., Hansjosten, K., Vue, P. M., ... & Golan, Y. (2008). Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci. Clinical infectious diseases, 46(5), 678-685.
Duerink, D. O., Hadi, U., Lestari, E. S., Roeshadi, D., Wahyono, H., Nagelkerke, N. J., ... & Van den Broek, P. J. (2013). A tool to assess knowledge, attitude and behavior of Indonesian health care workers regarding infection control. Acta medica Indonesiana, 45(3), 206-215.
Edwards, J. R., Peterson, K. D., Mu, Y., Banerjee, S., Allen-Bridson, K., Morrell, G., ... & Horan, T. C. (2009). National Healthcare Safety Network (NHSN) report: Data summary for 2006 through 2008, issued December 2009. American journal of infection control, 37(10), 783-805.
El-Masri, M. M., & Oldfield, M. P. (2012). Exploring the influence of enforcing infection control directives on the risk of developing healthcare associated infections in the intensive care unit: A retrospective study. Intensive and Critical Care Nursing, 28(1), 26-31.
Eskander, H. G., Morsy, W. Y. M., & Elfeky, H. A. A. (2013). Intensive Care Nurses’ Knowledge & Practices regarding Infection Control Standard Precautions at a Selected Egyptian Cancer Hospital. Journal of Education and Practice, 4(19), 160-174.
European Centre for Disease Prevention and Control (CDC). (2008). Annual epidemiological report on communicable diseases in Europe 2008: Report on the state of communicable disease in the EU and EEA/EFTA countries. Stockholm: European Centre for Disease Prevention and Control. Retrieved from http://www.ecdc.europa.eu/en/publications/Publications/0812_SUR_Annual_Epidemiological_Report_2008.pdf#page=27
Evanoff, B., Kim, L., Mutha, S., Jeffe, D., Haase, C., Andereck, D., & Fraser, V. (1999). Compliance with universal precautions among emergency department personnel caring for trauma patients. Annals of emergency medicine, 33(2), 160-165.
Fakih, M. G., Shemes, S. P., Pena, M. E., Dyc, N., Rey, J. E., Szpunar, S. M., & Saravolatz, L. D. (2010). Urinary catheters in the emergency department: Very elderly women are at high risk for unnecessary utilization. American journal of infection control, 38(9), 683-688.
Farsi, D., Zare, M. A., Hassani, S. A., Abbasi, S., Emaminaini, A., Hafezimoghadam, P., & Rezai, M. (2012). Prevalence of occupational exposure to blood and body secretions and its related effective factors among health care workers of three Emergency Departments in Tehran. Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences, 17(7), 656–661.
Ferguson, K. J., Waitzkin, H., Beekmann, S. E., & Doebbeling, B. N. (2004). Critical incidents of non-adherence with standard precautions guidelines among community hospital‐based health care workers. Journal of general internal medicine, 19(7), 726-731.
Ferguson, J. K. (2009). Preventing healthcare‐associated infection: Risks, healthcare systems and behavior. Internal medicine journal, 39(9), 574-581.
French, G., & Friedman, C. (2003). Infection control: Basic concept and training, 2nd ed. International Federation of Infection Control, pp. 25–35.
Gammon, J., Morgan‐Samuel, H., & Gould, D. (2008). A review of the evidence for suboptimal compliance of healthcare practitioners to standard/universal infection control precautions. Journal of Clinical Nursing, 17(2), 157-167.
Ganczak, M., & Szych, Z. (2007). Surgical nurses and compliance with personal protective equipment. Journal of Hospital Infection, 66(4), 346-351.
Garner, J. S. (1996). Guideline for isolation precautions in hospitals. Infection control, 17(01), 54-80.
Ghadmgahi, F., Zighaimat, F., Ebadi, A., & Houshmand, A. (2011). Knowledge, attitude and self-efficacy of nursing staffs in hospital infections control. Journal Military Medicine, 13(3), 167-172.
Glickman, S. W., Krubert, C., Koppenhaver, J., Glickman, L. T., Schulman, K. A., & Cairns, C. B. (2010). Increased rate of central venous catheterization procedures in community EDs. The American journal of emergency medicine, 28(2), 208-212.
Gokula, R. R. M., Hickner, J. A., & Smith, M. A. (2004). Inappropriate use of urinary catheters in elderly patients at a midwestern community teaching hospital. American journal of infection control, 32(4), 196-199.
Graves, N., Weinhold, D., Tong, E., Birrell, F., Doidge, S., Ramritu, P., ... & Whitby, M. (2007). Effect of healthcare-acquired infection on length of hospital stay and cost. Infection Control, 28(03), 280-292.
Grol, R., & Grimshaw, J. (2003). From best evidence to best practice: Effective implementation of change in patients' care. The lancet, 362(9391), 1225-1230.
Guillemin, F., Bombardier, C., & Beaton, D. (1993). Cross-cultural adaptation of health-related quality of life measures: Literature review and proposed guidelines. Journal of clinical epidemiology, 46(12), 1417-1432.
Gulilat, K., & Tiruneh, G. 2014. Assessment of knowledge, attitude and practice of health care workers on infection prevention in health institution Bahir Dar City administration. Science Journal of Public Health, 2(5), 384-393.
Guzzo, J. L., Seagull, F. J., Bochicchio, G. V., Sisley, A., Mackenzie, C. F., Dutton, R. P., ... & Xiao, Y. (2006). Mentors decrease compliance with best sterile practices during central venous catheter placement in the trauma resuscitation unit. Surgical infections, 7(1), 15-20.
Hammond, J. S., Eckes, J. M., Gomez, G. A., & Cunningham, D. N. (1990). HIV, trauma, and infection control: Universal precautions are universally ignored. Journal of Trauma and Acute Care Surgery, 30(5), 555-561.
Harbarth, S., Sax, H., & Gastmeier, P. (2003). The preventable proportion of nosocomial infections: An overview of published reports. Journal of Hospital infection, 54(4), 258-266.
Hazelett, S. E., Tsai, M., Gareri, M., & Allen, K. (2006). The association between indwelling urinary catheter use in the elderly and urinary tract infection in acute care. BMC geriatrics, 6(1), 15.
Henry, K., Campbell, S., & Maki, M. (1992). A comparison of observed and self-reported compliance with universal precautions among emergency department personnel at a Minnesota public teaching hospital: Implications for assessing infection control programs. Annals of emergency medicine, 21(8), 940-946.
Henry, K., Campbell, S., Collier, P., & Williams, C. O. B. (1994). Compliance with universal precautions and needle handling and disposal practices among emergency department staff at two community hospitals. American Journal of Infection Control, 22(3), 129-137.
Hoot, N. R., & Aronsky, D. (2008). Systematic review of emergency department crowding: Causes, effects, and solutions. Annals of emergency medicine, 52(2), 126-136.
Horan, T. C., Andrus, M., & Dudeck, M. A. (2008). CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. American journal of infection control, 36(5), 309-332.
Huang, S. S., Datta, R., & Platt, R. (2006). Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Archives of Internal Medicine, 166(18), 1945-1951.
Hugonnet, S., Chevrolet, J. C., & Pittet, D. (2007). The effect of workload on infection risk in critically ill patients. Critical care medicine, 35(1), 76-81.
Ippolito, G., Puro, V., Petrosillo, N., Pugliese, G., Wispelwey, B., & Tereskerz, P. M., et al. (1997). Prevention, management, and chemo-prophylaxis of occupational exposure to HIV. Charlottesville, VA: International Healthcare Worker Safety Center, University of Virginia.
Jagger, J., Powers, R. D., Day, J. S., Detmer, D. E., Blackwell, B., & Pearson, R. D. (1994). Epidemiology and prevention of blood and body fluid exposures among emergency department staff. The Journal of emergency medicine, 12(6), 753-765.
Jeffe, D. B., Mutha, S., L'Ecuyer, P. B., Kim, L. E., Singal, R. B., Evanoff, B. A., & Fraser, V. J. (1997). Healthcare workers' attitudes and compliance with universal precautions gender, occupation, and specialty differences. Infection Control, 18(10), 710-712.
Jenner, E. A., Fletcher, B. C., Watson, P., Jones, F. A., Miller, L., & Scott, G. M. (2006). Discrepancy between self-reported and observed hand hygiene behavior in healthcare professionals. Journal of hospital infection, 63(4), 418-422.
Joly, F. (2012). Medscape Medical News: Hospital-acquired infections quadruple ICU mortality. Retrieved from http://www.medscape.com/viewarticle/762031#vp_1
Kelen, G. D., Fritz, S., Qaqish, B., Brookmeyer, R., Baker, J. L., Kline, R. L., ... & Quinn, T. C. (1988). Unrecognized human immunodeficiency virus infection in emergency department patients. New England Journal of Medicine, 318(25), 1645-1650.
Kelen, G. D., DiGiovanna, T. A., Celentano, D. D., Kalainov, D., Bisson, L., Junkins, E., ... & Quinn, T. C. (1990). Adherence to universal (barrier) precautions during interventions on critically ill and injured emergency department patients. JAIDS Journal of Acquired Immune Deficiency Syndromes, 3(10), 987-994.
Kelen, G. D., Hansen, K. N., Green, G. B., Tang, N., & Ganguli, C. (1995). Determinants of emergency department procedure-and condition-specific universal (barrier) precaution requirements for optimal provider protection. Annals of emergency medicine, 25(6), 743-750.
Kelleher, D. C., Carter, E. A., Waterhouse, L. J., & Burd, R. S. (2013). Compliance with barrier precautions during pediatric trauma resuscitations. Resuscitation, 84(3), 314-318.
Kennedy, A. M., Elward, A. M., & Fraser, V. J. (2004). Survey of knowledge, beliefs, and practices of neonatal intensive care unit healthcare workers regarding nosocomial infections, central venous catheter care, and hand hygiene. Infection Control and Hospital Epidemiology, 25(9), 747-752.
Klevens, R. M., Edwards, J. R., Richards, C. L., Horan, T. C., Gaynes, R. P., Pollock, D. A., & Cardo, D. M. (2007). Estimating health care-associated infections and deaths in US hospitals, 2002. Public health reports, 122(2), 160.
Khorvash, F., Mohamadirizi, S., Ataiee, B., Khayamim, N., & Boroumandfar, Z. (2014). The Relationship between Knowledge, Attitude and Tendency to Care of HIV/AIDS Patients among Nurses and Midwives, Working in General Hospitals and Health Care Centers of Isfahan University of Medical Sciences, 2013. Journal of Midwifery and Reproductive Health, 2(4), 246-252.
Labrague, L. J., Rosales, R. A., & Tizon, M. M. (2012). Knowledge and compliance of standard precautions among student nurses. International journal of advanced nursing studies, 1(2), 84-97.
LeMaster, C. H., Agrawal, A. T., Hou, P., & Schuur, J. D. (2010). Systematic review of emergency department central venous and arterial catheter infection. International journal of emergency medicine, 3(4), 409-423.
Liang, S. Y., Theodoro, D. L., Schuur, J. D., & Marschall, J. (2014). Infection Prevention in the Emergency Department. Annals of emergency medicine, 64(3), 299-313.
Luo, Y., He, G. P., Zhou, J. W., & Luo, Y. (2010). Factors impacting compliance with standard precautions in nursing, China. International Journal of Infectious Diseases, 14(12), 1106-1114.
Madan, A. K., Raafat, A., Hunt, J. P., Rentz, D., Wahle, M. J., & Flint, L. M. (2002). Barrier precautions in trauma: Is knowledge enough? Journal of Trauma and Acute Care Surgery, 52(3), 540-543.
Magid, D. J., Sullivan, A. F., Cleary, P. D., Rao, S. R., Gordon, J. A., Kaushal, R., ... & Blumenthal, D. (2009). The safety of emergency care systems: Results of a survey of clinicians in 65 US emergency departments. Annals of emergency medicine, 53(6), 715-723.
Magill, S. S., Edwards, J. R., Bamberg, W., Beldavs, Z. G., Dumyati, G., Kainer, M. A., ... & Fridkin, S. K. (2014). Multistate point-prevalence survey of health care–associated infections. New England Journal of Medicine, 370(13), 1198-1208.
Maltezou, H. C., Maragos, A., Raftopoulos, V., Karageorgou, K., Halharapi, T., Remoudaki, H., ... & Pierroutsakos, I. N. (2008). Strategies to increase influenza vaccine uptake among health care workers in Greece. Scandinavian journal of infectious diseases, 40(3), 266-268.
McNaughton, C., Self, W. H., Jones, I. D., Arbogast, P. G., Chen, N., Dittus, R. S., & Russ, S. (2012). ED crowding and the use of nontraditional beds. The American journal of emergency medicine, 30(8), 1474-1480.
Ministry of Health of Indonesia, (2004). Ministry of Health of Republic of Indonesia Decree Number: 81/MENKES/SK/I/2004. Retrieved from bppsdmk.depkes.go.id/web/filesa/peraturan/6.pdf
Ministry of Health of Indonesia, (2010). Ministry of Health of Republic of Indonesia Regulation Number: 340/MENKES/PER/III/2010. Retrieved from bppsdmk.depkes.go.id/web/filesa/peraturan/2.pdf
Ministry of Health of Indonesia, (2012). Ministry of Health of Republic of Indonesia Regulation Number: 001 Year 2012. Retrieved from http://bksikmikpikkfki.net/file/download/PMK%20No.%20001%20Th%202012%20ttg%20Sistem%20Rujukan%20Yankes%20Perorangan.pdf
Ministry of Health of Indonesia, (2013). Basic health research. Retrieved from http://www.depkes.go.id/resources/download/general/Hasil%20Riskesdas%202013.pdf
Ministry of Health of Indonesia, (2014). Indonesia Health Profile of 2013. Retrieved from http://www.depkes.go.id/resources/download/pusdatin/profil-kesehatan-indonesia/profil-kesehatan-indonesia-2013.pdf
Moskop, J. C., Marco, C. A., Larkin, G. L., Geiderman, J. M., & Derse, A. R. (2005). From Hippocrates to HIPAA: Privacy and confidentiality in emergency medicine—part II: Challenges in the emergency department. Annals of emergency medicine, 45(1), 60-67.
Najeeb, N., & Taneepanichsakul, S. (2008). Knowledge, attitude, and practice of standard and transmission-based precautions of doctors and nurses in tertiary and secondary health care settings of Maldives. Journal of Health Research, 22, 45-48.
Nejad, S. B., Allegranzi, B., Syed, S. B., Ellis, B., & Pittet, D. (2011). Health-care-associated infection in Africa: A systematic review. Bulletin of the World Health Organization, 89(10), 757-765.
Niska, R., Bhuiya, F., & Xu, J. (2010). National hospital ambulatory medical care survey: 2007 emergency department summary. National Health Statistics Report, 26(26), 1-31.
Nseir, S., Blazejewski, C., Lubret, R., Wallet, F., Courcol, R., & Durocher, A. (2011). Risk of acquiring multidrug‐resistant gram‐negative bacilli from prior room occupants in the intensive care unit. Clinical Microbiology and Infection, 17(8), 1201-1208.
Occupational Safety & Health Administration (OSHA), (2010). Infectious Diseases. Federal Register 75 (87), 24835-24844. Retrieved from https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=FEDERAL_REGISTER&p_id=21497
Ocran, I., & Tagoe, D. N. A. (2014). Knowledge and attitude of healthcare workers and patients on healthcare associated infections in a regional hospital in Ghana. Asian Pacific Journal of Tropical Disease, 4(2), 135-139.
Osborne, S. (2003). Influences on compliance with standard precautions among operating room nurses. American journal of infection control, 31(7), 415-423.
Parmeggiani, C., Abbate, R., Marinelli, P., & Angelillo, I. F. (2010). Healthcare workers and health care-associated infections: Knowledge, attitudes, and behavior in emergency departments in Italy. BMC infectious diseases, 10(1), 35.
Pessoa-Silva, C. L., Hugonnet, S., Pfister, R., Touveneau, S., Dharan, S., Posfay-Barbe, K., & Pittet, D. (2007). Reduction of health care–associated infection risk in neonates by successful hand hygiene promotion. Pediatrics, 120(2), e382-e390.
Pittet, D. (2005). Infection control and quality health care in the new millennium. American journal of infection control, 33(5), 258-267.
Pittet, D., Allegranzi, B., Sax, H., Bertinato, L., Concia, E., & Cookson, B. (2005). Considerations for a WHO European strategy on health-care-associated infection, surveillance, and control. Lancet Infectious Disease, 5, 242 - 250.
Pittet, D., & Donaldson, L. (2005). Clean Care is Safer Care: A worldwide priority. Lancet, 366(9493), 1246-1247.
Pittet, D., & Donaldson, L. (2006). Challenging the world: Patient safety and health care-associated infection. International Journal for Quality in Health Care, 18(1), 4-8.
Pittet, D., Allegranzi, B., Storr, J., Nejad, S. B., Dziekan, G., Leotsakos, A., & Donaldson, L. (2008). Infection control as a major World Health Organization priority for developing countries. Journal of Hospital Infection, 68(4), 285-292.
Polit, D. F., & Beck, C. T. (2006). The content validity index: Are you sure you know what's being reported? Critique and recommendations. Research in Nursing and Health, 29(5), 489-497.
Pujol, M., Hornero, A., Saballs, M., Argerich, M. J., Verdaguer, R., Cisnal, M., ... & Gudiol, F. (2007). Clinical epidemiology and outcomes of peripheral venous catheter-related bloodstream infections at a university-affiliated hospital. Journal of Hospital Infection, 67(1), 22-29.
Puzniak, L. A., Gillespie, K. N., Leet, T., Kollef, M., & Mundy, L. M. (2004). A cost-benefit analysis of gown use in controlling vancomycin-resistant enterococcus transmission is it worth the price? Infection Control, 25(05), 418-424.
Quah, S. R., & Lee H. P. (2004). Crisis prevention and management during SARS outbreak, Singapore. Emerging Infectious Diseases, 10, 364–368.
Raad, I., Hanna, H., Jiang, Y., Dvorak, T., Reitzel, R., Chaiban, G., ... & Hachem, R. (2007). Comparative activities of daptomycin, linezolid, and tigecycline against catheter-related methicillin-resistant Staphylococcus bacteremic isolates embedded in biofilm. Antimicrobial agents and chemotherapy, 51(5), 1656-1660.
Richmond, J. A., Dunning, T. L., & Desmond, P. V. (2007). Health professionals’ attitudes toward caring for people with hepatitis C. Journal of viral hepatitis, 14(9), 624-632.
Rivers, E., Nguyen, B., Havstad, S., Ressler, J., Muzzin, A., Knoblich, B., ... & Tomlanovich, M. (2001). Early goal-directed therapy in the treatment of severe sepsis and septic shock. New England Journal of Medicine, 345(19), 1368-1377.
Roane, C. M. (1992). Registered nurses' use of universal barrier precautions in the pediatric emergency room. Pediatric nursing, 19(5), 453-455.
Rogers, A. E., Hwang, W. T., Scott, L. D., Aiken, L. H., & Dinges, D. F. (2004). The working hours of hospital staff nurses and patient safety. Health affairs, 23(4), 202-212.
Rowe, A. K., de Savigny, D., Lanata, C. F., & Victora, C. G. (2005). How can we achieve and maintain high-quality performance of health workers in low-resource settings? The Lancet, 366(9490), 1026-1035.
Rydman, R. J., Tannebaum, R. D., & Zalenski, R. J. (1994). An evaluation of hospital emergency department (HED) adherence to universal precautions. Journal of medical systems, 18(4), 207-220.
Santos, S. L. V., Sousab, T. K., Costa, D. M., Lopes, L. K. O., Pelejad, E. B., Sousa, D. M., Palosa, M. A. P., Pereira, M. S. (2012). Healthcare-associated infections at a Brazilian cancer hospital: five years of analysis. Enfermería Clínica, 25, 28-36. http://dx.doi.org/10.4321/S1695-61412012000100002.
Schabrun, S., & Chipchase, L. (2006). Healthcare equipment as a source of nosocomial infection: A systematic review. Journal of Hospital Infection, 63(3), 239-245.
Schoenbaum, E. E., & Webber, M. P. (1993). The under recognition of HIV infection in women in an inner-city emergency room. American journal of public health, 83(3), 363-368.
Schuur, J. D., & Venkatesh, A. K. (2012). The growing role of emergency departments in hospital admissions. New England Journal of Medicine, 367(5), 391-393.
Scott II, R., (2009). The direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention. Retrieved from www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf2009
Shaughnessy, M. K., Micielli, R. L., DePestel, D. D., Arndt, J., Strachan, C. L., Welch, K. B., & Chenoweth, C. E. (2011). Evaluation of hospital room assignment and acquisition of Clostridium difficile infection. Infection Control, 32(03), 201-206.
Simbar, M., Shayan-Menesh, M., Nahidi, F., & Akbar-Zadeh, A. R. (2011). Health beliefs of midwives about HIV/AIDS protection and the barriers to reducing risk of infection: An Iranian study. Leadership in Health Services, 24(2), 106-117.
Sternal, D., Franek, G., & Pieńkus, D. (2014). Knowledge of nurses on prevention of nosocomial infections in post-stroke patients. The Journal of Neurological and Neurosurgical Nursing, 3(2).
Suchitra, J. B. (2007). Impact of education on knowledge, attitudes and practices among various categories of health care workers on nosocomial infections. Indian journal of medical microbiology, 25(3), 181.
Siegel, J. D., Rhinehart, E., Jackson, M., Chiarello, L., & Health Care Infection Control Practices Advisory Committee. (2007). 2007 guideline for isolation precautions: Preventing transmission of infectious agents in health care settings. American journal of infection control, 35(10), S65-S164.
Sulaiman, H. A., Sie, A., Rustam, M., Melani, W., Corwin, A., & Jennings, G. B. (1995). Prevalence of hepatitis B and C viruses in healthy Indonesian blood donors. Transactions of the Royal Society of Tropical Medicine and Hygiene, 89(2), 167-170.
Tait A. R., Lewis T. V., Tuttle D. B., & Malviya, S. (2000). Compliance with standard guidelines for the prevention of occupational transmission of bloodborne and airborne pathogens: A survey of post- anesthesia nursing practice. Journal of Continuing Education in Nursing, 31, 38–44.
The World Bank, (2012). Nurses and midwives (per 1000 people). Retrieved from http://data.worldbank.org/indicator/SH.MED.NUMW.P3
Thurston, A. (2004). Sacred rituals in the operating theatre: Summarizing the science. Current Orthopaedics, 18(2), 135–146.
Trampuz, A., & Widmer, A. F. (2004). Hand hygiene: A frequently missed lifesaving opportunity during patient care. 79, 109-116, International Mayo Clinic Proceedings. Elsevier.
Umscheid, C. A., Mitchell, M. D., Doshi, J. A., Agarwal, R., Williams, K., & Brennan, P. J. (2011). Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infection Control, 32(02), 101-114.
Virtanen, M., Kurvinen, T., Terho, K., Oksanen, T., Peltonen, R., Vahtera, J., & Kivimäki, M. (2009). Work hours, work stress, and collaboration among ward staff in relation to risk of hospital-associated infection among patients. Medical care, 47(3), 310-318.
World Health Organization (WHO), (2005). WHO guidelines on hand hygiene in health care (advanced draft): A summary. Retrieved from http://www.who.int/patientsafety/events/05/HH_en.pdf
World Health Organization (WHO), (2005). Glove use information leaflet. Retrieved from http://www.who.int/gpsc/5may/Glove_Use_Information_Leaflet.pdf
World Health Organization (WHO), (2009). WHO guidelines on hand hygiene in health care: First global patient safety challenge clean care is safe care. Retrieved from http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf
World Health Organization (WHO), (2010). Wanted: 2.4 million nurses, and that’s just in India. Retrieved from http://www.who.int/bulletin/volumes/88/5/10-020510/en/
World Health Organization (WHO), (2011). Report on the burden of endemic health care-associated infection worldwide. Retrieved from http://whqlibdoc.who.int/publications/2011/9789241501507_eng.pdf
World Health Organization (WHO), (2014). Health care-associated infections fact sheet. Retrieved from http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf
Wright, S. B., Ostrowsky, B., Fishman, N., Deloney, V. M., Mermel, L., & Perl, T. M. (2010). Expanding roles of healthcare epidemiology and infection control in spite of limited resources and compensation. Infection Control, 31(02), 127-132.
Xiao, Y., Seagull, F. J., Bochicchio, G. V., Guzzo, J. L., Dutton, R. P., Sisley, A., ... & Scalea, T. M. (2007). Video-based training increases sterile-technique compliance during central venous catheter insertion. Critical care medicine, 35(5), 1302-1306.
Young E.W., Forti E.M., & Preston D.B. (1996). Rural nurses’ use of universal precautions in relation to perceived knowledge of patients’ HIV status. International Journal of Nursing Studies 33, 249–258.
Zaidi, A. K., Huskins, W. C., Thaver, D., Bhutta, Z. A., Abbas, Z., & Goldmann, D. A. (2005). Hospital-acquired neonatal infections in developing countries. The Lancet, 365(9465), 1175-1188.
Zhou, Y., Zhang, D., Chen, Y., Zhou, S., Pan, S., Huang, Y., & Ba-Thein, W. (2014). Healthcare-associated infections and shanghai clinicians: A multicenter cross-sectional study. PLos One, 9(8): e105838.