Background: The rate of the microbial exposure incidence among nurses through a variety of ways remains high. Paramedics play a vital role as a medium of nosocomial infection transmission in hospitals, especially the spread through direct contact. Objective: The purpose of this research was to determine the effectiveness of the auditing guidelines for methicillin-resistant Staphylococcus aureus(MRSA) infection prevention and control using directive discourse in an attempt to improve compliance with handwashing among nurses in hospitals. Materials and Methods: This was quasi-experimental research using a pretest–posttest noncontrol design. The research subject consisted of a group of 25 nurses. Results: Measurement of handwashing before and after the treatment in the treatment group performed with a Kolmogorov–Smirnov test showed P value before the treatment was 0.200 and after the treatment was 0.200, indicating data were normal. T-test result showed there was a difference in the compliance with handwashing before and after treatment (P = 0.018, P < 0.05). Conclusions: The auditing guidelines for MRSA infection prevention and control using directive discourse were effective for improving compliance with handwashing among nurses in hospitals.
Keywords: Handwashing, infection, microbial, prevention
The rate of the microbial exposure incidence among nurses through a variety of ways remains high. Paramedics play a vital role as a medium of nosocomial infection transmission in hospitals, especially the spread through contact. Nosocomial infections can be transmitted through contact, air, syringes, and other objects around us. Changes in behavior require knowledge which later affect nurses’ compliance with standard precautions. Such knowledge will support the implementation of attempts to prevent exposure to microorganisms during work.
There are two concepts of compliance, namely, conformity and obedience. The first refers to a tendency to change from the perceptions, opinions, and behavior derived from the norms or rules which exist in one group. The factors associated with this conformity among others are the influences of information, existing rules, a group’s size, awareness of the rules which exist in a group, age and gender differences, as well as cultural influences. The latter refers to changes in behavior due to the instruction or command of the authority holder. The factors associated with this obedience among others are leadership figures (the authority holder), responsibilities of each individual, and escalation of possible dangers.
Compliance with handwashing is defined as the adherence to handwashing in accordance with five moments specified in the WHO criteria, namely, before in contact with a patient, after in contact with the patient, before performing aseptic measures, after getting exposed to body fluids of the patient, and after coming into contact with the objects around the patient by washing hand in accordance with the six steps of washing hands recommended by the WHO.
The purpose of this research was to determine the effectiveness of the auditing guidelines for methicillin-resistant Staphylococcus aureus (MRSA) infection prevention and control using directive discourse in an attempt to improve compliance with handwashing among nurses in hospitals.
The equipment required to conduct the present research consisted of CCTVs, computer monitors, checklists for monitoring nurse activities, checklists of compliance with handwashing, LCDs, and stationery.
This was quasi-experimental research using a pretest–posttest noncontrol design. The research subject consisted of a group of 25 nurses. The treatment consisted of training conducted twice; the first training was on the materials about the dangers of MRSA infection and the urgency as well as procedures for handwashing, while the second one was on the delivery of materials about the auditing guidelines for MRSA infection prevention and control using directive discourse. This research has obtained the certificate of ethical approval issued by the Hospital Ethical Committee.
To determine the results of measuring handwashing before and after the treatment in the treatment group, a Kolmogorov–Smirnov test was performed and the results suggested that before the treatment the value of P = 0.200 and after the treatment the value of P = 0.200. It was concluded that these data were normal. Afterward, a t-test was undertaken to these data and generated a value of P = 0.018 (P< 0.05), meaning that there is a difference in the compliance with handwashing before and after the treatment [Table 1].
In this research, the results of the statistical analysis regarding difference in compliance with handwashing before and after the treatment were significant. These results suggest that the treatment in the form of training with auditing guidelines for MRSA infection prevention using directive discourse as the main reference is considered effective in changing the behavior of compliance with handwashing. It was due to the acceptance of training materials serving as positive reinforcement and stimulating compliance with handwashing. The increased compliance also resulted from the increased awareness relating to the importance of washing hands. It is suggested affecting respondents to be more obedient that later generates significant change after the treatment.
Education and training are effective ways to improve compliance with handwashing. However, some findings indicate that compliance with handwashing is influenced by several factors, and effects of training itself will only produce short-term compliance.
Knowledge, attitudes, and actions are the components of behavior, where changes can be made in three ways, that is, (1) seriousness, (2) starting from the closest environment, and (3) the existence of education. Such behavioral changes consist of six phases, namely, (1) the unfreezing phase, that is, individuals begin to consider accepting certain changes, (2) the problem diagnosis phase, that is, individuals begin to identify those who support and those who refuse changes, (3) the goal-setting phase, (4) the new behavior phase, (5) the refreezing phase, and (6) individuals’ permanent behavior.
The research investigating on behavior to comply with the standard precautions in the intensive care unit at Ghent University Hospital in Belgium was aimed at identifying and examining the predictors and determinants of poor adherence to the handwashing instruction in the Intensive Care Unit among nurses. The method employed in the research was filling out questionnaires distributed to 148 nurses working at the intensive care unit of Ghent University Hospital with a total of 40 beds. Questionnaires were returned by 73% of participated nurses. The compliance mean was equal to 84%.
Research on hand hygiene-related behavioral problems aimed to examine the relationship between knowledge, beliefs, and actions with hand hygiene in health students. The research used questionnaires with the total respondents of 1485 medical students and nursing students from 19 universities in Australia, Sweden, and Greece. The research findings revealed that the compliance with hand hygiene was influenced by the belief associated with significance of hand hygiene for infection prevention, knowledge, and frequencies of hand hygiene assessment.
Among the strategies to enhance compliance with standard precautions is to eliminate anything that may prevent health officers from complying with the handwashing rules. Such strategies include attempts to better understand that the rule to comply with the standard precautions is very vital. The hospital infection control officers can also always clarify the misconceptions about the use of gloves and the issue of skin convenience. In addition, the use of posters, videos, images about handwashing, and establishment of handwashing facilities are also important to improve compliance with handwashing.
The auditing guidelines for MRSA infection prevention and control using directive discourse were effective for improving compliance with handwashing among nurses in hospitals.
Conception and Design: Kusbaryanto
Analysis and interpretation of the data: Kusbaryanto
Drafting of the article: Kusbaryanto, Yuni Muriana
Critical Revision of the article for important intellectual content: Kusbaryanto
Final approval of the article: Kusbaryanto, Yuni Muriana
Statistical expertise: Agus Wibowo
Collection and assembly of data: Kusbaryanto.
The research was supported by the Universitas Muhammadiyah Yogyakarta, author thank to the research grant from department of hospital management school of postgraduate studies Universitas Muhammadiyah Yogyakarta.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
Source of Support: None, Conflict of Interest: None