kjan Korean Journal of Adult Nursing Korean J Adult Nurs 1225-4886 2288-338X Korean Society of Adult Nursing 10.7475/kjan.2018.30.2.161 kjan-30-161 Original Article Factors Influencing Hemodialysis Unit Nurses’ Compliance with Standard Precautions using Hierarchical Linear Modeling Kim Miyeun 1 Shin Juhhyun 2 Nurse, Samsung Medical Center, Seoul, Korea Division of Nursing, College of Nursing, Ewha Womans University, Seoul, Korea Corresponding author: Kim, Miyeun https://orcid.org/0000-0002-6815-882X Nursing Department, Samsung Medical Center, 81 Ilwon-ro, Gangnam-gu, Seoul 06351, Korea. Tel: +82-2-3410-2070, Fax: +82-2-3410-2076, E-mail: my1211@hanmail.net 42018 2142018 302 161170 26122017 16032018 02042018 Copyright © 2018 Korean Society of Adult Nursing 2018 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

The purpose of this study was to identify the factors associated with compliance with standard precautions among hemodialysis unit nurses.

 Methods

A cross-sectional study design was used. One hundred ninety six nurses were recruited from 18 hemodialysis units in South Korea. Data were analyzed using SPSS/WIN 23.0 to provide descriptive statistics to describe the characteristics of the sample and variables. A hierarchical linear model was used to analyze effects of individual and hospital characteristics on nurses’ compliance with standard precautions.

 Results

The majority of the sample was female (98%) and reported receiving in-service education on infection control (80%). The participants’ average year of work experience in hemodialysis units was 7 years and the average nurse-patient ratio was 7:1. At the individual level, the perception of patients'severity, the length of work experience in hemodialysis unit, and the safety climate on infection prevention practices were significantly associated with nurse's compliance with standard precautions. At the hospital level, clinics showed a lower compliance with standard precautions than general hospital or university hospital.

 Conclusion

In order to enhance compliance with standard precautions among hemodialysis unit nurses, it is imperative to warrant safety climate on infection prevention practice at clinics and develop infection control educational program for nurses with less work experience in hemodialysis units.

 Standard precautions Compliance Linear models Hemodialysis REFERENCES Inker LA Astor BC Fox CH Isakova T Lash JP Peralta CA KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD American Journal of Kidney Disease 2014 63 5 71335 https://doi.org/10.1053/j.ajkd.2014.01.416 The registry committee of Korean society of nephrology Current renal replacement therapy in Korea [Internet] Seoul The Korean Society of Nephrology 2017 [cited 2017 June 5]. Available from: http://www.ksn.or.kr/rang_board/list.html?code=sinchart Kim MS Kim MS Kim JA Jeong EJ Heo EH Hong HJ Development of nursing practice standards of hemodialysis care according to admission types Journal of Korean Clinical Nursing Research 2015 21 3 293308 Shehata AM Elsawi KA Ibrahim HY Nurses' knowledge and practice: preventing HCV in hemodialysis units Deutschland LAP Lambert 2015 134 Steenkamp R Rao A Fraser S UK renal registry 18th annual report: survival and causes of death of UK adult patients on renal replacement therapy in 2014: national and centre-specific analyses Nephron Clinical Practice 2016 123 suppl 1 11144 https://doi.org/10.1159/000444819 CDC Guide to infection prevention for outpatient settings [Internet] Atlanta Centre of Disease Control and Prevention 2016 [cited 2018 January 20]. Available from: https://www.cdc.gov/infectioncontrol/pdf/outpatient/guide.pdf Centers for Disease Control and Prevention Recommendations for prevention of HIV transmission in healthcare settings Morbidity and Mortality Weekly Report 1987 36 Suppl 2 S118 Healthcare Infection Control Practices Advisory Committee 2007 Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings American Journal of Infection Control 2007 35 10 S65164 https://doi.org/10.1016/j.ajic.2007.10.007 Nguyen DB Gutowski J Ghiselli M Cheng T Hamdounia SB Suryaprasad A A large outbreak of hepatitis C virus infections in a hemodialysis clinic Infection Control & Hospital Epidemiology 2016 37 2 12533 https://doi.org/10.1017/ice.2015.247 Rao AK Lin Y Thompson ND Luckman E Xia G Patel PR Outbreak of hepatitis C virus infections at an outpatient hemodialysis facility: the importance of infection control compe-tencies Nephrology Nursing Journal 2013 40 2 10110 Senatore S Galli C Conti A Faccini M Cantoni S Ciconali G Hepatitis C virus outbreak in a haemodialysis unit: learning from failures Journal of Hospital Infection 2016 94 3 24952 https://doi.org/10.1016/j.jhin.2016.07.021 Girou E Chevaliez S Challine D Thiessart M Morice Y Les-prit P Determinant roles of environmental contamination and noncompliance with standard precautions in the risk of hepatitis C virus transmission in a hemodialysis unit Clinical Infectious Diseases 2008 47 5 62733 https://doi.org/10.1086/590564 Suh YH Oh HY Knowledge, perception, safety climate, and compliance with hospital infection standard precautions among hospital nurses Journal of Korean Clinical Nursing Research 2010 16 1 6170 Shin HY Kim KH Kim KS Study on pediatric nurses' attitudes and compliance with hospital infection standard precautions Journal of Korean Academy of Child Health Nursing 2011 17 4 23846 https://doi.org/10.4094/jkachn.2011.17.4.238 Cho GL Choi JS Knowledge of and compliance with standard precautions by nurses in intensive care unit Journal of Korean Academic Fundamental Nursing 2010 17 1 7381 Luo Y He GP Zhou JW Luo Y Factors impacting compliance with standard precautions in nursing, China International Journal of Infectious Disease 2010 14e110614 https://doi.org/10.1016/j.ijid.2009.03.037 Kim MN Development of a guideline for the infection control in hemodialysis room. [Internet] Cheongju Korea Centers for Disease Control and Prevention 2009 [cited 2017 May 3]. Available from: http://cdc.go.kr/CDC/notice/CdcKrInfo0201.jsp?menuIds=HOME001-MNU1154-MNU0005-MNU1889&cid=1475 http://cdc.go.kr/CDC/notice/CdcKrInfo0201.jsp?menuIds=HOME001-MNU1154-MNU0005-MNU1889&cid=1475 Arenas MD Sánchez-Payá J Barril G García-Valdecasas J Gorriz JL Soriano A A multicentric survey of the practice of hand hygiene in haemodialysis unit: factors affecting compliance Nephrol Dial Transplant 2005 20 6 116471 Cho GL Influencing factors on the compliance about standard precautions among ICU and ER nurses [master's thesis] Seoul Seoul National University 2007 57 Lee KH Choi JO Lee KS Hur JA Hwang TY Nurses' knowledge, attitude, and compliance with hospital infection standard precautions Korean Journal of Hospital Management 2014 19 2 3342 Kang SJ Multilevel Modes. 1st ed Seoul Hakjisa 2016 53167 Howell DC Fundamental statistics for the behavioral sciences. 7th ed. Do KS, Park TJ, Shin HJ, translator Seoul Cengage learning 2012 2878 Lee KA Kim HS Lee YW Ham OK Factors influencing compliance with standard precautions in intensive care unit and emergency room nurses Journal of the Korean Academy of Fundamentals of Nursing 2012 19 3 30212 https://doi.org/10.7739/jkafn.2012.19.3.302 Kim MJ Kim JS Eum SJ Knowledge, universal practice, and hindrance factors of medical workers in a university hospital concerning blood-mediated disease Journal of Korean Clinical Nursing Research 2003 9 1 4154 Sax H Perneger T Hugonnet S Herrault P Chraiti MN Pittet D Knowledge of standard and isolation precautions in a large teaching hospital Infection Control and Hospital Epidemiology 2005 26 3 298304 https://doi.org/10.1086/502543 Qahtani AS Almetrek MA Knowledge, attitudes and practice of nurses in renal dialysis units regarding infection control in Abha city-Saudi Arabia, 2015 The Egyptian Journal of Hospital Medicine 2017 66 10314 https://doi.org/10.12816/0034640 Lee HR Beon YS Im NY Lee MS Kim IS Nursing research Seoul Korean Nurses Association 2012 1678 Barikani A Ahmad A Knowledge, attitude and practice towards standard isolation precautions among Iranian medical students Global Journal of Health Science 2012 4 2 1426 https://doi.org/10.5539/gjhs.v4n2p142 Kallenbach JZ Review of hemodialysis for nurse and dialysis personnel Missouri Elsevier 2015 11531 Yu JJ Understanding and application of hierarchical linear model Korean Association of Child Studies 2006 27 3 16987 Tables

General Characteristics of Participants (N=196)

Variables Categories n(%) M± SD Min-Max
Gender Female 192(98.0)
Male 4(2.0)
Age (year) 30 34(17.4) 37.24±7.28 22.00~53.00
30~39 90(45.9)
40~49 59(30.1)
≥50 13(6.6)
Clinical career (year) 5 30(15.3) 13.45±6.95 0.40~30.50
5~＜10 26(13.3)
10~＜15 54(27.5)
≥15 86(43.9)
Clinical career in hemodialysis room (year) 3 61(31.1) 7.14±5.69 0.40~26.00
3~＜10 74(37.8)
≥10 61(31.1)
Perception of patient's severity Moderate 81(42.4)
Severe 110(57.6)
Experience of needle stick injury Yes 102(52.0)
No 94(48.0)
Exposure on blood-born infections Exposed 89(45.4)
Unexposed 107(54.6)
Experience of infection control education Yes 157(80.1)
No 39(19.9)

General Characteristics of Hemodialysis Units from 18 Hospitals (N=18)

Variables Categories n (%) or M± SD
Geographical location Seoul 13(72.2)
Gyeonggido 5(27.8)
Type of hospital University hospital 5(27.8)
General hospital 6(33.3)
Clinic 7(38.9)
Quality evaluation of hemodialysis (points) 1 grade (≥90) 6(33.3)
2 grade (80~89) 10(55.6)
3 grade (70~79) 2(11.1)
Number of patients per nurse 7.19±1.00
Infection management guideline Yes 11(61.1)
No 7(38.9)

Scores for Knowledge, Awareness, Safety climate and Compliance of Participants (N=196)

Variables Range M± SD Min~Max
Knowledge 0~25 21.17±1.82 16~25
Awareness 0~10 8.72±1.18 4~10
Safety climate 0~6 4.67±1.62 0~6
Compliance 0~45 37.11±6.32 15~45

Hierarchical Linear Model of Individual Level and Hospital Level on Standard Precautions Compliance

Variables Categories Unconditional model Conditional model 1 Conditional model 2 Conditional model 3
Coefficient SE p Coefficient SE p Coefficient SE p Coefficient SE p
Fixed effects Intercept (Υ00) 36.95 0.89 .001 36.97 0.55 .001 36.91 0.49 .001 36.94 0.53 .001
Level 1(Nurses, n=196) Clinical career in HD unit 0.01 0.00 .034 0.01 0.01 .012
Perception of patient's severity: Severe 2.42 0.86 .006 1.81 0.92 .046
Experience of needle -0.90 0.71 .213 -0.43 0.95 .466
injury: Yes
Exposure on blood- born infections: Yes -0.76 0.68 .255 -0.82 0.89 .225
Knowledge 0.07 0.18 .681 -0.08 0.25 .662
Awareness 0.29 0.34 .381 0.41 0.37 .228
Safety environment 1.54 0.35 .001 1.27 0.32 .001
Level 2 Geographical location: (Hospitals, n=18) 1.15 1.18 .349 0.27 1.27 .756
Seoul
Type of hospital: Clinic -5.87 1.48 .002 -3.41 1.50 .014
Number of patients per nurse 0.18 0.52 .729 0.01 0.57 .979
Infection management guideline: Yes 0.12 1.54 .940 -0.72 1.34 .497
Random effect Variance of the individual level 30.86 30.92 27.71 27.47
Variance of the hospital level 11.49 .001 4.48 .003 2.20 .033 2.23 .041
Deviance 1,176 1,153 1,141 1,128
R2 0.102 0,110

HD=hemodialysis; SE=standard error.