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Kim and Shin: Factors Influencing Hemodialysis Unit Nurses’ Compliance with Standard Precautions using Hierarchical Linear Modeling
Original Article

Korean J Adult Nurs 2018;30(2):161-170.

Published online: 21 April 2018

DOI: https://doi.org/10.7475/kjan.2018.30.2.161

Factors Influencing Hemodialysis Unit Nurses’ Compliance with Standard Precautions using Hierarchical Linear Modeling

Miyeun Kim1, , Juhhyun Shin2

1Nurse, Samsung Medical Center, Seoul, Korea

2Division 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

Received 26 December 201716 March 2018       Accepted 2 April 2018

Copyright © 2018 Korean Society of Adult Nursing

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.

Keywords: Standard precautions, Compliance, Linear models, Hemodialysis

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Table 1.
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)
Table 2.
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)
Table 3.
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
Table 4.
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.

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