Journal of Korean Academy of Nursing

Original Articles

Predictors of Blood and Body Fluid Exposure and Mediating Effects of Infection Prevention Behavior in Shift-Working Nurses: Application of Analysis Method for Zero-Inflated Count Data: Ryu, Jae Geum , Smi, Choi-Kwon; J Korean Acad Nurs 2020;50(5):658-670. Published online October 31, 2020; DOI: https://doi.org/10.4040/jkan.20025

Purpose
This study aimed to identify the predictors of blood and body fluid exposure (BBFE) in multifaceted individual (sleep disturbance and fatigue), occupational (occupational stress), and organizational (hospital safety climate) factors, as well as infection prevention behavior. We also aimed to test the mediating effect of infection prevention behavior in relation to multifaceted factors and the frequency of BBFE.
Methods
This study was based on a secondary data analysis, using data of 246 nurses from the Shift Work Nurses’ Health and Turnover study. Based on the characteristics of zero-inflated and over-dispersed count data of frequencies of BBFE, the data were analyzed to calculate zero-inflated negative binomial regression within a generalized linear model and to test the mediating effect using SPSS 25.0, Stata 14.1, and PROCESS macro.
Results
We found that the frequency of BBFE increased in subjects with disturbed sleep (IRR = 1.87, p = .049), and the probability of non-BBFE increased in subjects showing higher infection prevention behavior (IRR = 15.05, p = .006) and a hospital safety climate (IRR = 28.46, p = .018). We also found that infection prevention behavior had mediating effects on the occupational stress-BBFE and hospital safety climate-BBFE relationships.
Conclusion
Sleep disturbance is an important risk factor related to frequency of BBFE, whereas preventive factors are infection prevention behavior and hospital safety climate. We suggest individual and systemic efforts to improve sleep, occupational stress, and hospital safety climate to prevent BBFE occurrence.

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A Survey on the Performance of Surgical Hand Scrubs: Hae Sang Yoon; Journal of Nurses Academic Society 1996;26(3):591-604. Published online March 30, 2017; DOI: https://doi.org/10.4040/jnas.1996.26.3.591

Abstract PDF

The surgical hand scrub(SHS) is the single most important procedure in the prevention of postoperative wound infections and yet it remains the most violated of all infection control procedures. The purpose of this study was to gain an overview of SHS habits in operative theatre personnel and to determine knowledge and attitudes to identify whether there is a need for improvement. The subjects for this study included 79 doctors and 94 nurses working in the operative theatres of four hospitals in Incheon City and Kyungki Province. Related data were collected from July 25 to August 10, 1995 by the author. The data were analyzed using descriptive statistics and Chi-squre test. The results of the study are summarized as follows: 1. Nurses felt that they conducted SHS for a longer period of time than doctors did(X=20.1, P= .005). 2. Nurses and doctors had some knowledge of slipping rings off fingers and the length of nails, but they lacked knowledge on the duration of SHS, handwashing after an operation and on manicure. 3. There were many reasons given for insufficient SHS included: 1) because they were so busy (38%). 2) brushes were too harsh(19.7%). 3) operations were very simple(18.7%). 4) surgical latex gloves provide functional barrier(11.6%). 5) SHSs were troublesome(7.4%) 6) there were no clocks near the sinks(2.5%) and 7) the operative patients were administered antibiotics after operartion(2.1%). 4. Most of nurses and doctors considered SHS to be important in prevention against post operative infections. 5. Nurses were found to do a thorough SHS, but residents were found to neglect SHS. 6. Considering prevention against postoperative infections, most nurses and doctors considered aseptic techniques, environment-sanitary management and SHS more important than the use of antibiotics, the resistance of patients or the method of operation. 7. Half of the nurses and doctors(54.3%) considered surgical latex gloves to function well as a barrier. 8. Half of the nurses(56.4%) and doctors(51.9%) learned SHS as part of the curriculum in their school education and the rest (nurses: 95.7%, doctors: 74.7%) learned SHS as part of their In Service Education. In conclusion, these findings suggest a need to develop an educational program on surgical hand scrub and hospital infection control for surgical personnels, to install clocks near the hand scrub sinks, to consider a violation report for negligent surgical hand scrubs, and to develop a soft brush for hand scrubs in order to increase performance of the surgical hand scrub.

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Status of and Factors Influencing Vaccination against the Pandemic (H1N1) 2009 Virus among University Students from the Fields of Nursing and Allied Health
Og Son Kim
Journal of Korean Academy of Nursing.2011; 41(3): 403. CrossRef

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Effect of Visiting and a Smartphone Application Based Infection Prevention Education Program for Child Care Teachers: A Non-Randomized Controlled Trial: Yun Jeong Yang, In Soo Kwon; J Korean Acad Nurs 2017;47(6):744-755. Published online January 15, 2017; DOI: https://doi.org/10.4040/jkan.2017.47.6.744

Abstract PDF

Abstract Purpose

This study was performed to develop an infection prevention education program for child care teachers and to verify its effects.

Methods

The study was conducted using a nonequivalent control group with a pretest-posttest design. Four private daycare centers (2 centers per city) that were alike in terms of the number of children by age, number of child care teachers, and child care environment were chosen. Participants were assigned to the experimental group (n=20) or control group (n=20). As a part of the program, visiting education (90 min) was provided in the 1st week, and smartphone application education (10 min) was provided thrice a week, in the 2nd and 3rd weeks.

Results

Child care teachers’ self-efficacy for infection prevention revealed a significant interaction effect between the group and time of measurement (F=21.62, p<.001). In terms of infection prevention behavior, a significant difference was observed between the experimental and control groups (z=-5.36, p<.001).

Conclusion

The program implemented in this study was effective in improving the infection prevention self-efficacy and infection prevention behavior of child care teachers. Thus, this program may be effective in enhancing their infection control.

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Hyewon Shin, Jung Min Lee, Shin Jeong Kim
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The Structural Equation Model on Resilience of Breast Cancer Patients Receiving Chemotherapy: Jeong Ha Yang, Ok Soo Kim; J Korean Acad Nurs 2016;46(3):327-337. Published online June 30, 2016; DOI: https://doi.org/10.4040/jkan.2016.46.3.327

Abstract PDF

Purpose

The purpose of this study was to construct and test a structural equation model on resilience of breast cancer patients receiving chemotherapy.

Methods

Participants were 204 patients with breast cancer who received chemotherapy treatment. They participated in a structured interview, which included social support, depression, symptom experience, self-efficacy, hope, resilience, and infection prevention behaviors. Data were analyzed using SPSS/WIN 20.0 and AMOS 18.0.

Results

Lower depression (γ=-.33, p=.020) and symptom experience (γ=-.31, p=.012) and higher self-efficacy (γ=.32, p=.005) and hope (γ=.48, p=.016) were influenced by higher social support. Greater resilience was influenced by lower symptom experience (β=-.18, p=.016), higher self-efficacy (β=.49, p=.023), and higher hope (β=.46, p=.012), and these predictors explained 66.7% of variance in resilience. Greater resilience (β=.54, p=.009) made an impact on greater infection prevention behaviors. Resilience mediated the relations of symptom experience (β=-.10 p=.013), self-efficacy (β=.27, p=.006) and hope (β=.25, p=.009) with infection prevention behaviors. These predictors explained 24.9% of variance in infection prevention behaviors.

Conclusion

The findings of the study suggest that breast cancer patientsw ith greater resilience who are receiving chemotherapy participate in increased infection prevention behaviors. Further research should be conducted to seek intervention strategies that improve breast cancer patients' resilience.

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Marlen Simancas Fernández, Carla Zapata Rueda, Gonzalo Galván Patrignani, Jose Carlos Celedón Rivero, Juan Hernández Padilla
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Scott E. Wilks, Wanda R. Spurlock, Sandra C. Brown, Bettina C. Teegen, Jennifer R. Geiger
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Risk Factors and Clinical Outcomes for Vancomycin-Resistant Enterococcus Colonization on Intensive Care Unit Admission: Sook-Jin Byun, Jiyeon Kang; J Korean Acad Nurs 2013;43(2):287-295. Published online April 30, 2013; DOI: https://doi.org/10.4040/jkan.2013.43.2.287

Abstract PDF

Purpose

The purpose of this study was to identify vancomycin-resistant enterococcus (VRE) colonization rate in patients admitted to the intensive care unit (ICU), associated risk factors and clinical outcomes for VRE colonization.

Methods

Of the 7,703 patients admitted to the ICUs between January, 2008 and December, 2010, medical records of 554 VRE colonized and 503 uncolonized patients were reviewed retrospectively. To analyzed the impact of colonization on patients' clinical outcomes, 199 VRE colonized patients were matched with 199 uncolonized patients using a propensity score matching method.

Results

During the study period, 567 (7.2%) of the 7,703 patients were colonized with VRE. Multivariate analysis identified the following independent risk factors for VRE colonization: use of antibiotics (odds ratio [OR]=3.33), having bedsores (OR=2.92), having invasive devices (OR=2.29), methicillin-resistant Staphylococcus aureus co-colonization (OR=1.84), and previous hospitalization (OR=1.74). VRE colonized patients were more likely to have infectious diseases than uncolonized patients. VRE colonization was associated with prolonged hospitalization and higher mortality.

Conclusion

Strict infection control program including preemptive isolation for high-risk group may be helpful. Further research needs to be done to investigate the effects of active surveillance program on the incidence of colonization or infection with VRE in the ICU.

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Vancomycin Resistant Enterococci Prevalence, Antibiotic Susceptibility Patterns and Colonization Risk Factors Among HIV-Positive Patients in Health-Care Facilities in Debre Berhan Town, Ethiopia
Mikiyas Zike, Abdurahaman Ahmed, Awraris Hailu, Bedru Hussien
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Previous antibiotic therapy as independent risk factor for the presence of vancomycin-resistant enterococci in surgical inpatients. Results from a matched case-control study
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Steady Inflow of Vancomycin-Resistant Enterococci from Outside a Hospital
Hye-sun An, Sang-Won Park, Su-hui Ko, Ji Hwan Bang
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Vancomycin-resistant Enterococcus colonization in the intensive care unit: Clinical outcomes and attributable costs of hospitalization
Euihan Jung, Sookjin Byun, Hojin Lee, Sang Yi Moon, Hyuck Lee
American Journal of Infection Control.2014; 42(10): 1062. CrossRef

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Effects of Case-based Small Group Learning about Care of Infected Children for Daycare Center Teachers: Eun Ju Choi, Seon Young Hwang; J Korean Acad Nurs 2012;42(6):771-782. Published online December 31, 2012; DOI: https://doi.org/10.4040/jkan.2012.42.6.771

Abstract PDF

Purpose

This study was conducted to develop and implement a case-based small group learning program on the care of children with infectious disease, and to examine its effects on knowledge, attitude and preventive practice behaviors of daycare center teachers compared to a control group.

Methods

Based on the need assessment, the case-based learning program for the management of infectious children was developed. For this quasi-experimental study, 69 teachers were recruited from 14 child daycare centers in a city located in J province. Thirty four teachers were assigned to experimental group and participated in the case-based small group learning once a week for 5 weeks. Data were analyzed using the SPSS 18.0 program to perform χ²-test and t-tests. Analysis of covariance was used to treat the covariate of the number of assigned children between experimental and control groups.

Results

The experimental group showed significantly higher posttest scores in knowledge, attitude and preventive practice behaviors than those of control group (p<.001).

Conclusion

These findings indicate that case-based small group learning is an effective educational strategy for daycare center teachers to learn infection management through the emphasis of self-reflection and discussion.

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Il Tae Park, Gi Joong Kim
The Journal of Korean Academic Society of Nursing Education.2024; 30(3): 222. CrossRef
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Yun Jeong Yang, In Soo Kwon
Journal of Korean Academy of Nursing.2017; 47(6): 744. CrossRef
The Influence of Case-Based Learning using video In Emergency care of infant and toddlers
Hye-Young Cho, Kyoung-Ah Kang
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Ji-young Seo, Eun Young Kim
Korean Journal of Adult Nursing.2013; 25(4): 422. CrossRef

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Ventilator-associated Pneumonia with Circuit Changes Every 7 Days versus Every 14 Days: Jeong-Sil Choi, Jeong-haw Yeon; J Korean Acad Nurs 2010;40(6):799-807. Published online December 31, 2010; DOI: https://doi.org/10.4040/jkan.2010.40.6.799

Abstract PDF

Purpose

To determine whether the practice of not routinely changing ventilator circuits in patients who require prolonged mechanical ventilation is associated with ventilator-associated pneumonia (VAP).

Methods

Patients were divided into two groups, ventilator circuits were routinely changed every 7 days for the control group (39) and every 14 days for the experimental group (40) over a period of 1 yr (April 1, 2009-March 31, 2010). Pediatric patients (age 17 yr or less) were not included. VAP was diagnosed by the criteria of the Centers of Disease Control and Prevention (CDC). Incidence of VAP and characteristics of infection were evaluated.

Results

In the experimental group, 2 episodes of pneumonia were observed in 40 patients and 1,322 ventilator days. The rate of VAP was 1.5 per 1,000 ventilator days. There was 1 episode of pneumonia in 39 patients and 481 ventilator days for the control group. The rate of VAP was 2.1 per 1,000 ventilator days. The difference between both groups was not significant (p=.695).

Conclusion

Extending ventilator circuit change interval from 7 days to 14 days does not increase the risk for VAP.

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Application and Evaluation of a Web-based Education Program on Blood-borne Infection Control for Nurses: Jeong Sil Choi, Keum Soon Kim; J Korean Acad Nurs 2009;39(2):298-309. Published online April 28, 2009; DOI: https://doi.org/10.4040/jkan.2009.39.2.298

Abstract PDF

Purpose

To develop a web-based program on blood-borne infection control and to examine the effect of the newly developed program on perceived threat of diseases, knowledge, preventive health behaviors for blood-borne infections, and incidence rates of accidental needle sticks and other sharp object injuries in nurses.

Methods

The program was developed through the processes of analysis, design, development, implementation, and evaluation. The research design involved a nonequivalent control group for pretest and posttest experiments. The setting was a 745-bed general hospital located in Korea.

Results

The program was designed and developed after consulting previous studies. After development of the program was completed, it was evaluated and revised by a panel of experts. The total score for perceived threat of diseases, knowledge, preventive health behaviors in the experimental group was significantly higher compared to the control group (p<.05). The incidence rates for needle sticks and other sharp object injuries in the experimental group were significantly lower compared to the control group (p<.05).

Conclusion

Application of a Web-based, blood-borne infection control program is effective, and can be expanded to other healthcare workers who also have a high risk of blood-borne infections.

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Predictors of Blood and Body Fluid Exposure and Mediating Effects of Infection Prevention Behavior in Shift-Working Nurses: Application of Analysis Method for Zero-Inflated Count Data
Jae Geum Ryu, Smi Choi-Kwon
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Ji Hyun Yun, Ihn Sook Jeong
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Cognition and Practice of Standard Precautions towards Hospital Infection Control in Emergency Medical Technology Students
Jin-Uk Kim, Yoon-Shin Kim, Hyun-Kyung Ji, Ki-Sook Bae
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Hospital Nurses' Knowledge and Compliance on Multidrug-resistant Organism Infection Control Guideline: Jiyeon Kang, Jinwan Cho, Yujung Kim, Dong-Hee Kim, Jiyoung Lee, Hey-Kyung Park, Sung-Hee Jung, Eun-Nam Lee; J Korean Acad Nurs 2009;39(2):186-197. Published online April 28, 2009; DOI: https://doi.org/10.4040/jkan.2009.39.2.186

Abstract PDF

Purpose

This study was done to investigate nurses' knowledge of, and compliance with the multidrug-resistant organism (MDRO) infection control guidelines.

Methods

A survey questionnaire was developed based on the institutional and national guidelines and was administered to a convenience sample of 306 nurses in a university hospital.

Results

The mean score for knowledge was 33.87 (percentage of correct answers: 82.61%). The percentages of correct answers for basic concepts, route of transmission, hand washing/protective devices and environment management were 74.27%, 94.29%, 92.90% and 75.54% respectively. The mean compliance score was 4.15 (range: 1-5). The compliance scores for education, communication, contact precaution, disinfection, surveillance culture, and hand washing were 3.29, 4.05, 4.20, 4.50, 4.40 and 4.48 respectively. Nurses indicated "lack of time (30.06%)", "lack of means (10.78%)" and "lack of knowledge (9.48%)" as reasons for noncompliance.

Conclusion

While most educational programs have focused on hand washing or use of protective devices to prevent transmission of MDRO in acute care settings, hospital nurses' knowledge of the basic concepts of MDRO and environmental management has remained insufficient. Nurses are relatively non-compliant to the guidelines in the areas of education (staff, patient, family) and communication. Comprehensive educational programs are needed to decrease hospital infection rates and to improve the health of patients.

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