LEVEL OF COMPLIANCE TO INFECTION CONTROL

GUIDELINES AMONG HEALTH WORKERS IN

COMPLEX QUEZON MEDICAL CENTER
 Chapter 1
THE PROBLEM AND ITS SETTINGS

Introduction

The purpose of standard precautions, devised and adopted many years ago in healthcare

history, is to ensure that the bare minimum of infection prevention methods is followed in

healthcare. To guarantee the adequacy and timeliness of standard precautions, they were

modified and updated in response to different risks of exposure among healthcare workers

(MMWR Morb Mortal. Wkly. Rep. 1985; Garner, J.S., 1996; Leach, R., 2020) to improve the

well-being of Heath Care Workers and patients (MMWR Morb Mortal. Wkly. Rep. 1985;

Garner, J.S., 1996; Leach, R. (Lam, S.C., 2014; World Health Organization, 2021). HCWs,

particularly nurses, are more likely than the public to become infected because of occupational

exposure in various healthcare settings (Magill, S.S., 2014; Verbeek, J.H.; Rajamaki, B.; Ijaz, S.;

Tikka, C.; Ruotsalainen, J.H.; Edmond, M.B.; Sauni, R.; Kilinc Balci, F.S., 2019), (Valim, M.D.,

2014).

As of January 2021, COVID-19 had become a global menace, infecting 94 million people

globally and inflicting approximately 2 million deaths (Covid By Numbers, 2021). As the

COVID-19 pandemic spreads, HCWs will become increasingly vital in providing treatment to

patients on the front lines of the disease's fight. They are, however, at a higher risk of becoming

infected, which might make epidemic control difficult and result in the healthcare system

collapsing (Barranco, R.; Ventura, F., 2020).

According to research, COVID-19 is present in roughly 10% of HCWs, with 29% of

infections caused by accidental exposure to a patient at a non-COVID-19 facility (Alajmi, J.;

Jeremijenko, A.M.; Abraham, J.C.; Alishaq, M.; Concepcion, E.G., Butt, A.A.; Abou-Samra,
A.B., 2020). Lee, S.; Meyler, P.; Mozel, M.; Tauh, T.; Merchant, R., 2020) show that the risk of

asymptomatic COVID-19 transmission to HCWs was also presented (Lee, S.; Meyler, P.; Mozel,

M.; Tauh, T.; Merchant, R., 2020). In addition to the usual precautions, the WHO has

recommended a range of workplace infection control measures at both the individual and

organizational levels for protecting HCWs and boosting the health system's response to COVID-

19 (World Health Organization, 2021). Although infection prevention in the workplace is an

essential aspect of occupational health in healthcare, it will not be effective if individual HCWs

do not follow them (Barranco, R.; Ventura, 2020). To protect HCWs' health and limit the danger

of cross-transmission and infection in the workplace during an infectious pandemic, it is vital to

implement agreeable and acceptable workplace infection control rules and practices in healthcare

settings. However, research on HCWs' perceptions of workplace infection control policies and

procedures in healthcare settings is scarce (McMahon, S.A.; Ho, L.S.; Brown, H.; Miller, L.;

Ansumana, R.; Kennedy, C.E., 2016), and the link between compliance and pandemic severity is

unknown.

The study’s goal is to determine the level of compliance with infection prevention and

control practices among Healthcare Workers in complex Quezon medical center and investigate

the relationship between obedience and attitudes toward infection prevention and control

practices and HCW characteristics. The findings are critical in informing strategies and

interventions needed to improve workplace policies in healthcare settings and retain a healthcare

system's capacity to combat a pandemic while maintaining vital health services.

Background of the Study

Dealing with a significant global health calamity involves an uncharted trip into the

unknown at multiple levels. To forecast infection rates, government agencies use data from other
countries. For most people, the high level of uncertainty connected with new infections adds to

their sense of anxiety and makes for a terrible overall experience. Individuals who use their

coping skills and work together in teams can make positive changes because of their problems.

Leaders' transformation can help countries prepare for future calamities by strengthening their

preparation.

The COVID-19 Pandemic, which originated in Wuhan, China, has wreaked havoc on the

world, altering every element of human life (WHO, 2021; Maliszewska M, Mattoo A, van der

Mensbrugghe D., 2020). As of February 8, 2021, there had been 105,805,951 COVID-19

instances registered worldwide, with 2,312,278 deaths (WHO, 2021). In Ghana, 72,328 COVID-

19 cases have been confirmed, with 472 deaths reported and 6,707 current cases (Ghana Health

Service, 2021). The disease is a highly contagious viral respiratory infection that affects the

elderly and persons with underlying medical issues more severely (Guan W, Ni Z, Hu Y, Liang

W, Ou C, He J, et al., 2019; Guo Yan-Rong, Cao Qing-Dong, Hong Zhong-Si, Tan Yuan-Yang,

Chen Shou-Deng, Jin1 Hong-Jun, et al., 2019). Fever, cough, sore throat, and shortness of breath

are the most common symptoms of COVID-19 infection (Cao J, Tu W, Cheng W, Yu L, Liu Y,

Hu X, et al., 2019; WHO, Aylward, Bruce (WHO); Liang W (PRC), 2020).

Healthcare workers play a crucial role in combating the COVID-19 pandemic, and they

are at a higher risk of contracting the virus while on the job (Verbeek JH, Rajamaki B, Ijaz S,

Sauni R, Toomey E, Blackwood B, et al., 2020). Healthcare workers, for example, are more

likely to be exposed to SARS-COV-2 (Kim R, Nachman S, Fernandes R, Meyers K, Taylor M,

Leblanc D, et al., 2020) and are thus at higher risk of COVID-19 infection than the general

public (Kim R, Nachman S, Fernandes R, Meyers K, Taylor M, Leblanc D, et al., 2020).

(Nguyen LH, Drew DA, Graham MS, Joshi AD, Guo CG, Ma W, et al., 2020). As a result, the
COVID-19 pandemic has significantly impacted healthcare personnel (Garralda J, Id F, Vilches

IM, Rodr AB, Torres IC, Isabel E, et al., 2021). However, the best weapon for safeguarding

healthcare workers from the COVID-19 pandemic is prevention (Cascella M, Rajnik M, Cuomo

A, Dulebohn SC, Di Napoli R., 2020). As a result, following infection prevention and control

methods is crucial for limiting healthcare personnel' exposure to the coronavirus that causes

severe acute respiratory syndrome 2 (SARS-CoV-2) (Verbeek JH, Rajamaki B, Ijaz S, Sauni R,

Toomey E, Blackwood B, et al., 2020; Id RHE, El-kholy A, Eldin SM, Khater WS, Gad DM,

Bahgat S, et al., 2021). Correct and consistent treatment adherence helps reduce the risk of

COVID-19 infection (.Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, et al.,

2020; Nguyen LH, Drew DA, Graham MS, Joshi AD, Guo CG, Ma W, et al., 2020). Training of

healthcare personnel, availability of information, and regular auditing of practices help ensure

that protocols are followed (WHO, 2020). Early detection, physical separation, source control,

precautions and appropriate use of personal protective equipment (PPEs), restriction of

movement, environmental cleaning, and disinfection, as well as support for healthcare workers,

should all be part of the response to highly infectious diseases like COVID-19 (WHO, 2020;

WHO, 2014).

Low compliance with infection prevention and control methods can have adverse effects

for workers, patients, and institutions, including workplace injuries, health-care-associated

infections, and institutional harm (Askarian et al., 2004; I. Jeong et al., 2008; Oliveira et al.,

2009; World Health Organization [WHO], 2011). More extended hospital stays, long-term

incapacity, significant additional expenses for health systems and organizations, and avoidable

deaths are all possible outcomes of health-care-associated infections (WHO, 2011). During the

COVID-19 pandemic, healthcare workers' compliance with PPE ranged from 54 percent to over
95 percent, depending on the study (Ashinyo et al., 2021; Darwish et al., 2021; Michel-Kabamba

et al., 2020; Neuwirth et al., 2020).

To the best of the researchers ' knowledge, few studies have examined healthcare

personnel’s compliance with proper infection-prevention and-control methods throughout this

epidemic. Following an epidemic, it is expected that compliance with PPE and hand hygiene

practices will alter, as seen by prior infectious outbreaks where considerable improvements in

compliance were documented (G. Jeong et al., 2016; Wong & Tam, 2005). As a result, it's worth

looking into how to deal with changes in compliance during the present epidemic. During the

COVID-19 pandemic, the researcher wants to analyze health care workers' compliance with

proper PPE and hand hygiene procedures in different health care sectors at Quezon Complex

Medical Center and investigate the hurdles to the appropriate use of such measures.

Conceptual Framework

1. Demographic Profile 1. Systematic Review To designed seminar

of the Respondents Analysis and workshop
2. Infection prevention 2. Data Gathering regarding the
and control practices Procedure through intesification of
Survey Questionnaire infection control
3. Level of guidelines to
Process

Output

Compliance in proper 3. Statistical Analysis

Input

healthcare worker's of
guidelines of infection of Data Quezon Medical
control Center

Figure 1
Research Paradigm
 Figure 1 depicts the study's conceptual framework, highlighting how thoughts are

organized and clarifying the study's themes. This section also includes the variables, theories,

and other study components. As the first line of defense against COVID-19 infection, health care

personnel are at a higher risk of becoming infected. They must follow infection prevention and

control procedures to protect themselves and their patients. In addition, the researcher wants to

see how well healthcare personnel in Quezon Medical Center followed infection-prevention and-

control methods during the COVID-19 epidemic.

Furthermore, systematic review analysis and a self-made and standard questionnaire

will gather the needed information. The researcher will do the tallying and run statistical analysis

of data interpreted and analyzed with the statistician's guide.

It is necessary to strengthen healthcare professionals’ compliance with infection-

prevention and-control procedures. Hospital and nursing management should conduct frequent

quality checks, provide appropriate supplies, and implement behavior modification programs to

increase compliance.

Statement of the Problem

Infection control has been recognized as a problem affecting health care quality. And

proper infection control in each hospital service area is required. Hospital-acquired infections are

a significant safety concern for both health care providers and patients. This could be the lack of

practices and proper procedures, high training, and regular habits. The study aims to determine

the compliance to infection control guidelines among health workers in the delivery room,

Quezon Medical Center.

Specifically, it sought to answer the following:

 1. What is the demographic profile of the respondents in terms of:

1.1. Age

1.2. Gender

1.3. Educational Attainment

1.4. Line of Work

2. What are the healthcare workers' infection prevention and control practices?

3. What is the compliance level of healthcare workers in proper guidelines of infection

control in terms of:

3.1. Proper use of PPE

3.2. Handwashing techniques

3.3. Disinfection of articles

3.4. Disinfection of the area

4. Is there any relationship between the practices and the level of awareness among the

respondents?

5. Based on the study, what seminar and workshop regarding intensifying infection control

guidelines to the healthcare workers of Quezon Medical Center?

Hypothesis

The researcher posited the null hypothesis that was subjected to acceptance and

rejection.

H0: There is no significant relationship between the practices and the level of

awareness among the respondents

Objectives of the Study

To satisfy the goal of this study, here is the following objective constructed by the

researchers:

1. The study’s goal was to determine the level of compliance with infection prevention and

control procedures among HCWs in various healthcare settings and the relationship

between compliance and infection prevention and control views.

2. The findings are critical in informing strategies and interventions needed to improve

workplace policies in healthcare settings and retain a healthcare system's capacity to

combat a pandemic while also maintaining vital health services. The findings are critical

in informing strategies and interventions needed to improve workplace policies in

healthcare settings and retain a healthcare system's capacity to combat a pandemic while

maintaining vital health services.

Significance of the Study

This study will be beneficial to the following sectors:

For the Healthcare Workers. The findings of this study will serve as a foundation or

guide for HCWs, particularly recruits and student affiliates, on the significance of following the

procedures to protect not only patients but also themselves as caregivers. This study will also aim

to raise HCW’s understanding of the risks associated with not following conventional measures.

Healthcare Organizations and Institutions. It hopes to assist or remind hospitals to

increase educational and motivational programs about universal/standard precautions, develop

policies for more stringent compliance monitoring, and implement routine monitoring and

potential penalties for participants who do not comply to achieve an acceptable compliance rate.
 Policy Makers in Infection Control Guidelines. Frequent quality checks, continuous

monitoring, adequate supplies (personal protective equipment and handwashing agents), and

behavior change interventions are some of the top strategies that policymakers, health care safety

managers, hospital and nursing administrators can use to improve compliance. It is necessary to

conduct more research that includes direct observation of infection prevention and control

procedures.

Scope and Delimitation

This study aims to assess the level of compliance with the standard precautions in

terms of handwashing/ hand hygiene, use of personal protective equipment, handling and

discarding of sharps, and other protective practices among healthcare workers in Quezon

Medical Center during the COVID-19 pandemic. It also looked at the socio-demographic and

health-related profile of the respondents. The significant relationship between the respondents’

level of compliance to the standard precautions and the socio-demographic and hospital-related

profile factors was also determined.

 Chapter 2
REVIEW OF RELATED LITERATURE AND STUDIES

This chapter contains the various literature and studies that’ll further support the

details indicated in the survey. Furthermore, it tackles the concepts circulating the ideas and

knowledge about the study.

Work-related Factors
Higher acuity settings, such as emergency, intensive care, or inpatient departments,

appeared to have higher compliance ( de Perio MA, Brueck SE, Mueller CA, et al.; Shigayeva A,

Green K, Raboud JM, et al.; Jaeger JL, Patel M, Dharan N, et al., 2011; Chia SE, Koh D, Fones

C, et al., 2005; Ki HK, Han SK, Son JS, et al., 2005). Staff in high-infection regions were more

likely to wear gowns, wash hands, and use disinfectants but less likely to comply with quarantine

measures, according to Wong et al. (2004). There was no significant link between setting and

compliance in the two experiments (Evirgen O, Savas N, Koksaldi Motor V, et al., 2014; Taghrir

MH, Borazjani R, Shiraly R., 2020).

In three research (de Perio MA, Brueck SE, Mueller CA, et al., 2012; Shigayeva A,

Green K, Raboud JM, et al., 2007; Chia SE, Koh D, Fones C, et al., 2005), having contact with

confirmed cases were linked to increased compliance. However, one study (Evirgen O, Savas N,

Koksaldi Motor V, et al., 2014) found Staff that worked directly with confirmed cases had higher

compliance, according to research by Pratt M, Kerr M, and Wong C (2009). SARS-exposed

employees were more likely than non-SARS-exposed employees to follow mask instructions,

although they were less likely to isolate themselves, according to Wong et al. (2004).

There was some evidence that high workload may be a barrier to compliance with

recommended personal protective behaviors ( Chor JSY, Pada SK, Stephenson I, et al., 2012;
Chau JPC, Thompson DR, Twinn S, et al., 2008; Shigayeva A, Green K, Raboud JM, et al.,

2007; Vinck L, Isken L, Hooiveld M, et al., 2011; Moore DM, Gilbert M, Saunders S, et al.,

2005; Corley A, Hammond NE, Fraser JF., 2010; Yassi A, Moore D, Fitzgerald JM, et al., 2005)

although one study also suggested that higher workload (in terms of working overtime) was

associated with increased compliance in terms of giving patients appropriate infection control

advice (Vinck L, Isken L, Hooiveld M, et al., 2011).

A tiny minority of participants in Hsu et al. (2011) .'s study felt that greater policing by

infection control professionals was the most effective technique for improving compliance (Hu

X, Zhang Z, Li N, et al., 2012; DiGiovanni C, Conley J, Chiu D, et al., 2004).

Two studies found that patient contact features were linked to compliance. Many of the

participants in de Perio et al.’s (2012) study said they didn't use recommended PPE because they

didn't know the patient had H1N1 or an influenza-like illness, didn't think it was necessary for

the activity they were doing, only entered the patient's room for a short time, didn't touch the

patient, or didn't come within 6 feet of the patient. Meanwhile, Shigayeva et al. (2007) found that

when providing care for patients with more severe illnesses (which the authors suggest may be

due to the time required to don barrier equipment leading staff to prioritize patient safety over

self-protection), and when they were only observing procedures rather than performing or

assisting with them, participants were less likely to follow recommended behaviors.

Occupational Role

Many studies that looked at the role as a predictor of compliance revealed a significant

association (Al-Amri S, Bharti R, Alsaleem SA, et al., 2019; Evirgen O, Savas N, Koksaldi

Motor V, et al., 2014; Chor JSY, Pada SK, Stephenson I, et al., 2012; Alsahafi AJ, Cheng AC.,
2016); nonetheless, There was no significant link between role and compliance in five studies

( Datta SS, Kuppuraman D, Boratne AV, et al., 2011; Nour MO, Babalghith AO, Natto HA,

2015; Nour MO, Babalghith AO, Natto HA, et al., 2017; Alshammari M, Reynolds K,

Verhougstraete M., 2018; Jaeger JL, Patel M, Dharan N, et al., 2011).

Five studies found no link between the length of time in a role and compliance (Al-Amri

S, Bharti R, Alsaleem SA, et al., 2019; Nour MO, Babalghith AO, Natto HA, et al., 2017; Pratt

M, Kerr M, Wong C., 2009; Chau JPC, Thompson DR, Twinn S, et al., 2008). However, two

studies found a link between (Vinck L, Isken L, Hooiveld M, et al., 2011).

Training and Knowledge

Taghrir et al. (2020) found no significant association between protective behaviors and

having received an education; Nour et al. (2017) found a non-significant increase in protective

practices following training, and Shigayeva et al. (2007) found that recent infection control

training was a significant predictor of compliance with recommended behaviors. Staff who

sought information on the epidemic and infection management were more likely to follow

recommended behaviors, according to Jeong et al. (2011). According to qualitative research,

staff thought their earlier training and education were ineffective in coping with the quickly

changing nature of developing infectious disease outbreaks (Moore DM, Gilbert M, Saunders S,

et al., 2005; Tan NC, Goh LG, Lee SS., 2006). Participants stated that insufficient training was a

barrier to compliance (Alsahafi AJ, Cheng AC., 2016). Infection control training with annual

refresher courses would benefit them (Corley A, Hammond NE, Fraser JF., 2010).

In two studies (Kim JS, Choi JS., 2016; Tahrir MH, Borazjani R, Shirley R., 2020),

sources of knowledge about the outbreak and protective behaviors were not associated with
protective behaviors, whereas knowledge from textbooks and attending Continuing Medical

Education activities were significantly associated with higher levels of defensive practice in one

study (Kim JS, Choi JS., 2016). (Al-Amri S, Bharti R, Alsaleem SA, et al., 2019). Although

receiving outbreak-specific training did not affect compliance, having more outbreak-related

knowledge did. This resulted in much higher compliance (Kim JS, Choi JS., 2016). Another

study (Alsahafi AJ, Cheng AC., 2016) indicated that most participants believed a lack of

understanding regarding the route of transmission related to poor compliance. Knowledge of

current recommendations was linked to compliance in three studies (Yap J, Lee VJ, Yau TY, et

al., 2010; Nour MO, Babalghith AO, Natto HA., 2015; Hu X, Zhang Z, Li N, et al., 2012); it was

linked to compliance in one hospital but not three others in another study (de Perio MA, Brueck

SE, Mueller CA, et al., 2012). It was not (Al-Amri S, Bharti R, Alsaleem SA, et al., 2012).

According to Hsu et al. (2011), a minority of participants stated that a lack of education was to

blame for their lack of compliance.

 Chapter 3
RESEARCH METHODOLOGY

This chapter will explain how the researcher will collect the data and information used in

the study. The research method, population and sampling technique, description of the

respondents, data gathering procedure, and research instrument are all included.

Research Design

The researcher uses the quantitative method, which, according to Babbie (2010),

emphasizes objective measurements and statistical, mathematical, or numerical analysis of data

obtained by-polls, questionnaires, and surveys and manipulating pre-existing statistical data

using computational techniques. In this way, the researcher will collect numerical data to achieve

the study’s objectives.

Furthermore, the descriptive research design is used to conduct this study. As cited by

McCombes (2019), descriptive research seeks to describe a group, condition, or phenomena

systematically and accurately. It answers questions about what, where, when, and how. Inline, it

aims to describe the level of compliance with healthcare workers at Quezon Medical Center.

Respondents of the Study

The inclusion criteria were working in a medical, surgical, obstetrics, operating theatre,

or laboratory department, having worked for at least one month at the institution, and being

willing to participate in the study. This group was chosen because they contact the bulk of the

patients treated at the facility, and their actions can either prevent or prolong illness transmission.

Research Sampling
 The 100 healthcare workers of Quezon Medical Center were chosen using simple random

sampling. Sloven's formula was used to calculate the sample size (Olatunde & Joshua, 2012).

with a level of certainty of 95%. The scope of the study, anonymity and confidentiality of their

responses, voluntary involvement, and freedom to refuse participation will all be explained to the

respondents.

Research Instrument

The researcher will construct and adapt the research instrument in a modified and

standardized checklist-type of questionnaire to answer the stated research problems.

Construction of Questionnaire. The researcher will create an English-language

questionnaire based on many surveys (Chia et al., 2005; Majeed, 2018; Schwartz et al., 2014;

Shimokura et al., 2006; WHO, 2020c). It is divided into three pieces. The first looks at the

participants' socio-demographic information and general COVID-19-related information like

having a friend or relative who has been infected, the status of training on proper PPE and hand

hygiene practices, and the frequency of dealing with suspected or confirmed COVID-19 cases.

The second and third sections assessed health care workers' compliance with infection prevention

and control measures (PPE and hand hygiene) and the barriers to proper use, respectively, using

a checklist adapted from the WHO risk assessment tool for health care workers in the context of

COVID-19 (WHO, 2020c).

Validation. Experts in the field will assure face and content validities.

Administration. The researchers used Google Forms to distribute the questionnaires in

administering questionnaires. Also, they contacted the respondents via social media platforms

and clarified the terms and conditions regarding their participation.

 Retrieval. After the respondents answered the questionnaires, the data gathered

underwent evaluation, tabulation, and interpretation.

Data Gathering Procedure

The researcher put a lot of time, effort, and teamwork into preparing the questionnaire for

their respondents and converted it to Google Forms. After that, the researcher wrote a letter

requesting that the questionnaires be approved.

The study was started by obtaining authorization from the Adviser, other panel members,

and the Hospital Director. Following the signature of the request letters, the survey's behavior

with the respondents began. Respondents were contacted and treated using statistical procedures

that were carefully chosen and applied.

The questionnaires were distributed using Google Forms, which the researchers used to

administer. They also spoke with the respondents through social media sites, clarifying the terms

and conditions. The data gathered was evaluated, tabulated, and interpreted after the respondents

completed the questionnaires.

Statistical Treatment of Data

The statistical treatment of data used in this study are the following:

1. Frequency. It's a statistical method for displaying the number of times the respondents

selected each answer. The symbol of frequency is denoted as f.

2. Percentage. It is defined as any proportion about a whole. In percentage, a whole always

has a value of a hundred percent. Rate is calculated by dividing a certain number of parts

into 100 parts. The symbol denotes th::

 f
Formula: %= × 100
n

Where:

% = Percentage

f = Frequency

n = Total number of Sampling Population

3. Weighted Mean. A weighted mean is a similar concept to an average. Rather than each

data point contributing evenly to the final standard, specific data points add more

"weight." Weighted means are prevalent, particularly when studying populations.

Σwx
Formula:
Σw