Systematic Review: Analysis of Relationship Organizational Climate

with Prevention of Infection in Hospital

Teorida Laia1 Bustami Syam 2 Diah Arruum 3

1
Master Student of Nursing Administration 2 Vice Rector IV for Information, Planning, and Development of Universitas
Sumatera Utara 3 Lecturer of Nursing Administration, Faculty of Nursing, Universitas Sumatera Utara
Prof. Maas Street Kampus USU, Medan, Indonesia
teorida.laia@gmail.com

Keywords: Organizational Climate, Prevention of Infection

Abstract: The high incidence of infection and the magnitude of the impact caused the prevention of infection as one of
the main focuses that must be done to reduce the incidence of infection in hospitals. Handling of infection is
assessed based on the organizational climate that is formed, which shapes the behavior of nurses in
prevention infection in hospitals. The purpose of this systematic review was to analyze research evidence as
a basis for new research on organizational climate relations with prevention of infection in hospitals. This
systematic review used journal search through CINAHL, Proquest, NCBI, JONA and Science Direct using
key organizational climate and prevention of infection in hospitals. The review method is done by selecting
journals according to keywords, published between 2013 and 2017. Journal search results obtained 7 article
both cross-sectional study and qualitative study. The results of this review indicate that the organizational
climate is one of the factors that can lead to the implementation of prevention of infection in the hospital.
Conclusion: Organizational understanding of the importance of preventing infection and understanding of
the climate impacts of organizations formed in hospitals is very important, so it is necessary to first know
how the organizational climate in a hospital can identify problems that underlie the level of infection
prevention so that a policy can be made to overcome problems in preventing infections in hospitals.

1. INTRODUCTION Weston (2013) states that 9% or equal to

Infections that occur in the hospital are
infections that occur in patients during hospital
treatment where when patients are admitted to the
hospital there is no infection and not during the
incubation period, including infections that occur in
the hospital that appear after the patient returns
home, as well as infection due to work hospital staff
or nurses related to health care processes in health
care facilities (Weston, 2013).
The prevalence of infections in hospitals in
developed countries varies from 3.5% to 12%. The
European Centers for Disease Control reports that
the average infection prevalence in Europe is 7.1%
and in the United States around 4.5% in 2002. World
Health Organization (2011) states that the incidence
of infection in high-income countries varies between
3 , 5-12% and in low-income countries between 5.7-
19.1%. Infection prevalence in Indonesia which
belongs to middle income countries is around 7.1%.
100,000 patients per year experience infections
originating from hospital services, and estimates that
hospital-acquired infections kill about 5,000 patients
annually in the UK. The high incidence of infection
in the hospital and the magnitude of the impact
caused by infections occurring in hospitals make
prevention of infection as one of the main focuses
that must be done well to reduce the incidence of
infection in hospitals..
Literature review is a written summary of
research involving identification, selection, critical
analysis and written descriptions of information on
the topic (Polit, 2012). In this case, the topic chosen
is the relationship of organizational climate with
prevention of infection. Writing this review can
conclude the adequacy of a study, the gap that exists
in a study becomes the basis for new research, and
what contribution you want to make (Polit, 2012).
Various research results with methodologies
have been carried out to analyze the actions taken in
2 Chapter Error! No text of specified style in document.

the prevention of hospital infections and analysis of

factors that can influence the level of prevention of
infection in hospitals. so the authors aim to find and
analyze relevant studies to make a review of the
relationship of organizational climate with Search by Title Match Exit: 19
prevention of infection in hospitals. Obtained: 47

2. METHOD
Overall Text Exit: 22
The review method focused on organizational Availability Obtained: 25
climate relations with infection prevention by
selecting journals that match the research keywords
published from 2013 to 2017. Various databases are Suitability of Content Exit: 18
used in journal searches, namely CINAHL, with Review Objectives Obtained: 7
Proquest, NCBI, JONA (Journal of Nursing
Management) and Science Direct. This search found
7 related journals, consisting of original research, Total Journals: 7
prospective, and retrospective review studies. The
keywords used in the search for journals that will be Fig 1. Flow of articles selection process
studied are organizational climate and hospital
acquired infection prevention. Based on searches
using keywords, 66 article were found, then issued
4. DISCUSSION
by looking at 47 journal journals. The next stage is
by looking at the availability of the entire journal Journal review results obtained showed that
text and obtaining 25 journals and then looking at many factors cause HAIs (infections that occur in
the suitability of the journal contents with the review hospitals), including the use and maintenance of
objectives obtained by the end of the 10 journals medical equipment, such as catheters and
(Figure 1). ventilators; complications after a surgical procedure;
transmission between patients and health care
workers; contaminated air conditioning system;
3. RESULT disproportionate ratio of nurses to patients; and
physical layout of health care facilities (Almeida,
The results of a review of 7 research journals 2015). Another factor that can influence the
found that the sample size used was 250 to 972 incidence of infection is the organizational climate.
respondents. Some research designs used in journal Nelson (2013) states that organizational climate is
reviews are cross-sectional and quanitative able to influence the incidence of infection in
(interview). The place of research was carried out by hospitals.
the majority carried out in the hospital. The Organizational climate is an individual's
measuring instrument used in the study was a perceptions and attitudes about the organization,
questionnaire, while in the study with qualitative whether the organization is a good or bad place to
methods using interview guides. Results of the work, friendly or unfriendly where these perceptions
review are generally found that there are several will affect the behavior and level of individual
factors that can have an impact on the incidence of motivation (Haseeb, Ali, Shaharyar & Butt, 2016).
infection in the hospital, namely: compliance with Organizational climate can influence the behavior of
clinical practice policies and guidelines, monitoring nurses (adherence to nursing actions based on
and indicators of performance, team composition, evidence-based guidelines) that have an impact on
leadership and leaders, involving patients in the the outcome or incidence of infection. A conducive
Database
prevention of Search: Title Found:
infection, communication, social organizational climate will create a condition that
media Keyword Search In addition, it was
and technology. 66 journals
found that encourages and motivates individuals to work better.
there was a significant relationship between the
climate of organization and a decrease in infection in
SearchResults
hospitals. by Title can
Match Exit: 19
be seen in the Appendix.
Obtained: 47
5. CONCLUSION
Database Search: Title Found:
Keyword Search 66 journals
Overall Text Availability Exit: 22
Obtained: 25

Suitability of Content Exit: 18

with Review Objectives Obtained: 7

Total Journals: 7
Error! No text of specified style in document.. SYSTEMATIC REVIEW: ANALYSIS OF 3
RELATIONSHIP ORGANIZATIONAL CLIMATE WITH PREVENTION

This journal review provides evidence about the Holmes, A. H., & Sanchez, E. (2015). Impact of
relationship of organizational climate with Organizations on Healthcare-Associated
prevention of infection in hospitals. This finding can Infections. Journal of Hospital Infection.
Doi:10.1016/j.jhin.2015.01.012
be the basis for further research related to the
Larson, E. L., Early, E., Cloonan, P., Sugrue, S., &
analysis of organizational climate relations with Parides, M. (2014). An Organizational Climate
prevention of infection in hospitals to improve Intervention Associated with Increased
organizational behavior and involvement in the Handwashing and Decreased Nosocomial
prevention of infection and for policy making to Infections. Behavioral Medicine, 26(1), 14-22.
prevent and overcome the prevention of infection in DOI:10.1080/08964280009595749
hospitals. Maziarz, M. P., Nembhard, IM., Schnall, R., Nelson, S., &
Stone, PW. (2016). Psychometric Evaluation
of an Instrument for Measuring Organizational
Climate for Quality: Evidence From a National
ACKNOWLEDGEMENTS Sample of Infection Preventionists. American
Journal of Medical Quality.
The author would like to thank the Ministry of DOI:10.1177/1062860615587322
Research and Technology Higher Education of the Polit, D. F., & Beck, C.T. (2012). Nursing research
Republic of Indonesia, Prof. Dr. Runtung, SH, Generating and Assessing Evidance for
Nursing Practice, 9th ed. William & Wilkins:
M.Hum as the Rector of Universitas Sumatera Utara, Lippincott.
Drs. Mahyuddin K. M. Nasution, M.I.T., Ph.D. as Schneider, B., & Barbera, K. M. (2014). The Oxford
Vice Rector III of Universitas Sumatera Utara, Handbook of Organizational Climate and
Setiawan, S.Kp, MNS, PhD as Dean of Nursing Culture. United States of America: Oxford
Faculty Universitas Sumatera Utara, Dr. Siti Saidah University Press. Retrieved from www.
Nasution, S.Kp, M.Kep, Sp. Mat as Vice Dean III of bookfi.org
Nursing Faculty Universitas Sumatera Utara, Prof. Weston, D. (2013). Fundamentals of Infection Prevention
Dr. Ir. Bustami Syam, MSME and Diah Arruum, and Control: Theory and Practice. 2th edition.
United states of America: Wiley Blackwell.
S.Kep, Ns, M.Kep as mentor of my thesis and
Retrieved from www. bookfi.org
lecture of Nursing Faculty Universitas Sumatera World Health Organization. (2011). Report on the Burden
Utara. of Endemic Health Care-Associated Infection
Worldwide. Departement of Communicable
Disease, Surveilance and Response. Retrieved
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http://apps.who.int/iris/bitstream/10665/80135/
1/9789241501507eng.pdf.
Almeida, Sherri-Lynne. (2015). Health Care-Associated
Infections (HAIs). Journal of Emergency
Nursing, 41, 100-101.
DOI:10.1016/j.jen.2015.01.006
Ashkanasy, N. M., Wilderom, C. PM., & Peterson, M. F.
(2011). The Handbook of Organizational
Culture and Climate. 2th edition. United States
of America. SAGE Publications, Inc.
Retrieved from www. bookfi.org
Gilmartin, H. M., & Sousa, K. H. (2016). Capturing the
Central Line Bundle Infection Prevention
Interventions Comparison of Reflective and
Composite Modeling Methods. Nursing
Research, September/October 2016, 65(5),
397–407. DOI:
10.1097/NNR.0000000000000168
Gilmartin, H. M., Maziarz, M., Thompson, S., & Sousa,
K. H. (2015). Confirmation of the Validity of
the Relational Coordination Survey as a
Measure of the Work Environment in a
National Sample of Infection Preventionists.
Journal of Nursing Measurement, 23(3).
Doi:10.1891/1061-3749.23.3.379
APPENDIX
Table 1: Summary of a Systematic Review

Autor/Year Study Design Sampel Size Instrument Result Country

Gilmartin, H. M., & Sousa, This research was 614 respondents This study uses the The results showed that Colorado
K. H. conducted by analyzing questionnaire compliance with the
2016 secondary data using Leading a Culture of implementation of a
latent variables with Quality Instrument central line bundle
modeling methods in (18 items) and the intervention was related to
the framework of Relational the organizational context,
structural equation Coordination Survey the relationship between
modeling (SEM) (28 items) to measure organizational contexts
the organizational and the incidence of blood
context. Results from flow infection (CLABSI)
CLABSI are was not significant.
measured using the
results of reporting
CLABSI infection
events
Gilmartin, H. M., Maziarz, Kuantitative The number of samples his study uses the The results showed that Colorado
M., Thompson, S., & Sousa, in the study was 614 RCS (Relational the Cronbach Alpha for
K. H respondents who were Coordination Survey) 28-item RCS was 0.91
2015 divided into two questionnaire which means that the
groups. 307 consisting of 28 results of the measuring
exploratory factor items. instrument were declared
analysis (EFA) and 307 valid with significant
confirmatory factor Bartlett's test of sphericity,
analysis (CFA) x2 (378) 5 4,896.30, p,
<.00,
Gittell, J. H Design cross-sectional The sample in this This study uses two The results showed a Brandeis
2011 study were nurses and questionnaires, significant impact between
residents in 15 nursing namely a special relational coordination and
homes questionnaire for quality of life, and
residents of nursing significant relational
homes, consisting of coordination with job
38 items that ask satisfaction
about the quality of
life of nursing home
residents. The second
questionnaire was
given to nurses,
consisting of 82 items
that asked about
relational
coordination, job
satisfaction and
working conditions.

Holmes, A. H., & Sanchez, Qualitative descriptive - Interview The results of the study London,
E found that the factors that
2015 can give dapak the
incidence of infection in
the hospital are:
 Compliance with
clinical practice policies
and guidelines
 Monitoring and
performance indicators
 Team composition
 Leadership and leaders
 Leadership and leaders
 Communication, social
media and technology
Maziarz, M. P., Nembhard,
IM., Schnall, R., Nelson, S.,
& Stone, PW
2016
Larson, E. L., Early, E.,
Cloonan, P., Sugrue, S.,
&Parides, M.
2014
Almeida, Sherri-Lynne.
2015
This research was 972 respondents This study uses a The results showed that Philadelphia
conducted by focusing modified Culture of LCQ-IP showed excellent
on 3 ICQ-IP instrument Quality for Infection internal consistency, with
assessments, namely Prevention (LCQ-IP) Cronbach α of 0.926.
structural validity, questionnaire Criteria validity is
internal consistency consisting of 75 items supported by the overall
and criteria validity LCQ-IP score, increasing
with the number of
available evidence-based
prevention policies (P
= .047)
The design of this study The sample of this This study was The results showed that Washington
was quasi-experimental study were two carried out for 8 there was a significant
by giving staff hospitals with 250 months, with 860. influence between the
intervention namely the beds. 567 soap was climate of organization
provision of hand provided and later and a decrease in infection
washing soap to find recorded the in the hospital. The
out infections frequency of incidence of methicillin-
associated with handwashing staff resistant Staphylococcus
methicillin-resistant aureus (MRSA) was not
Staphylococcus aureus significant in two hospitals
(MRSA) and but the level of
vancomycin-resistant vancomycin-resistant
enterococci (VRE) enterococci (VRE) was
significant.
Quantitative descriptive 340 respondents - The results showed that Orlando
the right education and
training provided to nurses
or health workers were
able to improve adherence
in carrying out best
practices to prevent HAI