@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2017;4(3):12-18

Background
Standard precautions are a fundamental strategy for preventing occupational exposure in pre-hospital emergency staff.
Previous Studies
By increasing the incidence of diseases transmitted through the blood and body fluids in health care workers and in order to reduce the burden of these infections, the WHO and the Infectious Disease Control Center have developed regulations called "Standard Precautions" [15-17]. Many international studies have reported the poor standard precautions in health care workers, especially nurses and emergency medical technicians [12, 15, 21, 22]. … [23, 24].
Aim(s)
The aim of this study was to determine the predictive factors for controlling infection based on the health belief model.
Research type
This research is a descriptive-analytic study.
Research society, place and time
This research was done on 84 pre-hospital emergency staff members in Hamadan, Iran, 2017.
Sampling method and number
The samples were selected through the census sampling method. The inclusion criterion was working in the pre-hospital emergency department of the operation sector and the exclusion criteria included unwillingness of samples to participate in the study.
Used devices&materials
Data collection tool was a researcher-made questionnaire including demographic information, awareness, health belief model constructs, and function. Ganbari et al. [25] questionnaire was used to design questions of the knowledge section. The validity of other questions was also assessed through an interview by 12 professors and faculty members of the Hamedan University of Medical Sciences. Moreover, reliability of the questionnaire was measured by the Cronbach's alpha test using 15 medical emergency technicians. Health belief model constructs including perceived sensitivity (7 questions) (such as "It is important for me to wash my hands before contact with a patient") were scored on a 5-point Likert scale from 0 (never) to 4 (always). Also, perceived severity (7 questions) (such as "Is the risk of occupational exposure to me is more than other health care workers?"), perceived benefits (6 questions) (such as "I take steps for my well-being by preventing infections caused by exposure to occupational exposure") and perceived self-efficacy (10 questions) (such as" I can repel needles and sharp objects hygienically") were scored on a 5-point Likert scale from totally disagreed (0) to totally agree (4). Perceived barriers were also measured with 8 questions (such as " washing hands can be replaced by wearing gloves in case of lack of time ") on a 5-point Likert scale, from 0 (totally agree) to 4 (totally disagree). The cues to action construct also measured by 7 questions (such as "How much standard precautions training is important") on a 5-point Likert scale from 0 (never) to 4 (high). Participants were evaluated using 12 questions, including hand sanitation, correct disposal of sharp and contaminated objects, using personal protective objects, standard precautions, etc. The positive responses scored 1 and negative answers were not scored. Finally, the knowledge, function and constructs scores were considered 100. Score 50 represented poor, 50 to 75 indicated moderate and scores higher than 75 indicated the desired state of the considered construct.
Findings by Text
The mean age of the subjects was 31.64±7.36 years (20 to 57 years) and the average number of shifts per month was 47.26±33.92 (3 to 120). Also, most of the staff (67.9%) had a working experience of less than 10 years; 44% had undergraduate degree and most of medical staff were working in medical emergencies (70.2%).50% of the subjects were official employees, 31% were contract employees and 19% were designers and messengers. 77.4% were working at the urban centers, 19% at the roadside centers, and 6.6% at the air bases; more than half (64.3%) were married; 35.7% had a history of needlestick through their services, of whom only 34.5% were informed about their antibody titration status; 85.7% had a history of hepatitis B vaccination; 41.7% of them reported more than 10 times exposure to blood and secretions during one month. In this study, the mean score of knowledge about the standard precautions to control infection and nosocomial infection was poor and obtained 46.85±15.13. Awareness of these employees regarding standard precautions and nosocomial infections showed that the highest awareness score (77.4%) obtained for washing hands can not be replaced by wearing gloves and 67.9% of the subjects correctly answered the standard precautions. The lowest level of awareness (7.1%) was related to long nails in the prevention of infections followed by serological test after hepatitis vaccination (16.7%). Moreover, there was a significant relationship between knowledge and educational degree (P=0.041) and educational level (P=0.043), but there was no significant relationship between knowledge and other demographic variables (P>0.05). Also, perceived benefits had the highest score (81.94±10.51) and the perceived barriers had the lowest score (60.41±20.09). It is worth noting that the average scores of the perceived sensitivity and benefits structures showed a desirable level. Other health belief model constructs showed a moderate level (Table 1). The Pearson correlation test results showed that there was a direct and significant correlation between knowledge and perceived benefits (P<0.05; Table 2). Also, there was a direct correlation between the performance of pre-hospital emergency staff in standard precautions with perceived sensitivity constructs (P<0.001), perceived benefits, cues to action and perceived self-efficacy in the health belief model constructs (P<0.05). It should be noted that the results of linear regression analysis were not significant in predicting standard precautions in the subjects (P<0.05; Table 3).
Main comparison to the similar studies
The results showed that knowledge about the standard precautions to control infection was poor in pre-hospital emergency staff and only 3.6% had a good knowledge about the issue, which is consistent with the results of Ganbari et al. [23] and Yang Lue et al. [24] who reported poor knowledge in infection prevention behaviors in nurses. Harris et al. [12], Parmeggiani et al. [25], Bucher et al. [26], and Bledsoe et al. [21] reported poor health care workers’ compliance with infection control principles. In the present study, elevated perceived sensitivity, perceived benefits, cues to action, and self-efficacy of health belief model constructs resulted in improved performance (observing standard precautions to control infection), which was consistent with the results of Rahimi-Ghilchalan et al. [27]. .. [28, 29].
Suggestions

Limitations
One of the limitations of the present study was that observation and objective control of observance of standard precautions were not possible.
Conclusions
Observance of the standard precautions for controlling infection among pre-hospital emergency staff can be improved by reinforcing the constructs of perceived benefits, perceived susceptibility, perceived self-efficacy, and cues to action.
Acknowledgments
The authors would like to thank the officials and the participants who have collaborated in this research.
Conflict of interest

Ethical Permissions
The present study was approved by the Ethics Committee of Hamadan University of Medical Sciences (Ethics code: IR.UMSHA.REC.1395.488) and was done by obtaining the informed consent.
Funding Sources
This research was supported by the research deputy of Hamedan University of Medical Sciences.

TABLES and CHARTS

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