A Differential Item Functioning (DIF) Study of the Infection Control Standard Isolation Precaution Instrument Across Gender and Major Among Healthcare Workers

Background: Measuring healthcare workers’ (HCWs) knowledge, attitudes, and practices (KAPs) regarding isolation precaution is essential for infection control which needs a valid and reliable instrument. Objectives: This study aimed to assess differential item functioning (DIF) across gender and major for the knowledge and practice items of the questionnaire, previously designed in Shiraz, Iran. Methods: This cross-sectional survey was conducted on 1070 participants (males/females: 306/764; medical students/nurses: 466/624). The study instrument had three subscales with nine questions for each KAP subscale. The Mantel-Haenszel (MH) statistic was used. The DIF and differential test functioning (DTF) analyses were also performed in this study. Results: There were very similar DIF outcomes for the knowledge and practice subscales, with one or two items indicating moderate DIF but comparable total scores across genders. Across majors, several items showed large DIF for both subscales. It was found that large DTF affects major for both subscales. Conclusions: Our findings indicated large DIF and DTF levels of the questionnaire among medical students and nursing groups. More attention should be paid when developing the items. This study shows the importance of paying attention to valid evidence for instruments developed within the field of healthcare.

User-centred participatory design of visual cues for isolation precautions

Background Isolation precautions are intended to prevent transmission of infectious agents, yet healthcare provider (HCP) adherence remains suboptimal. This may be due to ambiguity regarding the required precautions or to cognitive overload of HCPs. In response to the challenge of changing HCP behaviour, increasing attention should be paid to the role of engineering controls and facility design that incorporate human factors elements. In the current study, we aimed to develop an isolation precaution signage system that provides visual cues, serves as a cognitive aid at the point of care, and removes ambiguity regarding which precautions are necessary (e.g. masks, gowns, gloves, single rooms) when caring for isolated patients. Methods We employed a user-centred, participatory design approach in which HCPs were actively involved in generating an isolation precaution signage system based on human factors design principles. HCPs were purposefully sampled for each design phase to include a representative sample of potential system users. We conducted front-end analysis through interviews and observations to identify challenges related to the existing signage and to establish design requirements for new signage. This was followed by the creation of user personas, design thinking workshops, and prototyping, which then underwent iterative cycles of evaluation. Graphical symbols were developed and tested for comprehensibility. Results Front-end analysis revealed several barriers to use of the current signage system such as unclear target audience, low signal-to-noise ratio, and ambiguity regarding the applicable precautions. A comprehensive list of design requirements was generated. The project ultimately resulted in a collection of validated, comprehensible symbols and signs for contact, droplet, and airborne isolation, as well as the identification of several systems-level solutions for work re-organisation to improve compliance with isolation precautions. Conclusions The introduction of visual cues in the form of signage offers a promising opportunity to make guidelines available directly at the frontline. Anecdotal evidence based on observations and interviews with HCP have shown that the current solution is superior to previous isolation signage. User-centred participatory design was a useful approach that holds potential for further improving design in healthcare settings.

Survey of isolation room equipment and resources in an academic hospital

Purpose The purpose of this paper, a point prevalence study, is to quantify the incidence of isolation and identify the type of communicable diseases in isolation. The paper evaluates isolation precaution communication, availability of personal protective equipment (PPE) as well as other equipment necessary for maintaining isolation precautions. Design/methodology/approach A standardised audit tool was developed in accordance with the National Standards for the Prevention and Control of Healthcare Associated Infections (May 2009). Data were collected from 14 March 2017 to 16 March 2017, through observation of occupied isolation rooms in an academic hospital in Dublin, Ireland. The data were subsequently used for additional analysis and discussion. Findings In total, 14 per cent (125/869) of the total inpatient population was isolated at the time of the study. The most common isolation precaution was contact precautions (96.0 per cent). In all, 88 per cent of known contact precautions were due to multi-drug resistant organisms. Furthermore, 96 per cent of patients requiring isolation were isolated, 92.0 per cent of rooms had signage, 90.8 per cent had appropriate signs and 93.0 per cent of rooms had PPE available. Finally, 31 per cent of rooms had patient-dedicated and single-use equipment and 2.4 per cent had alcohol wipes available. Practical implications The audit tool can be used to identify key areas of noncompliance associated with isolation and inform continuous improvement and education. Originality/value Currently, the rate of isolation is unknown in Ireland and standard guidelines are not established for the evaluation of isolation rooms. This audit tool can be used as an assessment for isolation room compliance.

Assessment of knowledge, attitude and practice of clinical students’ of Yazd University of Medical Sciences toward Isolation Precaution

Background: To determine the level of knowledge, attitude and practice among clinical students’ of Yazd University of Medical Sciences toward Isolation Precaution -1394.Methods and material: A descriptive –analytical cross-sectional study was developed and distributed to 300 clinical students who studied in Yazd University of Medical Sciences. The self-administered questionnaire was composed of demographic data and three parts, knowledge, attitude, and practice, toward Isolation precaution (standard, droplet, airborne and contact precautions). Results: The survey was completed by 325 (response rate: 92/3%) of potential respondents. Mean scores of knowledge, attitude, and practice towards standard, droplets, airborne and contact isolation precautions were poor. In addition, a linear correlation was found between three items of the survey including knowledge-attitude, knowledge-practice and attitude- practice in all subgroups of isolation precautions.Conclusion: clinical students’ of Yazd University of Medical Sciences seemed to have low levels of knowledge, attitude and practice towards infection control. There are numerous educational deficits in our clinical students’ of Yazd University of Medical Sciences in relation to infection control that must urgently be addressed