Evaluation of Compliance with Standard Precautions and Burnout Levels of Nurses working in a University Hospital Standard Precautions and Burnout Levels of Nurses

 

Mine Tepetaş¹, Alaettin Unsal², Ali Kılınç², Feyza Nehir Oznur Muz², Didem Arslantaş², Halime Kuçuk³

¹MD, RA, Public Health, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey.

²MD, Prof, Public Health, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey.

³Ph.D, OHSS, Occupational Health and Safety, Eskişehir Osmangazi University, Eskişehir, Turkey.

 

ABSTRACT:

 

 

INTRODUCTION:

Standard precautions are applied by the health worker to all patients during service delivery, regardless of the current diagnosis of the patient being served and whether the patient has an infection. Standard precautions covering all patients, together with extended specific precautions covering some patients, constitute isolation precautions^1,2.

 

Standard precautions aim to prevent the transmission of infectious agents from infected or colonized patients to other people and healthcare personnel³. Standard precautions include hand hygiene, use of personnel protective equipment, hand hygiene when using gloves, use of piercing and cutting tools, prevention of environmental contamination and personnel health⁴. The Center for Disease Control (CDC) reports that approximately 30% of healthcare-associated infections are reduced when healthcare providers comply with standard precautions and that the most important standard precaution is to wear gloves during contact with anybody fluid other than sweat and to ensure hand hygiene by removing gloves after the procedure².

 

The healthcare-associated infection rate in Turkey varies between 1% and 16.5%. Healthcare-associated infections lead to prolonged hospitalization, loss of workforce, increased mortality, morbidity and treatment costs^5,6. It is known that compliance with standard precautions and isolation measures is important in the prevention of healthcare-associated infections. Standard precautions should be applied in every healthcare setting, assuming that patients' blood, body fluids, secretions and feces are potentially infectious⁷.

 

The main way to control healthcare-associated infections is through standardized measures covering all individuals receiving and providing healthcare services⁸. Factors such as age, gender, education level, professional experience, inadequate equipment, negative effects of protective materials on nurses, work intensity, insufficient staff, emergencies, negative role modeling of the nurse in charge, low level of compliance of physicians with standard precautions affect the level of compliance of nurses with standard precautions^8,9. Healthcare nurses have an important role in the occurrence and prevention of healthcare-associated infections¹⁰. Increased levels of burnout in healthcare professionals increase the incidence of healthcare-associated infections⁶.

 

Burnout means a state of being powerless and unable to make an effort. It was first used in the literature by Freudenberger in 1974 and has been the subject of many studies. Maslach and Jackson defined burnout syndrome as a syndrome of emotional exhaustion and cynicism frequently seen in professional groups with intensive communication with people¹¹. There are various symptoms of burnout, such as chronic fatigue, weakness, sleep disorders, depressive mood and dissatisfaction¹². Although it is not known how often burnout is seen in society, it is known that it is more common in professional groups such as nursing, which are in intense communication with people¹¹. 

 

Compliance with standard precautions and burnout levels of nurses, who constitute a large part of healthcare workers and undertake various tasks in the care and treatment of patients, affect the spread of healthcare-associated infections, and employee and patient health. This study aimed to determine the level of compliance with standard precautions, examine some variables thought to be related and evaluate the burnout levels of nurses working in Eskişehir Osmangazi University Faculty of Medicine Hospital.

 

MATERIAL AND METHOD:

This cross-sectional study was conducted on nurses working at EskişehirOsmangazi University Hospital between January 2022, and May 2022. In order to conduct the study, the necessary permissions were obtained from Eskişehir Osmangazi University Non-interventional Clinical Research Ethics Committee dated 18.01.2022 and numbered 48 and from Eskişehir Osmangazi University Health Practice and Research Hospital Chief Physician's Office. 

 

In order to collect data in the study, a questionnaire form consisting of 3 sections was prepared by making use of the literature^7,11,13,14. The first part of the questionnaire form includes some sociodemographic characteristics of the nurses (age, gender, marital status, educational status, total working time in the profession, etc.) and some variables thought to be related (history of mental illness, presence of physician-diagnosed chronic diseases, etc.). The second part includes the questions of the Compliance with Standard Precautions Scale (CSPS) and the third part includes the questions of the Maslach Burnout Scale (MBS).

 

In our study, without selecting a sample, it was aimed to reach all 500 nurses working in the hospital. The study group consisted of 392(78.4%) nurses who agreed to participate. In order to collect data, we visited the departments at predetermined times, explained the subject and purpose of the study to the nurses, and obtained the verbal consent of those who agreed to participate in the study. Then, the pre-prepared questionnaire forms were filled in by the nurses themselves under the observation of the researchers. This process took approximately 10-15 minutes. 

 

CSPS was used to determine nurses' compliance with standard precautions. Lam developed this scale in 2011 based on international preventive measures of the CDC and World Health Organization¹⁴. The Turkish validity and reliability study was conducted by Samur et al. in 2020. The scale consists of 20 questions in 4-point Likert type, and the answers are "never, rarely, sometimes and always". Questions 2, 4, 6 and 15 are reverse coded. For positive statements, 1 point is given for the answer 'always' and 0 points for other answers; for negative statements, 1 point is given for the answer 'never' and 0 points for other answers. Scores that can be obtained from the scale range from 0 to 20; as the scores increase, the level of compliance with standard precautions also increases¹⁵.

 

In our study, MBS was used to determine the burnout levels of nurses. Maslach and Jackson developed MBS in 1981¹¹. Ergin conducted the scale's Turkish validity and reliability study in 1992⁶. The scale consists of 22 questions in five-point Likert type and has 3 sub-domains: emotional exhaustion (9 questions-1, 2, 3, 6, 8, 13, 14, 16, 20. questions-), depersonalization (5 questions-5, 10, 11, 15, 22. questions-) and personal accomplishment (8 questions- 4, 7, 9, 12, 17, 18, 19, 21. questions-).  The answers to the questions were scored as "0; never" and "4; always". As the scores obtained from emotional exhaustion and depersonalization sub-domains increase, burnout level increases, and as the scores obtained from personal accomplishment sub-domain increase, burnout level decreases.

 

The data obtained were evaluated using SPSS (v15) Statistical Package Program. The Shapiro-Wilk test was used to evaluate the conformity of the data to normal distribution. Mann Whitney U test, Kruskal-Wallis test and Spearman Correlation analysis were used for analysis. A statistical significance value of p≤0.05 was accepted.

 

RESULTS:

Of the study group, 327(83.4%) were female, and 65 (16.6%) were male. Their ages ranged between 22 and 58 years, with a mean of 31.49±7.5 years. The scores of the nurses on the CSPS ranged from 0 to 19, with a mean of 13.7±3.3 (median: 14) points. The distribution of the scores obtained from the CSPS by the study group according to some sociodemographic characteristics is given in Table 1.

 

In the study group, 148(37.7%) had worked in the profession for more than 10 years and 136(35.1%) had worked in the same unit for two years or less. Of the nurses, 157(40.1%) reported that they had not received any training on protection methods against infectious diseases. The distribution of the scores obtained by the study group from the CSPS according to some variables thought to be related to compliance with standard precautions is given in Table 2.

 

Table 1: Distribution of the scores obtained from the CSPS according to some sociodemographic characteristics in the study group

 

Table 2: Distribution of the scores obtained from the CSPS by the study group according to some variables thought to be related

 

Graph 1. Distribution of the scores obtained by the study group from the CSPS and the scores obtained from the sub-domains of the MBS

 

The MBS' Emotional Burnout Subdomain scores of the study group ranged between 3-36 with a mean of 22.7 ± 7.6 (median: 24) points, Depersonalization Subdomain scores ranged between 0-20 with a mean of 7.3 ± 4.4 (median: 7) points and Personal Accomplishment Subdomain scores ranged between 8-32 with a mean of 23.1 ± 4.9 (median: 23) points. There was a weak negative correlation between the scores obtained by the nurses from the CSPS and the scores obtained from the Emotional Burnout Subdomain of the MBS (p=0.041, r=-0.103), a weak negative correlation between the scores obtained from the Depersonalization Subdomain (p=0.001, r=-0.163) and a weak positive correlation between the scores obtained from the Personal Achievement Subdomain (p=0.001, r=0.250). The distribution of the scores obtained by the nurses from the CSPS and the scores obtained from the subdomains of the MBS is given in Graph 1. 

 

DISCUSSION:

In order to reduce the risk of transmission of agents that can be transmitted by blood and body fluids in hospitals, a guideline called standard precautions was developed by the CDC in 1996. Compliance with standard precautions protects both patients and healthcare workers from infection and is still valid today. In our study, it was found that nurses' level of compliance with standard precautions was moderate. A similar result was reported in a study conducted on Saudi Arabian nurses ¹⁷. A study conducted in China reported that the level of compliance of healthcare workers with standard precautions was low ¹⁸. The different results reported in various studies may be that the studies were conducted in societies with different sociocultural characteristics.

 

The level of compliance with standard precautions is likely to be higher with the professional experience gained with age and the ability to cope with potentially dangerous work-related situations. In this study, no difference was found between age groups regarding the level of compliance with standard precautions. Osborne et al. reported similar results in their study¹⁹. A study by Pokorna et al. reported that the level of compliance with standard precautions increased with age²⁰. The different measurement tools used in the studies may be one of the reasons for the different results reported.  

 

Today, especially in patriarchal societies, it is obvious that women are more likely than men to undertake daily housework and organization tasks. Therefore, female health workers can be expected to be more meticulous in their workplaces and to comply with standard precautions at a higher level. It was found that women in the study group had higher levels of compliance with standard precautions than men. Several studies also reported that the level of compliance of women with standard precautions is higher than that of men ^21–23.

 

As in every profession, professional skills and abilities increase with increasing experience among nurses. Nurses are expected to be more successful in complying with standard precautions due to their experience. Our study found that the level of compliance with standard precautions increased as the working time of nurses increased. Some studies have reported that nurses with a longer working time in the profession have higher levels of compliance with standard precautions ^24–28.

 

It is expected that the level of knowledge and compliance of all healthcare workers, especially nurses, with standard precautions will increase with trainings on infectious disease prevention methods in hospitals. This study found that the level of compliance with standard precautions was higher in those who reported receiving training on methods of protection against infectious diseases. Similar results were reported in some studies conducted in various countries ^7,29,30.

 

Burnout in healthcare workers is usually caused by chronic work stress, heavy workload, role ambiguity, and team conflict ³¹. The feeling of burnout, which is examined in subdimensions such as emotional exhaustion, depersonalization and decrease in personal achievement, manifests itself in individuals with some emotional, behavioral and physical symptoms³². Burnout is becoming increasingly common among nurses, a professional group with high level of communication with patients³³. Nurses may be less likely to comply with standard precautions due to reasons such as not having the energy to comply with standard precautions due to emotional exhaustion, having problems in showing empathy and compassion during care as a result of depersonalization, and consequently negatively affecting both their health and the health of patients and perceiving themselves as unsuccessful in their work. In our study, it was found that nurses with high levels of emotional burnout and depersonalization and low levels of personal accomplishment had lower compliance with standard precautions. Some studies have also reported that compliance with standard precautions decreases as the burnout level increases ^34–37.

 

In our study, it can be said that nurses' compliance with standard precautions was moderate. It was found that women, those with a total working period of 5 years or more in the profession and those who received any training on methods of protection against infectious diseases had higher scores on the CSPS. There was a negative correlation between nurses' compliance with standard precautions and their levels of emotional burnout and depersonalization, and a positive correlation with their levels of personal accomplishment. Trainings to increase nurses' compliance with standard precautions may be useful. As a result of measures such as providing social support to nurses, improving working conditions, and teaching methods of coping with problems, it is expected that burnout levels will decrease and compliance with standard measures will increase. It is recommended that more comprehensive studies should be planned to reveal the relationship between compliance with standard measures and burnout levels.

 

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Received on 26.09.2022              Modified on 21.12.2022

Accepted on 13.03.2023        ©A&V Publications All right reserved