• Funding shortfalls can create barriers in implementing infection control programs and purchasing up to date equipment and technology . This result is echoed in Lee et al . ( 2018 ) who noted a lack of technological infrastructure for both managing and monitoring infections . Sax et al . ( 2005 ) noted a lack of means as a very important factor contributing to non-compliance .
• Inadequate or inappropriate policies , protocols or standards for infection prevention and control , was another significant factor which influenced why nurses don ’ t comply with infection control standards .
Regarding workplace environment :
• Factors related to the immediate environment are important considerations when understanding why nurses miss infection prevention and control activities . These factors include inappropriate or inconvenient nursing unit layout ; lack of facilities , access to , or availability of equipment , supply of ineffective or ill-fitting PPE , and type of department or hospital in which a nurse works .
• University-affiliated hospitals and health systems as well as private hospitals had higher rates of compliance with infection prevention and control precautions . Regarding type of care department :
• The setting and context in which nursing care is conducted can influence compliance with infection control guidelines ; for example , nurses working in intensive care units had stronger infection prevention and control compliance rates , studies show . As McCauley , et al . ( 2021 ) explain , “ Care context , where time is scarce or workload high , can be very influential around rates of compliance , with nurses prioritizing other care above infection control precautions . In units such as ICUs , cardiology , or burns units , nurses maintained that rationing infection prevention and control care was necessary in life-or-death situations , and they perceived that taking time to use standard precautions , may in fact have placed patients at higher risk in emergency situations . Donati , et al . ( 2019 ) reported nurses ’ conflict in choosing the provision of emergency care , rather than self -protection through use of PPE . Sometimes this conflict resulted in use of partial equipment ( gloves only , perhaps , where full or extra personal protective equipment is recommended ).”
• Exposure to certain body fluids such as blood or working with a certain patient demographic can influence practice . Researchers have found that an influential hierarchy exists by type of patient and perceived risk of infection nurses feel they pose . For example , Efstathiou , et al . ( 2011 ) and Ferguson , et al . ( 2004 ) viewed the provision of nursing care to children to be low-risk , and therefore , the use of preventive measures was considered to be less necessary . Conversely , adult age groups were considered high-risk , and therefore promoted nurse compliance with standard precautions . Regarding leadership in healthcare :
• Influences on missed nursing care include lack of effective management , managerial support and communication from management . Henderson , et al . ( 2020 ) suggest that managerial engagement with infection control guidelines is reflected in the overall ward culture . Nurses in this study suggested that effective leadership can improve ward culture and practices around infection prevention and that a lack of managerial support hindered good infection control practice . Lee , et al . ( 2018 ) call for motivational leadership , reporting that nurses did not feel inspired , motivated or energized by their managers to prevent HAIs . Poor management in areas such as daily workflow was also found to have a negative influence on compliance with infection control activities , according to Lee , et al . ( 2018 ). Nurses believed that the implementation of a code of hygiene issued by their managers provided greater authority in improving infection prevention and control practice , as they felt enabled to report colleagues who were non-compliant .
• Peer pressure matters . Some studies revealed that the relationship between nurses and medical staff influenced compliance which infection control guidelines . Henderson , et al . ( 2020 ) reported that medical staff may not accept correction of their infection control activities from nurses and that this perceived professional hierarchy can lead to difficulty and uncertainty in challenging poor infection control practices . Efstathiou , et al . ( 2011 ) found that that nurses might be influenced by non-compliance of other professionals , particularly medical staff , or might be directed towards carrying out protocols incorrectly by senior-level clinicians .
• Accountability is critical . Shah , et al . ( 2015 ) observed that prioritizing infection prevention and control activities and views on who is responsible for monitoring infection prevention and control is not consistent between and within different groups of healthcare workers . These differences can fuel tensions which may impact inter-professional communication and overall infection control , the researchers say .
McCauley , et al . ( 2021 ) did not skirt the issue of individual accountability among nurses , despite systemic factors contributing to missed nursing care . These critical factors include nurses ’ levels of training , nurses ’ education level , and nurses ’ knowledge and understanding of infection control protocols . For example , some studies indicated that nurses who took part in a relevant education or training program had higher compliance with infection control guidelines . Lack of knowledge was considered to be an important factor contributing to non-compliance , several studies suggested . Continuous education on infection prevention and control guidelines can improve overall compliance with standard precautions , some studies indicated , which may be an intervention guarding against forgetfulness , which some researchers indicated as being a critical factor contributing to non-compliance with standard- and transmission-based precautions .
As McCauley , et al . ( 2021 ) observe , “ Another factor which can influence nurse adherence to infection control guidelines is a nurse ’ s level of experience . This includes not only length of experience , but also experience working in particular practice environments and previous exposure to infection . In addition to the length of clinical experience , experience of working in departments such as the intensive care unit can help improve compliance . Additionally , having previous experience with needle injury , blood exposure or infection exposure in general also strongly influenced nurses ’ infection prevention and control compliance . Relevant nurse competencies linked to nurses ’ knowledge , attitude , skills , training , and experience were seen to be influential . Nurse experience could also be related to other personal factors such as self-efficacy and confidence .”
For example , Luo , et al . ( 2010 ) found a positive correlation between self-efficacy and compliance with precautions , while Shah , et al . ( 2015 ) reported that personal experience is highly valued among healthcare workers . However , they highlighted