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      Nurses' and midwives’ cleaning knowledge, attitudes and practices: An Australian study

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          Abstract

          Background

          As frontline providers of care, nurses and midwives play a critical role in controlling infections such as COVID-19, influenza, multi-drug resistant organisms and health care associated infections. Improved cleaning can reduce the incidence of infection and is cost effective but relies on healthcare personnel to correctly apply cleaning measures. As nurses and midwives have the most contact with patients and as an important first step in improving compliance, this study sought to explore nurses' and midwives’ knowledge on the role of the environment in infection prevention and control and identify challenges in maintaining clean patient environments.

          Methods

          Cross-sectional online survey of 96 nurses (RN/EN) and midwives (RW) employed in clinical settings (e.g. hospital, aged care, medical centre, clinic) in Australia.

          Results

          Nurses and midwives broadly stated that they understood the importance of cleaning. However, cleaning responsibilities varied and there was confusion regarding the application of different disinfectants when cleaning after patients with a suspected or diagnosed infection post-discharge. Most would not be confident being placed in a room where a previous patient had a diagnosed infection such as multi-drug resistant organism.

          Conclusion

          Greater organisational support and improving applied knowledge about infection control procedures is needed. This includes correct use of disinfectants, which disinfectant to use for various situations, and cleaning effectively following discharge of a patient with known infection. The cleanliness of shared medical equipment may also pose current risk due to lack of cleaning.

          Highlights

          • •

            Improved cleaning reduces incidence of healthcare associated infection but relies on correct application.

          • •

            Nurses and midwives expressed confusion regarding disinfectant use and cleaning responsibility.

          • •

            Most would not be confident being placed in a room where a previous patient had a diagnosed infection.

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          Most cited references29

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          Nurses' Reports On Hospital Care In Five Countries

          L. H. Aiken, S Clarke, D. Sloane … (2001)
          Article 0 comments Cited 189 times – based on 0 reviews     Review now
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            The role of environmental cleaning in the control of hospital-acquired infection.

            S.J Dancer (2009)
            Increasing numbers of hospital-acquired infections have generated much attention over the last decade. The public has linked the so-called 'superbugs' with their experience of dirty hospitals but the precise role of environmental cleaning in the control of these organisms remains unknown. Until cleaning becomes an evidence-based science, with established methods for assessment, the importance of a clean environment is likely to remain speculative. This review will examine the links between the hospital environment and various pathogens, including meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, norovirus, Clostridium difficile and acinetobacter. These organisms may be able to survive in healthcare environments but there is evidence to support their vulnerability to the cleaning process. Removal with, or without, disinfectants, appears to be associated with reduced infection rates for patients. Unfortunately, cleaning is often delivered as part of an overall infection control package in response to an outbreak and the importance of cleaning as a single intervention remains controversial. Recent work has shown that hand-touch sites are habitually contaminated by hospital pathogens, which are then delivered to patients on hands. It is possible that prioritising the cleaning of these sites might offer a useful adjunct to the current preoccupation with hand hygiene, since hand-touch sites comprise the less well-studied side of the hand-touch site equation. In addition, using proposed standards for hospital hygiene could provide further evidence that cleaning is a cost-effective intervention for controlling hospital-acquired infection.
            Article 0 comments Cited 154 times – based on 0 reviews     Review now
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              Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus.

              Walter Zingg, Alison Holmes, Markus Dettenkofer … (2015)
              Despite control efforts, the burden of health-care-associated infections in Europe is high and leads to around 37,000 deaths each year. We did a systematic review to identify crucial elements for the organisation of effective infection-prevention programmes in hospitals and key components for implementation of monitoring. 92 studies published from 1996 to 2012 were assessed and ten key components identified: organisation of infection control at the hospital level; bed occupancy, staffing, workload, and employment of pool or agency nurses; availability of and ease of access to materials and equipment and optimum ergonomics; appropriate use of guidelines; education and training; auditing; surveillance and feedback; multimodal and multidisciplinary prevention programmes that include behavioural change; engagement of champions; and positive organisational culture. These components comprise manageable and widely applicable ways to reduce health-care-associated infections and improve patients' safety.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Infect Dis Health
                Journal ID (iso-abbrev): Infect Dis Health
                Title: Infection, Disease & Health
                Publisher: Australasian College for Infection Prevention and Control. Published by Elsevier B.V.
                ISSN (Print): 2468-0451
                ISSN (Electronic): 2468-0869
                Publication date PMC-release: 30 September 2020
                Publication date (Electronic): 30 September 2020
                Affiliations
                [a ]School of Nursing and Midwifery, University of Newcastle, Ourimbah, New South Wales, Australia
                [b ]School of Nursing, Avondale College of Higher Education, Wahroonga, New South Wales, Australia
                [c ]Department of Nursing Research, Cabrini Institute, Malvern, VIC, Australia
                [d ]Nursing and Midwifery, Monash University, Frankston, VIC, Australia
                [e ]Richard Wells Research Centre, University of West London, Brentford, UK
                Author notes
                [∗ ]Corresponding author. School of Nursing and Midwifery, The University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia. Tel: +61 2 4349 4536.
                Article
                Publisher Item ID: S2468-0451(20)30065-1
                DOI: 10.1016/j.idh.2020.09.002
                PMC ID: 7526607
                PubMed ID: 33011114
                SO-VID: e0cfd6c8-1203-43d9-85a0-7781bbe139de
                Copyright © © 2020 Australasian College for Infection Prevention and Control. Published by Elsevier B.V. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 30 June 2020
                Date accepted : 7 September 2020
                Categories
                Subject: Research Paper

                Keywords: cleaning,infection prevention and control,patient environment,shared equipment,education,applied knowledge
                Data availability:
                Keywords: cleaning, infection prevention and control, patient environment, shared equipment, education, applied knowledge

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