الفهرس 
Literature ReviewOnly 14 pages are availabe for public view
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Abstract
Standard precautions are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infectious status of the patient, in any setting where health care is delivered. These practices are designed to prevent from spreading infections among patients. There are seven standard precautions include hand hygiene, personal protective equipment (PPE) (gloves, eyewear, gowns & masks), respiratory hygiene/cough etiquette, sharps safety, (engineering and work practice controls), safe injection practice (i.e. Aseptic technique for parental medications), sterile instruments and devices, and cleaning and disinfecting of the environmental surfaces (Central Disease Control and Prevention, 2018).
Ambulatory care unites refers to medical or surgical care that is rendered for consultative, diagnostic, or therapeutic purposes in facilities where the patient does not remain overnight (William Osler Health System, 2018).
Ambulatory care is provided in a variety of settings, including physician’s offices, hospital-based clinics, public health clinics, ambulatory surgery centers, dental offices, and the home. This care can include advanced medical technology and procedures even when provided outside of hospitals (Hospital-infection-control/ambulatory-care, 2017).
Health care workers (HCWs) are all people engaged in actions whose primary intent is to enhance health, delivers care and services of health to the sick and ailing either directly as medical physician, dentist, nurses, midwifes, pharmacist, public health professionals, nutritionist or indirectly as aides, helpers, laboratory technicians, or even medical waste handlers (WHO, Indonesia, 2019).
Significance of the study:
People receiving health and medical care, whether in a hospital or in Ambulatory day care units, are at risk of becoming infected unless precautions are taken to prevent infection. Nosocomial (hospital-acquired) infections are a significant problem throughout the world and are increasing (Yallew et al., 2016).
Unfortunately, the discipline of infection control is poorly developed in countries such as Egypt, where the healthcare system is developing rapidly and there is little expertise in infection control training. Establishing a cost-effective program for Egypt is a leading priority for the ministry of health and is an essential component of efforts to improve the quality of healthcare (CDC in Egypt, 2017).
Aim of the Study
The study aims to assess the standard precautions among health care workers in ambulatory units, through:
• Assessing health care workers knowledge about, standard precautions in Ambulatory units.
• Assessing health care worker the practices regarding, standard precautions in Ambulatory units.
• Assessing factors affecting the practices of health care workers regarding standard precautions.
• Assessing environmental structure in the ambulatory units.
Research Questions:
• What is the health care workers knowledge about standard precautions of infection control?
• Is there a relation between socio-demographic characteristics of health care workers and their knowledge about standard precautions?
• Is there a relation between factors affecting the practices of health care workers on their practice?
Technical design:
This part of methodology comprises a description of the study design, setting, subjects, and data collection tools.
Research design:
Descriptive research design was used in the conduction of the study.
Study setting:
The study was conducted at four ambulatory units in the New Emergency Hospital, affiliated to Ain Shams University Hospitals (medicine emergency unit, dressing unit, dental unit, orthopedic unit), in which the standard precautions applied. As these units provide health care services to a large segment of the surrounding population as well as from the various governorates of the Arab Republic of Egypt and are distinguished by the fact that they contain a large number of health care workers, including physician, nurses, and technicians.
Sampling:
Convenience sample was used to conduct this study. The study sample included all health care workers which consisted of 200 health care workers who working in ambulatory units which divided into 68 physicians, 100 of nurses, and 32 of workers. Those who cover all shifts through 24 hours for all 7 days a week.
Tools of data collection:
It was developed by the investigator based on reviewing related literature, magazines, and experts’ opinions to assess standard precautions among health care workers in ambulatory care units, the data were collected using two following tools.
First tool:
Self-administered questionnaire (Appendix I) was developed by the investigator in Arabic language which consists of four parts:
Part I: Questions to assess socio-demographic characteristics of the study sample of health care workers concerned with standard precautions,
Part II: This part was developed to assess the health status among HCWs as medical history of infectious diseases, history of chronic diseases, accidents, annual mandatory vaccinations taken, and the present complaint.
Part III: This part represents the assessment of knowledge of health care workers regarding standard precautions which divided to 8 sections.
1st section represents knowledge of health care workers regarding the stander’s precautions,
2nd section about hand washing
3rd section to assess the personal protective equipment
4th section about assessment of aseptic technique (safe injection practice)
5th section to represent the assessment of waste management
6th section about assessment of environmental cleaning (surface or linen)
7thsection represent the assessment of respiratory hygiene, and cough etiquette
Scoring system of total knowledge about standard precautions:
For each of the knowledge items about standard precautions, correct knowledge was scored 1, and incorrect one was scored 0, these scores were summed up and converted into percent scores for each area of knowledge.
The total score for all items related to knowledge about standard precautions was 34 points and categorized into 3 levels as followings > 85% (29: 34 marks) was considered good, 60%: <85% (20: 28 marks) is considered average, and < 60% (0: 19 marks) is considered poor.
Part IV: This part to assess the factors that affect the performance of health care workers in ambulatory care units which composed of five sections with 41 items of closed ended questions
Scoring system of factors affecting the performance of health care workers in ambulatory care units:
For each factor affecting health care workers in ambulatory care units, each item checked as fulfilled was scored 1 and wasn’t checked on scored with zero, these scores were converted into percent scores.
Second tool:
An observational checklist (Appendix II) was developed by investigator and under supervision by professors of community health nursing in Ain Shams University. It consisted of two parts as following:
Part I: A standard precautions practices checklist: It consisted of 7 sections of checklists to evaluate the practices of health care workers in the ambulatory care units regarding standard precautions such as hand hygiene, personal protective equipment (PPE), aseptic technique, environment cleaning, waste management, respiratory hygiene, and cough etiquette procedures with 88 points.
Scoring system of total health care workers’ practices:
For each of the practice items about slandered precautions’ procedure, each observed item, scored as either done = 1 or not done = zero. The sum of the total practices was calculated and transferred to percentage.
The total score for all items related to it was 88 points and categorized into 2 levels as following > 75% (66:88 marks) is considered as adequate practices and <75% (0:65 marks) is considered as inadequate practices.
Part II: An environmental checklist: This part to assess the suitability of the infrastructure in ambulatory units to follow standard precautions which composed of seven sections with 47 items closed ended questions.
Scoring system of the suitability of the infrastructure to follow standard precautions:
For each of the environmental suitability items about standard precautions, each observed item, scored as either found = 1 or not found = zero. The sum of the total items was calculated and transferred to percentage
The total score for all items related to environmental suitability was 47 points were categorized into 2 levels as following > 75% (35:47 marks) is considered as suitable environment and <75% (0:34 marks) is considered as unsuitable environment.
The results of the present study
The study result shows that, 46% of the study sample their age ranged between 30-<40 years, the Mean SD of age is 38.5±17.9 years. As regard to academic qualification, 36% and 34% of the study sample have diploma / technical institute and bachelor, respectively. Moreover, 53% of the study sample are female.
Moreover, 87.5% of them interact directly with the patient. Also, 75% of them working 12 hours per day. In addition, 40% of the study sample have experience from 5 years to less than 10 years in their field. Also, 40% of the study sample attending training courses on standard precautions.
The result shows that, 55% of the study sample have past history of respiratory infection. In addition, 56% of them have past history of wounds. Moreover, 60% of them take hepatitis B vaccines. Furthermore, 87.5% of the study sample take novel coronavirus two doses
Also, the study result shows that, 46% of the study sample have good level of total knowledge about standard precautions. While 30% of them have average level and 24% of them have poor level.
In addition, it illustrates that, 25% of the ambulatory units were suitable regarding to standard of environmental structure. While 75% of them were unsuitable.
illustrates that, 60% of the study sample of HCWs had inadequate level of total practices regarding to standard precautions in ambulatory units.
Finally, the result revealed that, there was highly statistically significant relation between HCWs’ knowledge and practices about standard precautions and their socio- demographic characteristics.
proves that there was highly significant negative correlation between sample’ total practices, and unsuitable infrastructure to follow standard precautions, and lack of resources like personal protective equipment (PPEs) at (P= < 0.01). and just significant with lack of infection control supplies, and administrative factors at (P= < 0.05).
Conclusion
On the light of the study results and research questions the study was concluded that:
There was highly significant positive correlation between HCWs’ total knowledge and their levels of practices at (P= < 0.01). Finally, the result proved that there was highly significant negative correlation between HCWs’ total practices, and factors affecting standard precautions. at (P= < 0.01).
Recommendations
1. Updating knowledge and practices of nurses through continuing in-service educational programs in other ambulatory units.
2. Providing training programs for newly nurses about standard precautions and at regular intervals.
3. Availability of all facilities, materials, and supplies (PPEs) required for applying standard precautions of infection control.
4. Further research about improvement of HCWs performance regarding standard precautions in ambulatory units.
5. Disseminations of standard precautions guidelines through all ambulatory units.
6. Providing on job training programs for all health care workers in ambulatory care units about standard precaution and its importance of prevention of infection for them and for patients.