Issues in infection controlAttitudes toward practice guidelines among intensive care unit personnel: A cross-sectional anonymous survey
Section snippets
Sample and setting
This cross-sectional, anonymous survey was a component of a larger study, “Effect of Hand Hygiene Guideline on Infections and Costs” (1 R01 NR008242, National Institute of Nursing Research). Hospitals were recruited from The National Nosocomial Infection Surveillance (NNIS) System, a voluntary CDC reporting network of acute care hospitals. Electronic messages were sent from the CDC to NNIS hospitals explaining the study and inviting them to contact the principal investigator if they were
Results
Personnel from 70 ICUs in 39 U.S. hospitals were included. A total of 1995 surveys were distributed, and 1359 were returned (68.2%). Respondents included 1003 nurses (74%), 228 physicians (17%), and 128 others (eg, phlebotomist, radiologist, respiratory therapist, dieticians, 10%). Staff participants were predominantly female and white with a mean age of 37 years. The mean number of active beds of the 39 hospitals visited was 417. Approximately three-fourths (70.9%) of the respondents were in
Correlates of attitudes toward practice guidelines
This attitude survey regarding practice guidelines included the largest sample of critical care staff of any published to date, which allowed us to identify possible differences in attitudes by certain staff and hospital characteristics. Most of the research related to attitudes and beliefs about practice guidelines has been conducted among physicians in general11, 13, 14, 15, 16 and in various specialties including psychiatry,17 pediatrics,10 family medicine,18, 19 and intensivists.20, 21
Study Limitations
This study suffers from the same limitations as does any study using self-report data. Although self-report is one of the few ways to assess attitudes, there is concern about desirability bias (ie, participants provide responses they think the researcher wants or expects). We attempted to minimize this potential bias by ensuring respondent anonymity. Despite the fact that survey forms were collected in person, it is unlikely that this would have had a major impact on responses because the data
Summary and Implications
In this large survey of ICU personnel, significantly more positive attitudes toward practice guidelines were found among staff in pediatric compared with adult ICUs. Nurses and other staff when compared with physicians had more positive attitudes toward guidelines in general but not toward the specific Hand Hygiene Guideline. Older respondents had more positive attitudes, and respondents scored significantly higher on the specific Hand Hygiene Guideline compared with attitudes toward guidelines
References (54)
Status of practice guidelines in the United States: CDC guidelines as an example
Prev Med
(2003)- et al.
Guideline for Hand Hygiene in Health-Care SettingsRecommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force
Am J Infect Control
(2002) A tool to assess barriers to adherence to hand hygiene guideline
Am J Infect Control
(2004)- et al.
Why do physicians not follow evidence-based guidelines for preventing ventilator-associated pneumonia:a survey based on the opinions of an international panel of intensivists
Chest
(2002) - et al.
A survey of doctors’ and nurses’ knowledge, attitudes and compliance with infection control guidelines in Birmingham teaching hospitals
J Hosp Infect
(2003) - et al.
Universal precautions guideline: self-reported compliance by gastroenterologists and gastrointestinal endoscopy nurses—a decade’s lack of progress
Am J Gastroenterol
(2003) - et al.
Behavioral interventions to improve infection control practices
Am J Infect Control
(1998) - et al.
Effectiveness of a nationally implemented smoking cessation guideline on provider and patient practices
Prev Med
(2003) - et al.
Understanding adherence to hand hygiene recommendations: the theory of planned behavior
Am J Infect Control
(2001) - et al.
Geographic variation in the treatment of acute myocardial infarction: the Cooperative Cardiovascular Project
JAMA
(1999)
Elderly patients receive less aggressive medical and invasive management of unstable angina: potential impact of practice guidelines
Arch Intern Med
Adverse outcomes and variations in organization of care delivery
Med Care
Patient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit
Pediatr Infect Dis J
The role of understaffing in central venous catheter-associated bloodstream infections
Infect Control Hosp Epidemiol
Outcomes of evidence-based clinical practice guidelines: a systematic review
Int J Technol Assess Health Care
Barriers pediatricians face when using asthma practice guidelines
Arch Pediatr Adolesc Med
Reasons for pediatrician nonadherence to asthma guidelines
Arch Pediatr Adolesc Med
Why don’t physicians follow clinical practice guidelines?A framework for improvement
JAMA
Physicians’ attitudes towards treatment guidelines: differences between teaching and nonteaching hospitals
Eur J Clin Pharmacol
Canadian physicians’ attitudes about and preferences regarding clinical practice guidelines
CMAJ
Practice guidelinesWhat are internists looking for?
J Gen Intern Med
Provider-perceived barriers and facilitators for ischaemic heart disease (IHD) guideline adherence
J Eval Clin Pract
A survey of psychiatrists’ attitudes toward treatment guidelines
Community Ment Health J
Family physicians’ opinions and attitudes to three clinical practice guidelines
J Am Board Fam Pract
Family physicians’ attitudes about and use of clinical practice guidelines
J Fam Pract
Nursing adherence with evidence-based guidelines for preventing ventilator-associated pneumonia
Crit Care Med
Provider attitudes and beliefs about clinical practice guidelines
SCI Nurs
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2017, International Journal of Nursing StudiesAdherence to the Women's Preventive Services Guidelines in the Affordable Care Act
2016, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal NursingCitation Excerpt :Barriers assessed were lack of equipment or clinic space, lack of time during a patient visit, lack of educational materials, lack of support staff, lack of reimbursement for services, and lack of acceptability to patients. General attitudes toward clinical practice guidelines (not specific to the women's health preventive guidelines) were measured using the Attitudes Regarding Practice Guidelines Scale (Quiros et al., 2007), a 12-item scale with 6-point response options ranging from strongly agree to strongly disagree (Cronbach's alpha = .83). This scale, modeled after tools developed by Cabana et al. (1999; 2000; 2001), measures provider motivation to use guidelines, relevance of guidelines to practice, and outcome expectancy.
Barriers and facilitators of nurses' use of clinical practice guidelines: An integrative review
2016, International Journal of Nursing StudiesCitation Excerpt :The studies included in this review were conducted in seven countries; the United States (n = 4), Australia (n = 2), Canada (n = 2), Finland (n = 1), Singapore (n = 1), Sweden (n = 2), and the Netherlands (n = 4). Data for the seven quantitative studies were obtained from cross-sectional surveys (Ebben et al., 2015; Forberg et al., 2014; Jansson et al., 2013; Koh et al., 2008; Quiros et al., 2007; Scott et al., 2003; Sinuff et al., 2007a). The sample populations of the seven studies were similar and included a mix of nurses, physicians, pharmacists and/or physical/occupational therapists.
Funded by The National Institute of Nursing Research, National Institutes of Health, 1 RO1 NR008242, “Impact of Hand Hygiene Guideline on Infections and Costs.”