American Journal of Infection Control 42 (2014) 980-4
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Major article
Factors influencing the self-perceived practice levels of professional standard competency among infection control nurses in Korea Jeong Sil Choi RN, MPH, PhD, ICAPN a, Kyung Mi Kim RN, PhD, ICAPN b, * a b
Gachon University College of Nursing, Incheon, South Korea Semyung University Department of Nursing, Jecheon, Chungbuk, South Korea
Key Words: Competence Infection preventionist
Background: This study investigated the self-perceived infection control (IC) knowledge and practice levels of professional standards competency (PSC) among Korean infection control nurses (ICNs) to identify factors that may influence PSC. Methods: Using a self-reporting questionnaire method, we collected data from a total of 104 ICNs. Results: The average self-perceived IC knowledge level was 3.1 0.8, with hand hygiene scoring the highest at 3.7 0.8. The total proportion of responders who did not meet the expected standard in 4 future-oriented domains was 51.7%. Of the 4 domains, technology had the highest number of respondents meeting the desired standard (57%). There were significant differences in self-perceived levels of PSC in relation to ICN specialist certification and continuing education (eg, extra coursework, conference attendance) in the field. Self-perceived practice levels of PSC also were significantly correlated with age, years of total clinical experience, years of ICN experience, hospital bed count, and IC knowledge. Predictors of self-perceived practice levels of PSC were knowledge and years of ICN experience. Conclusion: Educational programs are needed to promote knowledge and competency, the lack of which was recognized by the ICNs. Also, various efforts are needed to prevent turnover of ICNs with a high level of competency. Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Today’s health care system requires nurse specialists to translate their knowledge and skills into practice to provide quality care.1 In particular, infection control (IC) knowledge levels are closely related to patient safety and the quality of the health care services offered. Identifying and reinforcing consistent levels of professional standards competency (PSC) for infection control nurses (ICNs) can ensure the delivery of quality health care to patients. The concept of competency encompasses a combination of skills, performance, and daily behavior.2 Competencies provide a framework of practice standards designed to assist new practitioners in a specialty in developing necessary skills.3 According to Murphy et al,4 knowledge and skill are essential components of professional competency, along with additional components, including communication, values, reasoning, and teamwork. Since the mid-1990s, studies on competencies and practice standards in the IC profession have been conducted by the Association for Professionals in Infection Control and Epidemiology (APIC), the Canadian Community and * Address correspondence to Kyung Mi Kim, RN, PhD, ICAPN, 65 Semyung-ro, Jecheon, Chungbuk, South Korea. E-mail addresses: [email protected], [email protected] (K.M. Kim). Conflict of interest: None to report.
Hospital Infection Control Association (CHICA-Canada), and the Australian Infection Control Association.4 In addition, APIC and CHICA-Canada used their studies to develop a set of professional and practice standards for use in evaluating ICN competencies.5 Murphy et al.4 identified 4 future-oriented domainsd leadership, infection prevention and control, technology, and performance improvement and implementation sciencedwhich are linked to the Certification Board of Infection Control (CBIC) core competencies. The authors explained that these 4 future-oriented domains will enable ICNs to build these core competencies, thereby advancing in their careers from novice to expert. Bobay et al6 suggested that experience as an RN was highly correlated with age and clinical nursing experience, whereas certification and initial educational preparation were not significantly correlated with competencies. Other studies also have identified IC experience and the number of hospital beds as factors influencing ICN competency.7,8 Nonetheless, despite a heightened interest in the competency of individual ICNs as an attempt to promote the concept of health care as it relates to successful infection control, few studies have evaluated standards of ICN competency. Many Korean ICNs have taken a 1-month IC course for nurses (offered by a national university hospital based in Seoul), various
0196-6553/$36.00 - Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2014.05.023
J.S. Choi, K.M. Kim / American Journal of Infection Control 42 (2014) 980-4
short-term IC training courses (based at other Korean-based university hospitals), or an IC training series of basic and advanced courses. The latter has been offered annually by the Korean Society for Nosocomial Infection Control (KOSNIC) since 1996. In addition, some nurses have received ICN specialist certification from the Korean Ministry of Health and Welfare by taking the certification examination after completing a master’s course in accordance with the Medical Treatment Law.9 Because Korean ICNs have such diverse clinical and educational backgrounds, their reported difficulties in performance of their duties vary. In addition, it is believed that this diverse training leads to different levels of nursing competency within the profession. The specific goals of this study were to investigate the general characteristics, self-perceived knowledge level of IC, and selfperceived practice levels of IC PSC among Korean ICNs, and to identify the factors related to the self-perceived practice levels of PSC. METHODS Design and sampling
981
perform IC tasks independently as a professional in the field of infection prevention and control. Therefore, only those respondents with a score of 3 points were included in the analysis. Two nursing professors and 2 ICN specialists reviewed the surveys for content and clarity. Data analysis Data analysis was performed using SPSS 20.0 (IBM, Armonk, NY). The self-perceived knowledge level of IC and practice levels of PSC showed a normal distribution (Kolmogorov-Smirnov test). Frequency, percentage, mean, and standard deviation (SD) were used for identification of respondents’ general characteristics. Mean and SD were used to measure self-perceived knowledge levels of IC and practice levels of PSC. The independent t test was used to examine the relationships between demographics and the practice levels of PSC. Pearson correlation was used to test correlations among the main variables. Hierarchical multiple linear regression analysis was used to determine the predictive factors of practice levels of PSC.
This study was conducted between December 2012 and January 2013. Data collection was completed via an e-mailed query and questionnaire sent to 285 ICNs whose e-mail addresses were publicized in the 2012 Korean Association for Infection Control Nurses (KAICN) address book. This book included the contact information of nurses in both temporary and permanent positions; however, the questionnaire confirmed that respondents held permanent nursing positions. Both ICNs and nurses with an interest in IC can become members of the KAICN; ICNs holding temporary positions were excluded because their duties tend to be simple tasks, like data input. Of the 191 ICNs who viewed the e-mail, 105 replied (55% response rate). All responses were through the voluntary participation of the subjects. One questionnaire was excluded because it was incomplete, leaving data from a total of 104 ICNs for analysis. This study was approved by the Institutional Review Board of the Semyung University Oriental Medicine Hospital, and each participant provided written consent.
RESULTS
Study tool
Self-perceived knowledge of IC and practice levels of PSC
The self-reporting questionnaire was composed based on a review of the literature.4,5,10 The questionnaire consists of 3 parts: general characteristics of ICNs, self-perceived IC knowledge, and self-perceived practice levels of PSC. In this study, PSC is defined as an individual’s competence in his or her professional role as an ICN. A total of 22 items on self-perceived IC knowledge level were developed using the CBIC’s core competencies as a baseline.4,10 These items were measured on a 5-point Likert scale: 1, “I have fully sufficient knowledge”; 2, “I have sufficient knowledge”; 3, “I have a medium level of knowledge”; 4, “I have insufficient knowledge”; and 5, “I have very insufficient knowledge.” A higher score indicates greater knowledge of IC (Cronbach’s a ¼ 0.92). The questionnaire on PSC was developed from the professional and practice standards of APIC-CHICA5 and the 4 future-oriented domains of Murphy et al.4 This questionnaire consisted of 44 questions, including 8 questions on leadership, 20 questions on infection prevention and control, 11 questions on technology, and 5 questions on performance improvement and implementation science. Practice levels of PSC were measured on a 5-point Likert scale as well, from 1 (“I do not perform at all”) to 5 (“I perform very well”). A higher score indicates greater PSC (Cronbach’s a ¼ 0.96). A category with a score of 4 points was considered to indicate sufficient knowledge and practice level of that competency to
Self-perceived IC knowledge level The mean ( SD) self-perceived IC knowledge level was 3.1 0.8. The total proportion of responders who did not meet the desired standard (a score 4 on the Likert scale) was 62.3%. The knowledge level of hand hygiene scored the highest, at 3.7 ( 0.7). Of the self-perceived knowledge levels of IC reviewed, the lowest scores were recorded in research (2.5 1.0) and construction and renovation (2.5 0.9). At 85.6%, the domain of construction and renovation in patient care facilities had the highest percentage of respondents not meeting the desired standard. The percentage of responders who did not meet the desired standard was lowest for hand hygiene, at 35.6% (Table 1).
Differences in self-perceived practice levels of PSC by general characteristics The average reported clinical experience was 15 years, and the average IC specialty experience was 5 years. Slightly more than one-half (52%) of the subjects had less than 5 years of experience in IC at the time of the survey. Almost 40% of the responding ICNs were working in Seoul. The average hospital bed count was 821 beds. Forty-seven percent of the respondents were certified as ICN specialists through the Korean Ministry of Health and Welfare, 35.6% completed an IC course before accepting an appointment as a dedicated ICN, and 97.1% reported attending academic conferences or training courses provided annually by the KAICN and KOSNIC. Significant differences in the self-perceived practice levels of PSC were observed in relation to IC certification (P < .001) and attendance at an academic conference or training course (P ¼ .041).
Self-perceived practice levels of PSC according to 4 future-oriented domains The total percentage of subjects who did not meet the desired standard for this section (a score 4 on the Likert scale) was 51.7%. The technology domain scored the highest of the future-oriented domains (3.5 0.7) and had the highest percentage of respondents meeting the desired standard (57%). The lowest scoring domain was performance improvement and implementation science (3.0 1.1), which also had the lowest percentage of respondents meeting the desired standard, at 36.2% (Table 2).
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J.S. Choi, K.M. Kim / American Journal of Infection Control 42 (2014) 980-4
Table 1 Self-perceived knowledge level of infection control Category Hand hygiene Initiation and discontinuation of isolation/barrier precautions as indicated Patient placement, transfer, and discharge Employee/occupational health Recall of potentially contaminated equipment and supplies Management of patient care products and medical equipment Education Surveillance and epidemiologic investigation Quality improvement and patient safety Specific direct and indirect care setting IC Cleaning, disinfection, sterilization Environmental hazards Immunization programs for patients Influx of patients with communicable diseases Management and leadership Infection risk from therapeutic and diagnostic procedures and devices Effective communication and feedback Identification of infectious disease Research Construction and renovation of patient care facilities Average
Table 2 PSC in the 4 future-oriented domains Mean SD
%*
3.7 0.7 3.6 0.8
35.6 41.3
3.4 0.8 3.4 0.8 3.3 0.9
50.0 51.9 52.9
3.3 0.8
58.7
3.2 3.1 3.2 3.2 3.1 3.2 3.1 3.1 2.9 3.1
0.9 1.0 0.8 0.9 0.9 0.8 0.9 0.9 1.0 0.9
59.6 59.6 60.6 60.6 61.5 65.4 66.3 67.3 69.2 70.2
2.9 2.9 2.5 2.5 3.1
0.9 0.9 1.0 0.9 0.8
71.2 74.0 84.6 85.6 62.3
*Proportion of responders who did not meet the desired standard.
Correlation among variables and self-perceived practice level of PSC Self-perceived practice level of PSC was significantly correlated with age (r ¼ 0.39; P < .01), years of total clinical experience (r ¼ 0.32; P < .01), years of ICN experience (r ¼ 0.83; P < .01), number of hospital beds (r ¼ 0.23; P < .01), and self-perceived knowledge of IC (r ¼ 0.77; P < .01) (Table 3). Predictors of self-perceived practice levels of PSC Hierarchical regression was used to examine the effects of general characteristics of the respondents and their self-perceived knowledge levels of IC. General characteristics, including age, years of total clinical experience, years of ICN experience, ICN specialist certification, and academic conference or training course attendance, were controlled for in the first block, based on previous studies2,6-8 suggesting that demographic variables might be associated with self-perceived practice levels of PSC. Self-perceived knowledge level of IC was added in the second block. In the first model, age, years of total clinical experience, years of ICN experience, number of hospital beds, ICN specialist certification, and academic conference or training course attendance increased the explained variance by 69.2% (F ¼ 47.275; P < .001). The coefficient of years of ICN experience was significant (b ¼ 0.792; t ¼ 10.606; P < .001). This indicates that self-perceived practice levels of PSC increased with increasing time working as an ICN. When self-perceived knowledge level of IC was entered into the second model, the explained variance was increased by 8.80% (F ¼ 62.035; P < .001). The full model accounted for 78.0% of the variance in self-perceived practice levels of PSC (Table 4). DISCUSSION This study has attempted to contribute to the promotion of health care quality by measuring the self-perceived knowledge level of IC and practice levels of PSC of Korean ICNs. This study is the first work to investigate the competency of Korean ICNs. Our goal was to clarify areas of competency that need strengthening, as well
Competency Domain 1: Leadership and program management Recommends changes in practice based on clinical outcomes and financial implications Collaborates with others as a leader, facilitator, and team member Supports others as an infection control professional when the infection control team is organized Domain 2: Infection prevention and control Understands advantages and disadvantages of complex diagnostic tests (eg, polymerase chain reaction) and interprets results Is involved in the establishment of patient care environment to reduce infection risks during construction and renovation Domain 3: Technology Uses automated algorithmic detection of possible HAIs Accesses the clinical database (eg, EMR, OCS) Domain 4: Performance improvement and implementation science Has sufficient skills and experience to use performance improvement tools (eg, Plan, Do, Study, Act; Six Sigma; Lean) Is aware of the need for performance improvement Average
Mean SD
%*
3.3 0.9 2.8 1.1
51.8 75.0
3.9 0.9
34.6
3.7 1.0
34.6
3.3 0.9 2.7 1.0
52.6 83.7
4.1 0.8
21.2
0.7 1.2 0.8 1.1
43.0 78.8 17.3 63.8
2.8 1.2
70.2
3.5 1.0 3.05 1.14
49.0 51.7
3.5 2.6 4.3 3.0
OCS, order communication system. *Proportion of the responders who did not meet the desired standard. The table only shows the highest and lowest values.
as to create opportunities for comparison between Korean infection preventionists and those from other countries to contribute to the international growth of ICN competency. The Nursing Expertise Self-Report Scale was developed using the Benner model of clinical competence.2 Garland,11 in a study using this model to identify ICU nurses’ self perception of clinical competence, found that a self-perception scale can be useful in identifying clinical competency. In that study, significant differences in practice levels of PSC were related to ICN specialist certification and attendance at academic conferences or training courses. Goldrick reported that certification validated knowledge and clinical competency in a specialty.12 In Korea, ICN specialist certification is acquired through a national qualifying examination after graduating from a specialist nursing program based at a university graduate school.9 Our data demonstrate that this ICN specialist program enhanced the ICNs’ practice levels of PSC. Annual participation in academic conferences and training courses was also shown to be beneficial to ICN competency; however, 62.3% of the respondents still rated their knowledge as insufficient. It seems that this outcome may be related to the wide range of IC experience, from 2 months to 19 years in the field, among responding ICNs. Most respondents reported having insufficient knowledge in the areas of research and construction and renovation in patient care facilities. These domains included tasks that the respondents performed less often during their daily duties. According to Her et al,13 Korean ICNs report the desire to participate in programs, such as statistics, as related to IC practice. APIC and CHICA-Canada suggest that infection preventionists participate in IC prevention and related research on their own or work collaboratively on research to develop practice standards in these fields.5 This suggests that ICN programs should be research-based or be developed to require an advanced degree with a strong research orientation. In addition, ICNs need to be encouraged to do their own research on IC practices. Of the PSC in the 4 future-oriented domains, the technology area had the ICNs’ highest self-perceived levels of competency. This result could be related to ICNs’ need to access patient information, including the electronic medical record (EMR), for monitoring.4 Some studies have reported that using the EMR enables precise
J.S. Choi, K.M. Kim / American Journal of Infection Control 42 (2014) 980-4
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Table 3 Mean SD and Pearson correlation among the main research variables (n ¼ 104) Variable 1. Practice of PSC 2. Age 3. Years of clinical experience 4. Years of ICN experience 5. Number of hospital beds 6. Knowledge of IC Mean SD Observed range
1
2
3
4
5
6
1.00 0.39** 0.32** 0.83** 0.23** 0.77** 3.05 1.14 1-5
1.00 0.95** 0.52** 0.26** 0.32** 37.5 6.00 23-53
1.00 0.45** 0.24* 0.24* 14.93 5.94 2-30
1.00 0.20 0.65** 5.40 3.95 0.2-19
1.00 0.16 821.38 514.88 99-2780
1.00 3.11 0.76 1-5
*P < .05, **P < .01, independent Pearson correlation test.
Table 4 Predictors of practice levels of PSC (n ¼ 104) Step 1
2
Predictor
b
t
P
R2 change
Adjusted R2
F (P)
Age Years of clinical experience Years of experience as infection control nurse Number of hospital beds ICN specialist certification* Attendance of academic conference or training course* Knowledge of IC
0.073 0.123 0.792 0.066 0.770 0.079 0.395
0.413 0.716 10.606 1.170 1.173 1.404 6.365
.680 .476
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Major article
Factors influencing the self-perceived practice levels of professional standard competency among infection control nurses in Korea Jeong Sil Choi RN, MPH, PhD, ICAPN a, Kyung Mi Kim RN, PhD, ICAPN b, * a b
Gachon University College of Nursing, Incheon, South Korea Semyung University Department of Nursing, Jecheon, Chungbuk, South Korea
Key Words: Competence Infection preventionist
Background: This study investigated the self-perceived infection control (IC) knowledge and practice levels of professional standards competency (PSC) among Korean infection control nurses (ICNs) to identify factors that may influence PSC. Methods: Using a self-reporting questionnaire method, we collected data from a total of 104 ICNs. Results: The average self-perceived IC knowledge level was 3.1 0.8, with hand hygiene scoring the highest at 3.7 0.8. The total proportion of responders who did not meet the expected standard in 4 future-oriented domains was 51.7%. Of the 4 domains, technology had the highest number of respondents meeting the desired standard (57%). There were significant differences in self-perceived levels of PSC in relation to ICN specialist certification and continuing education (eg, extra coursework, conference attendance) in the field. Self-perceived practice levels of PSC also were significantly correlated with age, years of total clinical experience, years of ICN experience, hospital bed count, and IC knowledge. Predictors of self-perceived practice levels of PSC were knowledge and years of ICN experience. Conclusion: Educational programs are needed to promote knowledge and competency, the lack of which was recognized by the ICNs. Also, various efforts are needed to prevent turnover of ICNs with a high level of competency. Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Today’s health care system requires nurse specialists to translate their knowledge and skills into practice to provide quality care.1 In particular, infection control (IC) knowledge levels are closely related to patient safety and the quality of the health care services offered. Identifying and reinforcing consistent levels of professional standards competency (PSC) for infection control nurses (ICNs) can ensure the delivery of quality health care to patients. The concept of competency encompasses a combination of skills, performance, and daily behavior.2 Competencies provide a framework of practice standards designed to assist new practitioners in a specialty in developing necessary skills.3 According to Murphy et al,4 knowledge and skill are essential components of professional competency, along with additional components, including communication, values, reasoning, and teamwork. Since the mid-1990s, studies on competencies and practice standards in the IC profession have been conducted by the Association for Professionals in Infection Control and Epidemiology (APIC), the Canadian Community and * Address correspondence to Kyung Mi Kim, RN, PhD, ICAPN, 65 Semyung-ro, Jecheon, Chungbuk, South Korea. E-mail addresses: [email protected], [email protected] (K.M. Kim). Conflict of interest: None to report.
Hospital Infection Control Association (CHICA-Canada), and the Australian Infection Control Association.4 In addition, APIC and CHICA-Canada used their studies to develop a set of professional and practice standards for use in evaluating ICN competencies.5 Murphy et al.4 identified 4 future-oriented domainsd leadership, infection prevention and control, technology, and performance improvement and implementation sciencedwhich are linked to the Certification Board of Infection Control (CBIC) core competencies. The authors explained that these 4 future-oriented domains will enable ICNs to build these core competencies, thereby advancing in their careers from novice to expert. Bobay et al6 suggested that experience as an RN was highly correlated with age and clinical nursing experience, whereas certification and initial educational preparation were not significantly correlated with competencies. Other studies also have identified IC experience and the number of hospital beds as factors influencing ICN competency.7,8 Nonetheless, despite a heightened interest in the competency of individual ICNs as an attempt to promote the concept of health care as it relates to successful infection control, few studies have evaluated standards of ICN competency. Many Korean ICNs have taken a 1-month IC course for nurses (offered by a national university hospital based in Seoul), various
0196-6553/$36.00 - Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2014.05.023
J.S. Choi, K.M. Kim / American Journal of Infection Control 42 (2014) 980-4
short-term IC training courses (based at other Korean-based university hospitals), or an IC training series of basic and advanced courses. The latter has been offered annually by the Korean Society for Nosocomial Infection Control (KOSNIC) since 1996. In addition, some nurses have received ICN specialist certification from the Korean Ministry of Health and Welfare by taking the certification examination after completing a master’s course in accordance with the Medical Treatment Law.9 Because Korean ICNs have such diverse clinical and educational backgrounds, their reported difficulties in performance of their duties vary. In addition, it is believed that this diverse training leads to different levels of nursing competency within the profession. The specific goals of this study were to investigate the general characteristics, self-perceived knowledge level of IC, and selfperceived practice levels of IC PSC among Korean ICNs, and to identify the factors related to the self-perceived practice levels of PSC. METHODS Design and sampling
981
perform IC tasks independently as a professional in the field of infection prevention and control. Therefore, only those respondents with a score of 3 points were included in the analysis. Two nursing professors and 2 ICN specialists reviewed the surveys for content and clarity. Data analysis Data analysis was performed using SPSS 20.0 (IBM, Armonk, NY). The self-perceived knowledge level of IC and practice levels of PSC showed a normal distribution (Kolmogorov-Smirnov test). Frequency, percentage, mean, and standard deviation (SD) were used for identification of respondents’ general characteristics. Mean and SD were used to measure self-perceived knowledge levels of IC and practice levels of PSC. The independent t test was used to examine the relationships between demographics and the practice levels of PSC. Pearson correlation was used to test correlations among the main variables. Hierarchical multiple linear regression analysis was used to determine the predictive factors of practice levels of PSC.
This study was conducted between December 2012 and January 2013. Data collection was completed via an e-mailed query and questionnaire sent to 285 ICNs whose e-mail addresses were publicized in the 2012 Korean Association for Infection Control Nurses (KAICN) address book. This book included the contact information of nurses in both temporary and permanent positions; however, the questionnaire confirmed that respondents held permanent nursing positions. Both ICNs and nurses with an interest in IC can become members of the KAICN; ICNs holding temporary positions were excluded because their duties tend to be simple tasks, like data input. Of the 191 ICNs who viewed the e-mail, 105 replied (55% response rate). All responses were through the voluntary participation of the subjects. One questionnaire was excluded because it was incomplete, leaving data from a total of 104 ICNs for analysis. This study was approved by the Institutional Review Board of the Semyung University Oriental Medicine Hospital, and each participant provided written consent.
RESULTS
Study tool
Self-perceived knowledge of IC and practice levels of PSC
The self-reporting questionnaire was composed based on a review of the literature.4,5,10 The questionnaire consists of 3 parts: general characteristics of ICNs, self-perceived IC knowledge, and self-perceived practice levels of PSC. In this study, PSC is defined as an individual’s competence in his or her professional role as an ICN. A total of 22 items on self-perceived IC knowledge level were developed using the CBIC’s core competencies as a baseline.4,10 These items were measured on a 5-point Likert scale: 1, “I have fully sufficient knowledge”; 2, “I have sufficient knowledge”; 3, “I have a medium level of knowledge”; 4, “I have insufficient knowledge”; and 5, “I have very insufficient knowledge.” A higher score indicates greater knowledge of IC (Cronbach’s a ¼ 0.92). The questionnaire on PSC was developed from the professional and practice standards of APIC-CHICA5 and the 4 future-oriented domains of Murphy et al.4 This questionnaire consisted of 44 questions, including 8 questions on leadership, 20 questions on infection prevention and control, 11 questions on technology, and 5 questions on performance improvement and implementation science. Practice levels of PSC were measured on a 5-point Likert scale as well, from 1 (“I do not perform at all”) to 5 (“I perform very well”). A higher score indicates greater PSC (Cronbach’s a ¼ 0.96). A category with a score of 4 points was considered to indicate sufficient knowledge and practice level of that competency to
Self-perceived IC knowledge level The mean ( SD) self-perceived IC knowledge level was 3.1 0.8. The total proportion of responders who did not meet the desired standard (a score 4 on the Likert scale) was 62.3%. The knowledge level of hand hygiene scored the highest, at 3.7 ( 0.7). Of the self-perceived knowledge levels of IC reviewed, the lowest scores were recorded in research (2.5 1.0) and construction and renovation (2.5 0.9). At 85.6%, the domain of construction and renovation in patient care facilities had the highest percentage of respondents not meeting the desired standard. The percentage of responders who did not meet the desired standard was lowest for hand hygiene, at 35.6% (Table 1).
Differences in self-perceived practice levels of PSC by general characteristics The average reported clinical experience was 15 years, and the average IC specialty experience was 5 years. Slightly more than one-half (52%) of the subjects had less than 5 years of experience in IC at the time of the survey. Almost 40% of the responding ICNs were working in Seoul. The average hospital bed count was 821 beds. Forty-seven percent of the respondents were certified as ICN specialists through the Korean Ministry of Health and Welfare, 35.6% completed an IC course before accepting an appointment as a dedicated ICN, and 97.1% reported attending academic conferences or training courses provided annually by the KAICN and KOSNIC. Significant differences in the self-perceived practice levels of PSC were observed in relation to IC certification (P < .001) and attendance at an academic conference or training course (P ¼ .041).
Self-perceived practice levels of PSC according to 4 future-oriented domains The total percentage of subjects who did not meet the desired standard for this section (a score 4 on the Likert scale) was 51.7%. The technology domain scored the highest of the future-oriented domains (3.5 0.7) and had the highest percentage of respondents meeting the desired standard (57%). The lowest scoring domain was performance improvement and implementation science (3.0 1.1), which also had the lowest percentage of respondents meeting the desired standard, at 36.2% (Table 2).
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J.S. Choi, K.M. Kim / American Journal of Infection Control 42 (2014) 980-4
Table 1 Self-perceived knowledge level of infection control Category Hand hygiene Initiation and discontinuation of isolation/barrier precautions as indicated Patient placement, transfer, and discharge Employee/occupational health Recall of potentially contaminated equipment and supplies Management of patient care products and medical equipment Education Surveillance and epidemiologic investigation Quality improvement and patient safety Specific direct and indirect care setting IC Cleaning, disinfection, sterilization Environmental hazards Immunization programs for patients Influx of patients with communicable diseases Management and leadership Infection risk from therapeutic and diagnostic procedures and devices Effective communication and feedback Identification of infectious disease Research Construction and renovation of patient care facilities Average
Table 2 PSC in the 4 future-oriented domains Mean SD
%*
3.7 0.7 3.6 0.8
35.6 41.3
3.4 0.8 3.4 0.8 3.3 0.9
50.0 51.9 52.9
3.3 0.8
58.7
3.2 3.1 3.2 3.2 3.1 3.2 3.1 3.1 2.9 3.1
0.9 1.0 0.8 0.9 0.9 0.8 0.9 0.9 1.0 0.9
59.6 59.6 60.6 60.6 61.5 65.4 66.3 67.3 69.2 70.2
2.9 2.9 2.5 2.5 3.1
0.9 0.9 1.0 0.9 0.8
71.2 74.0 84.6 85.6 62.3
*Proportion of responders who did not meet the desired standard.
Correlation among variables and self-perceived practice level of PSC Self-perceived practice level of PSC was significantly correlated with age (r ¼ 0.39; P < .01), years of total clinical experience (r ¼ 0.32; P < .01), years of ICN experience (r ¼ 0.83; P < .01), number of hospital beds (r ¼ 0.23; P < .01), and self-perceived knowledge of IC (r ¼ 0.77; P < .01) (Table 3). Predictors of self-perceived practice levels of PSC Hierarchical regression was used to examine the effects of general characteristics of the respondents and their self-perceived knowledge levels of IC. General characteristics, including age, years of total clinical experience, years of ICN experience, ICN specialist certification, and academic conference or training course attendance, were controlled for in the first block, based on previous studies2,6-8 suggesting that demographic variables might be associated with self-perceived practice levels of PSC. Self-perceived knowledge level of IC was added in the second block. In the first model, age, years of total clinical experience, years of ICN experience, number of hospital beds, ICN specialist certification, and academic conference or training course attendance increased the explained variance by 69.2% (F ¼ 47.275; P < .001). The coefficient of years of ICN experience was significant (b ¼ 0.792; t ¼ 10.606; P < .001). This indicates that self-perceived practice levels of PSC increased with increasing time working as an ICN. When self-perceived knowledge level of IC was entered into the second model, the explained variance was increased by 8.80% (F ¼ 62.035; P < .001). The full model accounted for 78.0% of the variance in self-perceived practice levels of PSC (Table 4). DISCUSSION This study has attempted to contribute to the promotion of health care quality by measuring the self-perceived knowledge level of IC and practice levels of PSC of Korean ICNs. This study is the first work to investigate the competency of Korean ICNs. Our goal was to clarify areas of competency that need strengthening, as well
Competency Domain 1: Leadership and program management Recommends changes in practice based on clinical outcomes and financial implications Collaborates with others as a leader, facilitator, and team member Supports others as an infection control professional when the infection control team is organized Domain 2: Infection prevention and control Understands advantages and disadvantages of complex diagnostic tests (eg, polymerase chain reaction) and interprets results Is involved in the establishment of patient care environment to reduce infection risks during construction and renovation Domain 3: Technology Uses automated algorithmic detection of possible HAIs Accesses the clinical database (eg, EMR, OCS) Domain 4: Performance improvement and implementation science Has sufficient skills and experience to use performance improvement tools (eg, Plan, Do, Study, Act; Six Sigma; Lean) Is aware of the need for performance improvement Average
Mean SD
%*
3.3 0.9 2.8 1.1
51.8 75.0
3.9 0.9
34.6
3.7 1.0
34.6
3.3 0.9 2.7 1.0
52.6 83.7
4.1 0.8
21.2
0.7 1.2 0.8 1.1
43.0 78.8 17.3 63.8
2.8 1.2
70.2
3.5 1.0 3.05 1.14
49.0 51.7
3.5 2.6 4.3 3.0
OCS, order communication system. *Proportion of the responders who did not meet the desired standard. The table only shows the highest and lowest values.
as to create opportunities for comparison between Korean infection preventionists and those from other countries to contribute to the international growth of ICN competency. The Nursing Expertise Self-Report Scale was developed using the Benner model of clinical competence.2 Garland,11 in a study using this model to identify ICU nurses’ self perception of clinical competence, found that a self-perception scale can be useful in identifying clinical competency. In that study, significant differences in practice levels of PSC were related to ICN specialist certification and attendance at academic conferences or training courses. Goldrick reported that certification validated knowledge and clinical competency in a specialty.12 In Korea, ICN specialist certification is acquired through a national qualifying examination after graduating from a specialist nursing program based at a university graduate school.9 Our data demonstrate that this ICN specialist program enhanced the ICNs’ practice levels of PSC. Annual participation in academic conferences and training courses was also shown to be beneficial to ICN competency; however, 62.3% of the respondents still rated their knowledge as insufficient. It seems that this outcome may be related to the wide range of IC experience, from 2 months to 19 years in the field, among responding ICNs. Most respondents reported having insufficient knowledge in the areas of research and construction and renovation in patient care facilities. These domains included tasks that the respondents performed less often during their daily duties. According to Her et al,13 Korean ICNs report the desire to participate in programs, such as statistics, as related to IC practice. APIC and CHICA-Canada suggest that infection preventionists participate in IC prevention and related research on their own or work collaboratively on research to develop practice standards in these fields.5 This suggests that ICN programs should be research-based or be developed to require an advanced degree with a strong research orientation. In addition, ICNs need to be encouraged to do their own research on IC practices. Of the PSC in the 4 future-oriented domains, the technology area had the ICNs’ highest self-perceived levels of competency. This result could be related to ICNs’ need to access patient information, including the electronic medical record (EMR), for monitoring.4 Some studies have reported that using the EMR enables precise
J.S. Choi, K.M. Kim / American Journal of Infection Control 42 (2014) 980-4
983
Table 3 Mean SD and Pearson correlation among the main research variables (n ¼ 104) Variable 1. Practice of PSC 2. Age 3. Years of clinical experience 4. Years of ICN experience 5. Number of hospital beds 6. Knowledge of IC Mean SD Observed range
1
2
3
4
5
6
1.00 0.39** 0.32** 0.83** 0.23** 0.77** 3.05 1.14 1-5
1.00 0.95** 0.52** 0.26** 0.32** 37.5 6.00 23-53
1.00 0.45** 0.24* 0.24* 14.93 5.94 2-30
1.00 0.20 0.65** 5.40 3.95 0.2-19
1.00 0.16 821.38 514.88 99-2780
1.00 3.11 0.76 1-5
*P < .05, **P < .01, independent Pearson correlation test.
Table 4 Predictors of practice levels of PSC (n ¼ 104) Step 1
2
Predictor
b
t
P
R2 change
Adjusted R2
F (P)
Age Years of clinical experience Years of experience as infection control nurse Number of hospital beds ICN specialist certification* Attendance of academic conference or training course* Knowledge of IC
0.073 0.123 0.792 0.066 0.770 0.079 0.395
0.413 0.716 10.606 1.170 1.173 1.404 6.365
.680 .476
