Healthcare Associated Infections Control and Nurse Uniforms

Antia

, Krisna Yetti

and Tuti Nuraini

Department of Nursing, Universitas Esa Unggul, Jl. Arjuna Utara No.9, Jakarta, Indonesia

Faculty of Nursing, Universitas Indonesia, Kampus Depok, Depok, Indonesia

Keywords: Healthcare Associated Infections Control, Uniform, Nurses, the Chain Breaker, Hospital.

Abstract: Healthcare Associated Infections control is an effort to improve patient safety in hospitals. Nurses and

uniforms act as one way to break the chain of infection. This study aims to identify the views of nurses in

Healthcare Associated infections cont rol through nurse uniforms. The research design uses descriptive

phenomenology, the process of collecting data is done by Focus Group Discussion. Participants in this study

were taken by purposive sampling of 16 participants, data analysis using the Giorgi method. The results of

the study identified themes: headscarves, sleeves, jewelry and watches, as well as footwear or shoes as part of

Healthcare Associated infections control through uniform. It was concluded that the nurse’s uniform as one

part of the infection chain breaker in the hospital. It is recommended the role of the nursing manager to

establish detailed rules for nurse uniforms during service in the hospital.

1 INTRODUCTION

Patient safety according Peraturan Menteri

Kesehatan No. 11 tahun 2017 is a system that

makes patient care safer, including risk

assessment, identification and management of

patient risk, reporting and analysis of incidents,

the ability to learn from incidents and their follow-

up, as well as the implementation of solutions to

minimize risks and prevent injuries caused by

mistakes caused by carrying out an action or not

taking the action that should be taken (Haryati,

Yetti, Afriani, Handiyani, 2019). The

implementation of patient safety in hospitals is

often not optimal due to role of nurses in the

implementation of patient safety. Gunes research

(2016) shows the results that many nurses in

Turkey still have a negative perception of the

culture of patient safety in their institutions. This

was also expressed by Freixas Sala et al. (2017) that

only 16% of nurses are dedicated full time in the

patient safety program. Nurses are a profession that

lasts for twenty-four hours accompanying and

being close to patients. The role of nurses to

improve patient safety is to try to break the chain of

infection. Handayani's research (2006) found that

data significantly increased the number of

microorganism colonies on uniform use on the

second day compared to the number of colonies

before uniform use.

The phenomenon at the hospital today is nurses

rarely use white uniforms so we did not know how

long the uniforms have been used. White color on

the uniform will show color changes from day to

day. Uniforms that are used are also often added

accessories such as brooches or bracelets on the

wrists. If nurses wear headscarves, it is often seen

that nurses only tie back and often fall forward

while taking action in nursing. This was seen in

several hospitals, both in the capital and in the

regions, at government or private hospital.

However, researchers see that there are still some

hospitals that apply regulations in the use of

uniforms in their hospitals. The hospital is usually

an international hospital. Apart from the concept

that is owned by the hospital management,

researchers are interested in getting a picture of the

perception of nurses who are in hospital

management related to the regulations applied in

the use of uniforms. A good hospital regulation

where when all members under the auspices of

management understand the purpose of the

regulation.

This study aims to obtain an overview of what

components are understood by nurses in the effort

to control infection so that patient safety can be

guaranteed. Specifically, this study aims to know

the correct way to wear the hijab, to know the

settings for the nurses' uniforms, know the use of

jewelry and watches, and to know the correct use of

Antia, ., Yetti, K. and Nuraini, T.

Healthcare Associated Infections Control and Nurse Uniforms.

DOI: 10.5220/0009562700400044

In Proceedings of the 1st International Conference on Health (ICOH 2019), pages 40-44

ISBN: 978-989-758-454-1

footwear or shoes. This research is important as an

effort to increase the awareness of nurses in the use

of uniforms so that the infection chain breaker is not

only through washing hands but also by paying

attention to the use of uniforms that are worn

every day. For educational institutions, through

this research can be used as a scientific foundation

in managing the use of student uniforms while in

hospital. For the general public, the results of this

study if implemented will reduce the number of

HAIs among clients in the inpatient room and

reduce the risk of spreading HAIs from the hospital

to the community.

2 THEORITICAL REVIEW

Quality nursing care needs to be sought to meet the

needs of patients optimally. The optimal

fulfillment of the patient's needs is expected to be

able to improve the patient's health status and not

cause additional unwanted health problems while

the patient is hospitalized. Undang-Undang No. 38

tahun 2014 states that nursing services are a form

of professional service based on nursing

knowledge and tips addressed to individuals,

families, groups, or the community, both healthy

and sick, which are an integral part of health care

services that good nursing services will also

contribute well on health, safety, and patient

safety in hospitals. Nurses who work for 24 hours

caring for patients certainly have a big share not

only in healing, but also risk causing incidents that

can harm patients and hospitals. Management of

services and management of nursing care are two

things that must be carried out optimally by all

managerial levels of nursing led by a Director of

Nursing to ensure quality care and patient safety.

Management according to Weiss and Tappen

(2015) is doing a job through other people. Or in

other words, nursing service management is a way

to manage nurses to provide professional services

based on nursing knowledge to individuals,

families, groups, or communities, both healthy and

sick. Management of nursing services needs to be

supported by good management of nursing care.

Management of nursing care is defined as an

activity to solve or improve needs and quality of life

by assessing needs, planning care and

implementing care for people who need support

because of health problems (Cho et al, 2015).

TKRS 13 Komisi Akreditasi Rumah Sakit 2017

said that every Care Professional is directed to

support a safe culture. Safety culture is defined as

"a collaborative environment in which all care

professionals treat one another with respect, the

head encourages effective teamwork and supports

psychological security, the team learns from

mistakes and is almost injured, the caregiver is

aware of the limitations of human performance in

systems that are complex (stress recognition), and

there is a visible process of learning and

implementing improvements through briefings. At

TKRS 13 Komisi Akreditasi Rumah Sakit 2017,

behaviors that did not support safety culture were

conveyed, including: threatening others that would

affect staff morale and endanger patients.

Effective hygiene and preventing infections

are absolute in all healthcare settings. Although

there is no conclusive evidence that uniforms and

work wear play a direct role in spreading infection,

the clothes that staff wear should facilitate good

practice and minimize any risk to patients. Uniforms

and work wear should not impede effective hand

hygiene, and should not unintentionally come into

contact with patients during direct patient care

activity. Similarly, nothing should be worn that

could compromise patient or staff safety during

care, for example false nails, rings, earings other

than studs, and necklaces. Local policies may

allow a plain ring, such as a wedding ring (United

Kingdom Department of Health, 2010). These are

recommended good practices based on evidence

from the literature reviews, testing and effective

hand hygiene procedures: wear short-sleeved tops

and do not wear white coats during patient care

activity, change immediately if uniform or clothing

becomes visibly soiled or contaminated, dress in

manner which inspires patient and public

confidence, change into and out of, or cover

uniform completely when travelling to and from

work, wear clear indentifiers, wash uniforms and

clothing worn at work at the hottest temperature

suitable for the fabric, clean washing machines and

tumble driers regularly, have clean, short,

unvarnished fingernails; tie long hair back off the

collar. Poor practice includes go shopping in

uniform or engage in other activities outside work,

wear false nails during patient care activity, wear

any jewellery while on duty other than a smooth

ring or plain stud earrings, including a wrist-watch,

on the hands or wrists during direct patient care

activity, wear neckties/lanyards during direct

patient care activity, carry pens, scissors or other

sharp or hard objects in outside breast pockets,

wear numerous badges, wear prominents facial

piercings or display tattoos, dress untidily and in an

unprofessional manner.

Healthcare Associated Infections Control and Nurse Uniforms

3 METHOD

The method used in this study is a qualitative

research method with a phenomenological

approach. This research was conducted on private

Hospital, nurses who were attended by 16 nurses

representing the care unit. The method use Focus

Group Discussion, the place were three times, the

first group was 5 nurses, the second group was 6

nurses, and the third group was 5 nurses.

Participants represent each type of nursing room

where children are represented by 2 (two) nurses,

adult care rooms are represented by 7 (seven)

nurses, ICU / CCU rooms are represented by 2 (two)

nurses, polyclinic rooms are represented by 2 (two)

people, space IGD was represented by 1 (one)

person, and NICU room was represented by 2 (two)

nurses. All participants were female. The data

collection tools used in this study are: a) The

researcher herself as a discussion guide, b)

Unstructured discussion guidelines that contain

open-ended questions to explore data in

accordance with the research objectives, c) Field

notes used to take notes researcher observations

during the discussion process. In analyzing the

data of this study the researcher used the Giorgi

method where clarification was carried out

together with the supervisor.

4 RESULT

Participants said attention should be given to

appearance and uniforms to prevent HAIs. It was

revealed by 13 participants, with age over 30 years

were seven participants, Bachelor degree were

eight participants. Work experience under 5 years

revealed were five participants, 5 to 10 years were

three participants and more than 10 years were five

participants. The category of prevention of HAIs

was mostly revealed in the third DKT, four out of

five participants revealed this category. One

participant even though not expressing the

category still shows agree with the expression of

other participants. The expression is shown

through non- verbal expressions through the nod

of the head signifying agree with the expression.

Prevention of HAIs by paying attention to the

length of the veil used, the veil is inserted into the

clothes. Other components that must be considered

are the sleeves, jewelry and watches as well as

footwear or shoes. Illustrated from the following

participant's statement:

"If we have put the

headscarves in the hospital, it is already good ...

because it reduces contamination

" (FGD 15 May

2015)

"Even if wearing a veil is not long ... so wash

your hands without nosocomial infections."

(FGD

15 May 2015)

If it's possible to use a wedding ring only ...

the watch was originally also not allowed, we

were given a watch that was hung on a shirt to

calculate the pulse, but a few months later the

watch was broken so we were allowed to wear the

watch again. But besides that it shouldn't be used

... for HAI’s

(FGD 18 may 2015)

"It's not possible even when we want to put

infusion, our veil down and it covers. Nosocomial

infections must also be able not to interfere when we

do activity

(FGD May 20, 2015)

Those who wear the headscarf, the sleeve is

3 fingers below the elbow ... but if you do not wear

the hijab the arms are normal ... so as not to get

hit when working ... no nosocomial infection

(FGD 18 May 2015)

5 DISCUSSION

Uniform is one of the media for nosocomial

infections. Uniforms worn by nurses to facilitate

each user's movement and minimize the risk of

contact with patients (LeTexier, 2005, Royal College

of Nursing, 2014). Good management of uniforms

such as changing uniforms in hospitals can reduce

the risk of spreading pathogens from hospitals to

homes and home to hospital (Marcus, 1998,

Handayani, 2006). Uniforms must be managed well

so that they can control the occurrence of HAIs by

changing clinical uniforms every day (Handayani

& Megapurwarsa, 2006). Uniforms must also be

clean at all times. Public opinion indicates that

clean service from nurses can be seen by changing

uniforms at workor covering uniforms when

outside the work area (United Kingdom Department

of Health, 2010).

Participants revealed one way to prevent HAIs

through the use of headscarves that are inserted

into clothing, the size of the headscarf is not too

long, the shape of the arms measuring three-

quarters of the arms. Minimal use of jewelry is also

a thing that can reduce the spread of HAIs, in this

case only using a wedding ring. Some participants

revealed that the use of bracelets is still permissible

as long as not in large quantities. The phrase reflects

not yet fully understood by the participants about

the purpose of applying the policy of using jewelry

ICOH 2019 - 1st International Conference on Health

during service. The expression reflects the use of

jewelry more to the image formed to the patient that

nurses must be simple, not just because to prevent

HAIs. Affirmed by Salisbury, 1997 and the Royal

College of Nursing, 2014, the use of rings, except

wedding rings are permitted during service but

care must be taken of hand hygiene when

washing. Jewelry can be used but in a minimal form

so as to maintain the health and safety or

cleanliness of the jewelry components when doing

activities (Quiambao-udan, 2009; Wilson, et al.,

2007). The role of managers is very necessary in

giving direction so that a correct understanding of

the use of jewelry in the appearance of nurses

(Gillies, 1994; Huber, 2010; Lin, et al. 2007; Longest,

1996; Manulang, 1983; Marquis & Huston, 2008;

Siagian, 2002). Management to improve nurses'

understanding of the prevention of HAIs is very

important. Researchers believe that good

management in terms of direction can increase

nurses' efforts to reduce the number of HAIs

through appearance and uniform clothing. Good

understanding makes nurses limit themselves when

going to use jewelry during business hours.

Directing can be done by periodic supervision and

motivation or by holding and involving nurses in

seminars on the topic of prevention of HAIs. This

directive process will be more effective because

nurses gain knowledge and have the desire to

change themselves from within themselves, not

from the leadership (Hewlett et al., 2009).

The interaction between researchers and nurses

at the hospital was obtained information, many

hospitals hold seminars on various topics

including HAIs. Seen from the results of the FGD,

the expression of the prevention of HAIs was

expressed by thirteen participants out of sixteen

participants. The number of these expressions

reflects the understanding of the prevention of

HAIs through uniform appearance and clothing

understood by almost all participants.

Of the thirteen participants, seven participants

were over 30 years old and had a Bachelor's degree

in nursing were eight people. The distribution

shows cognitive factors are strongly influenced by

the level of education and experience of

individuals. Toha (2008) explains that perception is

essentially a cognitive process experienced by

everyone in understanding information about their

environment, both through vision, hearing,

appreciation, feeling, and smell. A person's

understanding is inseparable from the existing

organizational climate. A positive organizational

climate shapes the satisfaction and motivation of its

members (Fumham, 2003; Gillies, Franks, & Child,

1990; Runtu & Widyarini, 2009). The results

showed that the longer a person interacted with a

positive organizational climate formed a good

understanding of its members.

6 CONCLUSION

This study illustrates nurses' views on controlling

HAIs through the uniforms they use. The results of

the study through the Integrated Group Discussion

found participants revealed the prevention of HAIs

by paying attention to the length of the veilused, the

veil put into clothing. Other components that must

be considered are the sleeves, jewelry and watches

as well as footwear and shoes.

Hospital agencies need to emphasize the

importance of managing nurse uniforms through

firmer policies, especially in the use of

headscarves, sleeves, accessories (brooches) and

watches as well as footwear or shoes. This

research is one of the bases for subsequent studies

including the ability of germs to survive in nurse

uniforms.

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