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Original Article

The Factors Influencing Compliance of Multidrug-resistant Organism Infection Control in Intensive Care Units Nurses

Ji Hee Kim1, Kyung Hee Lim2
Korean Journal of Adult Nursing 2015;27(3):325-336.
Published online: June 30, 2015

1Keimyung University Dongsan Medical Center · Keimyung University Research Institute of Nursing Science, Daegu

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Corresponding author: Lim, Kyung Hee College of Nursing, Keimyung University, 1095 Dalgubeol-daero, Daegu 704-701, Korea. Tel: +82-53-580-3909, Fax: +82-53-580-3904, E-mail: khlim7@kmu.ac.kr
• Received: April 1, 2015   • Accepted: June 11, 2015

Copyright © 2015 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This study was conducted to identify factors influencing compliance of multidrug-resistant organism infection control in intensive care units (ICU) nurses.
  • Methods
    Data were collected from 254 ICU nurses who were working at 6 general and advanced general hospitals in D city and G Province.
  • Results
    77.2% and 84.4% of the subjects correctly answered to questions about Methicillin-Resistant Staphylococcus Aureus (MRSA) and Vancomycin Resistant Enterococcus (VRE), respectively. The scores of MRSA infection control compliance and VRE infection control compliance were 3.41 and 3.43, respectively. The factors influencing MRSA infection control compliance were empowerment, environmental safety recognition, and education satisfaction, which explained 30% of MRSA infection control compliance. The factors significantly related to VRE infection control compliance were empowerment, hospital types, environmental safety recognition, number of education sessions, and neonatal ICU, which explained 37% of VRE infection control compliance.
  • Conclusion
    It is necessary to develop efficient educational programs for infection control including educational contents to improve empowerment and environmental safety recognition of nurses. Furthermore, administrative support for those infection control programs is also necessary.
  • Key Words: Infection control; Intensive care units; Methicillin-resistant staphylococcus aureus; Vancomycin resistance; Enterococcus
Table 1.
The Mean Scores of the Study Variables for Multidrug-resistant Organism Infection (N=254)
Scale M±SD
Knowledge on MRSA   12.35±1.41
Knowledge on VRE 13.50±1.27
Environmental safety recognition 3.02±0.41
Empowerment Meaning 3.97±0.82
Competence 3.31±0.83
Self-determination 3.37±0.86
Impact 3.34±0.81
  Total 3.50±0.70
Compliance with MRSA infection control Hand washing 3.56±0.47
Isolation 3.17±0.73
Gloving 3.66±0.51
Wearing mask 3.43±0.76
Environment management 3.30±0.61
Total 3.41±0.61
Compliance with VRE infection control Isolation 3.34±0.50
Hand washing 3.67±0.42
Environment management 3.43±0.58
Total 3.43±0.44

MRSA=methicillin-resistant staphylococcus aureus; VRE=vancomycin-resistant enterococcus.

Table 2.
Score Differences of the Main Variables according to the General Characteristics (N=254)
Characteristics Categories n (%) Knowledge on MRSA Knowledge on VRE Environmental safety recognition Empowerment Compliance with MRSA Infe5ction Control Compliance with VRE Infection Control
M±SD t t or F (p) M±SD t or F (p) M±SD t or F (p) M±SD t or F (p) M±SD t or F (p) M±SD t or F (p)
Age (year) ＜25a 64 (25.2) 12.17±1.41 0.91 13.45±1.25 1.68 2.97±0.39 4.50 3.24±0.69 11.23 3.30±0.50 14.25 3.38±0.43 2.95
25~29b 85 (33.5) 12.28±1.47 (.435) 13.35±1.38 (.171) 2.99±0.38   3.40±0.57 (＜.001) 3.37±0.45   3.36±0.45 (.033)
30~34c 51 (20.0) 12.47±1.41   13.45±1.12   2.95±0.48 (.004) 3.54±0.78 a, b, c＜d 3.40±0.47 (＜.001) 3.50±0.47  
≥35d 54 (21.3) 12.56±1.31   13.83±1.24   3.20±0.39 a, b, c＜d 3.91±0.64   3.63±0.35 a, b＜d 3.36±0.37  
Education 3-year coursea 117 (46.1) 12.21±1.40 1.36 13.42±1.33 0.44 3.01±0.41 0.08 3.40±0.77 3.90 3.42±0.49 0.00 3.45±0.47 0.00
4-year courseb 108 (42.5) 12.44±1.33 (.260) 13.56±1.25 (.643) 3.03±0.43 (.930) 3.53±0.64 (.022) 3.38±0.45 (.931) 3.40±0.45 (.984)
≥Master degreec 29 (11.4) 12.62±1.68   13.59±1.27   3.04±0.39   3.80±0.50 a＜c 3.48±0.35   3.49±0.29  
Marital status Single 168 (66.1) 12.20±1.40 -2.36 13.38±1.26 -2.21 2.99 (0.40) -1.73 3.39±0.66 -3.63 3.39±0.47 -1.07 3.43±0.43 -0.25
Married 86 (33.9) 12.64±1.40 (.019) 13.74±1.27 (.028) 3.09 (0.45) (.085) 3.71±0.73 (＜.001) 3.46±0.43 (.284) 3.44±0.47 (.802)
Clinical experience (year) ＜3 86 (33.9) 12.05±1.50 -2.49 13.52±1.22 0.21 2.97±0.38 -1.53 3.24±0.65 -4.41 3.31±0.48 -2.62 3.37±0.43 -1.72
≥3 168 (66.1) 12.51±1.33 (.014) 13.49±1.30 (.835) 3.05±0.43 (.127) 3.63±0.69 (＜.001) 3.47±0.44 (.009) 3.47±0.44 (.087)
ICU experience (year) ＜3 124 (48.8) 12.10±1.47 -2.75 13.43±1.30 -0.89 2.96±0.39 -2.28 3.32±0.67 -4.13 3.33±0.48 -2.75 3.37±0.44 -2.17
≥3 130 (51.2) 12.58±1.32 (.006) 13.57±1.25 (.376) 3.08±0.43 (.023) 3.67±0.69 (＜.001) 3.48±0.44 (.006) 3.50±0.43 (.031)
ICU unit MICUa 88 (34.6) 12.32±1.48 1.43 13.33±1.31 1.43 3.05±0.40 0.39 3.57±0.71 0.75 3.43±0.45 1.19 3.53±0.39 4.46
SICUb 80 (31.5) 12.41±1.29 (.224) 13.64±1.25 (.224) 3.02±0.45 (.816) 3.51±0.68 (.558) 3.43±0.43 (.318) 3.49±0.47 (.002)
NSICUc 52 (20.5) 12.58±1.53   13.38±1.30   2.99±0.42   3.42±0.77   3.44±0.44   3.34±0.44 a＞d
Neonatal ICUd 25 (9.9) 12.16±1.25   13.92±1.15   2.97±0.62   3.46±0.56   3.30±0.55   3.22±0.35  
General ICUe 9 (3.5) 11.33±1.12   13.44±1.13   3.11±0.53   3.24±0.81   3.17±0.55   3.17±0.53  
Hospital General Advanced general 108 (42.5) 12.17±1.42 -1.80 13.60±1.24 1.10 3.05±0.46 0.98 3.45±0.81 -0.98 3.44±0.46 1.03 3.57±0.41 4.34
146 (57.5) 12.49±1.40 (.074) 13.42±1.30 (.273) 3.00±0.38 (.331) 3.53±0.60 (.331) 3.39±0.46 (.303) 3.33±0.44 (＜.001)
Position Staff 233 (91.7) 12.34±1.39 -0.27 13.44±1.27 -2.44 3.00±0.41 -2.75 3.46±0.68 -3.07 3.34±0.47 -3.71 3.41±0.44 -3.69
Charge 21 (8.3) 12.43±1.69 (.791) 14.14±1.20 (.015) 3.26±0.40 (.006) 3.94±0.83 (.002) 3.63±0.27 (.001) 3.68±0.30 (.001)
Job satisfaction Disagree 30 (11.8) 12.10±1.21 0.54 13.57±1.41 0.10 2.84±0.38 3.23 3.51±0.80 0.10 3.37±0.49 0.58 3.49±0.48 0.31
Neutral 128 (50.4) 12.39±1.40 (.584) 13.47±1.16 (.912) 3.05±0.41 (.041) 3.48±0.68 (.902) 3.39±0.44 (.563) 3.42±0.46 (.733)
Agree 96 (37.8) 12.38±1.48   13.52±1.38   3.05±0.43   3.52±0.70   3.45±0.47   3.44±0.40  
Education No 45 (17.7) 12.31±1.40 0.94 13.31±1.56 0.94 2.89±0.35 2.46 3.27±0.64 2.45 3.37±0.50 0.67 3.36±0.41 1.31
experience of MRSA & VRE Yes 209 (82.3) 12.36±1.41 (.837) 13.54±1.21 (.354) 3.05±0.42 (.015) 3.55±0.71 (.015) 3.42±0.45 (.506) 3.45±0.44 (.191)
Educational method
Lecture 168 (80.4) 12.31±1.42 1.50 13.51±1.22 0.86 3.05±0.42 2.13 3.51±0.69 2.25 3.41±0.49 1.30 3.43±0.44 1.98
Others 12 (5.8) 12.08±1.62 (.227) 13.33±1.07 (.424) 2.85±0.28 (.122) 3.45±0.63 (.108) 3.25±0.50 (.276) 3.36±0.54 (.141)
≥2 methods 29 (13.8) 12.76±1.24   13.79±1.18   3.14±0.48   3.80±0.80   3.39±0.41   3.60±0.41  
Educational satisfaction
Yes 139 (66.5) 12.47±1.33 1.57 13.63±1.15 1.45 3.11±0.42 2.90 3.56±0.69 0.46 3.48±0.45 2.55 3.50±0.42 2.14
No 70 (33.5) 12.14±1.57 (.117) 13.37±1.30 (.150) 2.93±0.41 (.004) 3.52±0.73 (.643) 3.31±0.44 (.012) 3.36±0.49 (.034)

MRSA=methicillin-resistant staphylococcus aureus; VRE=vancomycin-resistant enterococcus.

Table 3.
Correlations of the Main Variables for Multidrug-resistant Organism Infection Control (N=254)
Variables No. of education sessions Knowledge Environmental safety recognition Empowerment
r (p) r (p) r (p) r (p)
Compliance with MRSA infection control .25 (＜.001) .00 (.956) .39 (＜.001) .49 (＜.001)
Compliance with VRE infection control .30 (＜.001) .10 (.126) .40 (＜.001) .44 (＜.001)

MRSA=methicillin-resistant staphylococcus aureus; VRE=vancomycin-resistant enterococcus.

Table 4.
Factors Affecting Compliance with MRSA & VRE Infection Control (N=254)
Dependent variables Independent variables B SE β t p
Compliance with MRSA infection control Empowerment .23 .00 .42 6.70 ＜.001
Environmental safety recognition .30 .01 .20 2.85 .003
Educational satisfaction .12 .06 .12 2.03 .044
      Adj. R2=.30, F=30.82, p＜.001  
Compliance with VRE infection control Empowerment .02 .00 .39 6.49 ＜.001
Secondary hospital .23 .05 .25 4.46 ＜.001
Environmental safety recognition .03 .01 .21 3.40 .001
No. of education sessions .26 .08 .19 3.22 .002
Neonatal ICU -.08 .03 -.14 -2.42 .016
      Adj. R2=.37, F=25.36, p＜.001  

Adj. R2=Adjusted R2; MRSA=me ethicillin-resistant staphylococcus aureus; VRE =vancomycin-res sistant enteroc coccus.

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    The Factors Influencing Compliance of Multidrug-resistant Organism Infection Control in Intensive Care Units Nurses
    Korean J Adult Nurs. 2015;27(3):325-336.   Published online June 30, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.3.325
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    The Factors Influencing Compliance of Multidrug-resistant Organism Infection Control in Intensive Care Units Nurses
    Korean J Adult Nurs. 2015;27(3):325-336.   Published online June 30, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.3.325
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    The Factors Influencing Compliance of Multidrug-resistant Organism Infection Control in Intensive Care Units Nurses
    The Factors Influencing Compliance of Multidrug-resistant Organism Infection Control in Intensive Care Units Nurses

    The Mean Scores of the Study Variables for Multidrug-resistant Organism Infection (N=254)

    Scale M±SD
    Knowledge on MRSA   12.35±1.41
    Knowledge on VRE 13.50±1.27
    Environmental safety recognition 3.02±0.41
    Empowerment Meaning 3.97±0.82
    Competence 3.31±0.83
    Self-determination 3.37±0.86
    Impact 3.34±0.81
      Total 3.50±0.70
    Compliance with MRSA infection control Hand washing 3.56±0.47
    Isolation 3.17±0.73
    Gloving 3.66±0.51
    Wearing mask 3.43±0.76
    Environment management 3.30±0.61
    Total 3.41±0.61
    Compliance with VRE infection control Isolation 3.34±0.50
    Hand washing 3.67±0.42
    Environment management 3.43±0.58
    Total 3.43±0.44

    MRSA=methicillin-resistant staphylococcus aureus; VRE=vancomycin-resistant enterococcus.

    Score Differences of the Main Variables according to the General Characteristics (N=254)

    Characteristics Categories n (%) Knowledge on MRSA Knowledge on VRE Environmental safety recognition Empowerment Compliance with MRSA Infe5ction Control Compliance with VRE Infection Control
    M±SD t t or F (p) M±SD t or F (p) M±SD t or F (p) M±SD t or F (p) M±SD t or F (p) M±SD t or F (p)
    Age (year) ＜25a 64 (25.2) 12.17±1.41 0.91 13.45±1.25 1.68 2.97±0.39 4.50 3.24±0.69 11.23 3.30±0.50 14.25 3.38±0.43 2.95
    25~29b 85 (33.5) 12.28±1.47 (.435) 13.35±1.38 (.171) 2.99±0.38   3.40±0.57 (＜.001) 3.37±0.45   3.36±0.45 (.033)
    30~34c 51 (20.0) 12.47±1.41   13.45±1.12   2.95±0.48 (.004) 3.54±0.78 a, b, c＜d 3.40±0.47 (＜.001) 3.50±0.47  
    ≥35d 54 (21.3) 12.56±1.31   13.83±1.24   3.20±0.39 a, b, c＜d 3.91±0.64   3.63±0.35 a, b＜d 3.36±0.37  
    Education 3-year coursea 117 (46.1) 12.21±1.40 1.36 13.42±1.33 0.44 3.01±0.41 0.08 3.40±0.77 3.90 3.42±0.49 0.00 3.45±0.47 0.00
    4-year courseb 108 (42.5) 12.44±1.33 (.260) 13.56±1.25 (.643) 3.03±0.43 (.930) 3.53±0.64 (.022) 3.38±0.45 (.931) 3.40±0.45 (.984)
    ≥Master degreec 29 (11.4) 12.62±1.68   13.59±1.27   3.04±0.39   3.80±0.50 a＜c 3.48±0.35   3.49±0.29  
    Marital status Single 168 (66.1) 12.20±1.40 -2.36 13.38±1.26 -2.21 2.99 (0.40) -1.73 3.39±0.66 -3.63 3.39±0.47 -1.07 3.43±0.43 -0.25
    Married 86 (33.9) 12.64±1.40 (.019) 13.74±1.27 (.028) 3.09 (0.45) (.085) 3.71±0.73 (＜.001) 3.46±0.43 (.284) 3.44±0.47 (.802)
    Clinical experience (year) ＜3 86 (33.9) 12.05±1.50 -2.49 13.52±1.22 0.21 2.97±0.38 -1.53 3.24±0.65 -4.41 3.31±0.48 -2.62 3.37±0.43 -1.72
    ≥3 168 (66.1) 12.51±1.33 (.014) 13.49±1.30 (.835) 3.05±0.43 (.127) 3.63±0.69 (＜.001) 3.47±0.44 (.009) 3.47±0.44 (.087)
    ICU experience (year) ＜3 124 (48.8) 12.10±1.47 -2.75 13.43±1.30 -0.89 2.96±0.39 -2.28 3.32±0.67 -4.13 3.33±0.48 -2.75 3.37±0.44 -2.17
    ≥3 130 (51.2) 12.58±1.32 (.006) 13.57±1.25 (.376) 3.08±0.43 (.023) 3.67±0.69 (＜.001) 3.48±0.44 (.006) 3.50±0.43 (.031)
    ICU unit MICUa 88 (34.6) 12.32±1.48 1.43 13.33±1.31 1.43 3.05±0.40 0.39 3.57±0.71 0.75 3.43±0.45 1.19 3.53±0.39 4.46
    SICUb 80 (31.5) 12.41±1.29 (.224) 13.64±1.25 (.224) 3.02±0.45 (.816) 3.51±0.68 (.558) 3.43±0.43 (.318) 3.49±0.47 (.002)
    NSICUc 52 (20.5) 12.58±1.53   13.38±1.30   2.99±0.42   3.42±0.77   3.44±0.44   3.34±0.44 a＞d
    Neonatal ICUd 25 (9.9) 12.16±1.25   13.92±1.15   2.97±0.62   3.46±0.56   3.30±0.55   3.22±0.35  
    General ICUe 9 (3.5) 11.33±1.12   13.44±1.13   3.11±0.53   3.24±0.81   3.17±0.55   3.17±0.53  
    Hospital General Advanced general 108 (42.5) 12.17±1.42 -1.80 13.60±1.24 1.10 3.05±0.46 0.98 3.45±0.81 -0.98 3.44±0.46 1.03 3.57±0.41 4.34
    146 (57.5) 12.49±1.40 (.074) 13.42±1.30 (.273) 3.00±0.38 (.331) 3.53±0.60 (.331) 3.39±0.46 (.303) 3.33±0.44 (＜.001)
    Position Staff 233 (91.7) 12.34±1.39 -0.27 13.44±1.27 -2.44 3.00±0.41 -2.75 3.46±0.68 -3.07 3.34±0.47 -3.71 3.41±0.44 -3.69
    Charge 21 (8.3) 12.43±1.69 (.791) 14.14±1.20 (.015) 3.26±0.40 (.006) 3.94±0.83 (.002) 3.63±0.27 (.001) 3.68±0.30 (.001)
    Job satisfaction Disagree 30 (11.8) 12.10±1.21 0.54 13.57±1.41 0.10 2.84±0.38 3.23 3.51±0.80 0.10 3.37±0.49 0.58 3.49±0.48 0.31
    Neutral 128 (50.4) 12.39±1.40 (.584) 13.47±1.16 (.912) 3.05±0.41 (.041) 3.48±0.68 (.902) 3.39±0.44 (.563) 3.42±0.46 (.733)
    Agree 96 (37.8) 12.38±1.48   13.52±1.38   3.05±0.43   3.52±0.70   3.45±0.47   3.44±0.40  
    Education No 45 (17.7) 12.31±1.40 0.94 13.31±1.56 0.94 2.89±0.35 2.46 3.27±0.64 2.45 3.37±0.50 0.67 3.36±0.41 1.31
    experience of MRSA & VRE Yes 209 (82.3) 12.36±1.41 (.837) 13.54±1.21 (.354) 3.05±0.42 (.015) 3.55±0.71 (.015) 3.42±0.45 (.506) 3.45±0.44 (.191)
    Educational method
    Lecture 168 (80.4) 12.31±1.42 1.50 13.51±1.22 0.86 3.05±0.42 2.13 3.51±0.69 2.25 3.41±0.49 1.30 3.43±0.44 1.98
    Others 12 (5.8) 12.08±1.62 (.227) 13.33±1.07 (.424) 2.85±0.28 (.122) 3.45±0.63 (.108) 3.25±0.50 (.276) 3.36±0.54 (.141)
    ≥2 methods 29 (13.8) 12.76±1.24   13.79±1.18   3.14±0.48   3.80±0.80   3.39±0.41   3.60±0.41  
    Educational satisfaction
    Yes 139 (66.5) 12.47±1.33 1.57 13.63±1.15 1.45 3.11±0.42 2.90 3.56±0.69 0.46 3.48±0.45 2.55 3.50±0.42 2.14
    No 70 (33.5) 12.14±1.57 (.117) 13.37±1.30 (.150) 2.93±0.41 (.004) 3.52±0.73 (.643) 3.31±0.44 (.012) 3.36±0.49 (.034)

    MRSA=methicillin-resistant staphylococcus aureus; VRE=vancomycin-resistant enterococcus.

    Correlations of the Main Variables for Multidrug-resistant Organism Infection Control (N=254)

    Variables No. of education sessions Knowledge Environmental safety recognition Empowerment
    r (p) r (p) r (p) r (p)
    Compliance with MRSA infection control .25 (＜.001) .00 (.956) .39 (＜.001) .49 (＜.001)
    Compliance with VRE infection control .30 (＜.001) .10 (.126) .40 (＜.001) .44 (＜.001)

    MRSA=methicillin-resistant staphylococcus aureus; VRE=vancomycin-resistant enterococcus.

    Factors Affecting Compliance with MRSA & VRE Infection Control (N=254)

    Dependent variables Independent variables B SE β t p
    Compliance with MRSA infection control Empowerment .23 .00 .42 6.70 ＜.001
    Environmental safety recognition .30 .01 .20 2.85 .003
    Educational satisfaction .12 .06 .12 2.03 .044
          Adj. R2=.30, F=30.82, p＜.001  
    Compliance with VRE infection control Empowerment .02 .00 .39 6.49 ＜.001
    Secondary hospital .23 .05 .25 4.46 ＜.001
    Environmental safety recognition .03 .01 .21 3.40 .001
    No. of education sessions .26 .08 .19 3.22 .002
    Neonatal ICU -.08 .03 -.14 -2.42 .016
          Adj. R2=.37, F=25.36, p＜.001  

    Adj. R2=Adjusted R2; MRSA=me ethicillin-resistant staphylococcus aureus; VRE =vancomycin-res sistant enteroc coccus.
    Table 1. The Mean Scores of the Study Variables for Multidrug-resistant Organism Infection (N=254)

    MRSA=methicillin-resistant staphylococcus aureus; VRE=vancomycin-resistant enterococcus.

    Table 2. Score Differences of the Main Variables according to the General Characteristics (N=254)

    MRSA=methicillin-resistant staphylococcus aureus; VRE=vancomycin-resistant enterococcus.

    Table 3. Correlations of the Main Variables for Multidrug-resistant Organism Infection Control (N=254)

    MRSA=methicillin-resistant staphylococcus aureus; VRE=vancomycin-resistant enterococcus.

    Table 4. Factors Affecting Compliance with MRSA & VRE Infection Control (N=254)

    Adj. R2=Adjusted R2; MRSA=me ethicillin-resistant staphylococcus aureus; VRE =vancomycin-res sistant enteroc coccus.

    Table 1.

    Table 2.

    Table 3.

    Table 4.

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