Factors Influencing Emergency Department Nurses' Compliance with Standard Precautions for Infection Control During the COVID-19 Pandemic

Article information

J Korean Acad Fundam Nurs. 2025;32(3):332-341

Publication date (electronic) : 2025 August 31

doi : https://doi.org/10.7739/jkafn.2025.32.3.332

¹⁾Graduate Student, College of Nursing ‧ Research Institute of Nursing Science, Chungbuk National University, Cheongju, Korea

²⁾Associate Professor, College of Nursing ‧ Research Institute of Nursing Science, Chungbuk National University, Cheongju, Korea

Corresponding author: Park, Hyung-Ran College of Nursing, Chungbuk National University 1 Chungdae-ro, Seowon-gu, Cheongju 28644, Korea Tel: +82-43-249-1751, Fax: +82-43-266-1710, E-mail: hyungran@chungbuk.ac.kr

*This article is a revision of the first author's master's thesis from Chungbuk National University.

Received 2025 April 9; Revised 2025 May 26; Accepted 2025 August 18.

Abstract

Purpose

This study explored the impact of infection control knowledge, attitude, and fatigue on compliance with standard precautions (SPs) among emergency department (ED) nurses.

Methods

A descriptive survey design was used with 151 ED nurses from one tertiary hospital and six general hospitals located in C province and D city in South Korea as participants. Data were analyzed using SPSS Statistics, version 29.0. Associations were examined using Pearson correlation coefficients, and factors influencing compliance with SPs were determined through multiple regression analysis.

Results

Compliance with SPs had a statistically significant positive correlation with infection control attitudes (r=0.65, p<.001). Regression analysis confirmed that two variables-infection control attitude (β=.59, p<.001) and hospital type (β=-.22, p<.001)-had significant effects on participants’ compliance with SPs. These variables had a total explanatory power of 46% (F=64.94, p<.001).

Conclusion

This study identified infection control attitudes as a key factor influencing compliance with SPs. Therefore, programs such as ongoing education and campaigns to promote positive infection control attitudes are needed to improve compliance with SPs, and the impact of these programs should be evaluated.

Keywords: Emergency service; hospital; Fatigue; Infection control; Nurses; Universal precautions

INTRODUCTION

The emergence of new infectious diseases is increasing globally and in South Korea. Consequently, the incidence of various infectious diseases is increasing globally, with mortality occasionally occurring during treatment [1]. This situation places a significant strain on the national healthcare system. Since 2000, South Korea has faced several outbreaks of emerging infectious diseases, including SARS in 2003, H1N1 in 2009, MERS in 2015, and COVID-19 in 2019 [1]. These recurring outbreaks have wide-reaching impacts on the nation and the society as a whole [2].

The emergency department (ED) has environmental characteristics that make it the first point of contact for patients with infectious symptoms in a hospital and the primary pathway for hospitalization [3]. ED nurses are often the first to have direct contact with patients whose diagnoses have not yet been confirmed, increasing their likelihood of exposure to infection [4]. To prevent this, during the COVID-19 pandemic, South Korea implemented infection control and screening guidelines based on the 2015 MERS response protocols [2]. Patients with fever and respiratory symptoms were allowed to enter the hospital only after a negative PCR test (Polymerase Chain Reaction test) result, and coughing was monitored in the ED, as even asymptomatic individuals could be infectious. Healthcare providers in the ED use five types of personal protective equipment (PPE) to ensure safety during treatment [5].

ED nurses face difficulties in complying with SPs owing to the severity of patients' conditions and the need to perform their duties quickly [6]. A previous study conducted during the MERS outbreak found that over 40% of ED nurses did not follow PPE guidelines, and hand hygiene compliance was low [7]. During the COVID-19 pandemic, nurses assigned to negative-pressure isolation wards or isolation rooms in general units demonstrated better infection control performance than those working in negative-pressure isolation rooms within emergency departments [8]. Additionally, other studies have shown that ED nurses tend to adhere less to infection control principles than nurses in other departments [9]. Therefore, ensuring ED nurses' compliance with SPs is crucial to prevent infection transmission.

SPs are essential in all hospital settings, including EDs, to prevent infection transmission during all treatments and nursing care, regardless of the patient infection status [10]. As practicing SPs in primary care settings is crucial for enhancing patient safety and quality, attention should be paid in improving compliance with SPs [11]. Healthcare providers' knowledge of infectious diseases is a critical prerequisite for preventing infection [12]. Knowledge promotes behavior by changing attitudes [12]. Poor knowledge of infection control makes it challenging to curb the transmission of infection and consequently enables the spread of infectious diseases [12]. Moreover, since in-depth knowledge of infection control is associated with greater compliance with SPs [13], it is vital to examine the relationship between knowledge of infection control and the practice of compliance with SPs.

Additionally, infection control attitudes were strongly related to compliance with SPs [8]. A positive or negative attitude toward illness can facilitate the adoption of behaviors that intervene in the disease or prevent its transmission [14]. Hence, attitudes toward infection must be identified to promote compliance with SPs to prevent infection.

As infection control has become increasingly important in clinical settings, nurses are required to perform additional tasks such as outbreak response, patient isolation, medication, testing, and prophylaxis alongside their routine duties [15-17]. These responsibilities, which sometimes substitute for physicians' roles, contribute to significant physical and psychological fatigue [15,18]. During outbreaks of emerging infectious diseases, frequent changes in guidelines, shifts in work systems, and continuous vigilance increase infection control fatigue, which negatively affects performance [15,19]. During the COVID-19 pandemic, key factors included prolonged PPE use, rapidly evolving guidelines, and limited experience with infectious disease care [20]. Therefore, it is essential to assess infection control fatigue among ED nurses and examine its impact on compliance with SPs.

This study aimed to identify the relationship between knowledge and attitudes toward infection control, infection control fatigue, and compliance with SPs among ED nurses and to identify factors influencing compliance with SPs.

METHODS

1. Design

A descriptive survey was used to determine the impact of infection control knowledge, attitudes, and fatigue on compliance with SPs among ED nurses.

2. Participants and Setting

Participants in this study are comprised of nurses working in the EDs of one tertiary hospital and six general hospitals located in C province and D city in South Korea, who agreed to participate. Nurses with at least 6 months of clinical experience were selected.

The sample size was calculated using G-power 3.1.9.4 to perform multiple regression analysis. The minimum sample size was 147, with a medium effect size of .15, according to Cohen [21], a significance level of .05, a power of .90, and 10 predictor variables (three independent variables and seven general characteristics). Considering a 10% dropout rate, 162 questionnaires were distributed and 155 were returned. Finally, 151 questionnaires were used for data analysis after excluding four incomplete questionnaires.

3. Measures

A structured questionnaire was administered to assess general characteristics, compliance with SPs, infection control knowledge, infection control attitudes, and infection control fatigue. The general characteristic data collected included age, hospital type, highest education level, total years of work experience, experience in the ED, and experience with infection control training.

1) Compliance with SPs

Compliance with SPs was measured using the SPs Performance Instrument developed by Hong et al. [22] based on the SPs guidelines of the U.S. Centers for Disease Control and Prevention (CDC), modified and validated by Baek [23], and further revised by the authors according to the Guidelines for Prevention and Control of Healthcare-Associated Infections (HAIs) [24]. Content validity was assessed by one nursing professor certified as an Infection Control Advanced Practice Nurse (ICAPN), one ICAPN-certified infection control nurse, and one infection control nurse working in an infection control team who also holds an ICAPN certification. The content validity index (CVI) for all evaluated items was 1.0. The tool consists of 48 questions across nine subsections: 11 on hand hygiene, 9 on PPE, 5 on respiratory/cough etiquette, 2 on equipment and supplies, 3 on environmental management, 2 on linen management, 11 on safe injection practices, 3 on Healthcare worker (HCW) safety, and 2 on patient placement. Each item is rated on a 5-point Likert scale, ranging from "never performed" (1 point) to "always performed" (5 points), with higher scores indicating greater compliance with SPs. In Baek's [23] study, the Cronbach's ⍺ was .89. Meanwhile, the Cronbach's ⍺ in this study was .95.

2) Infection control knowledge

Infection control knowledge was measured using a 42-item instrument originally developed by Kim et al. [25], which was modified by the authors based on the Guideline for Prevention and Control of HAIs [24]. Content validity was assessed by one nursing professor certified as an Infection Control Advanced Practice Nurse (ICAPN), one ICAPN-certified infection control nurse, and one infection control nurse working in an infection control team who also holds an ICAPN certification. The CVI for all evaluated items was 1.0. The tool comprises 49 questions across subsections: 4 on the concept of SPs, 6 on hand hygiene, 13 on the use of PPE, 5 on respiratory/cough etiquette, 2 on linen management, 3 on environmental management, 12 on safe injection practices, 2 on HCW safety, and 2 on patient placement. Each question was answered by "yes", "no", or "don't know", with a score of 1 for a correct answer and 0 for an incorrect answer or a "don't know" answer. A higher score suggested a deeper level of knowledge. Three items that were ambiguous in their interpretation were removed, which hindered reliability owing to low correct response rates. The original tool had a Kuder-Richardson Formula (KR)-20 score of .82, while the KR-20 in this study was .51.

3) Infection control attitude

To measure infection control attitudes, we adapted the original compliance items to evaluate whether the participants held positive or negative views of each standard precaution item. Attitudes and compliance are closely related concepts [8]. The SPs Performance Instrument, developed by Hong et al. [22] based on the CDC SPs Guidelines, modified and validated by Baek [23], and further revised according to the Guidelines for Prevention and Control of HAIs [24], was used. Infection control attitudes were measured using this item. The content validity of the adapted tool was assessed by a nursing professor certified as an infection control nurse practitioner, an infection control nurse practitioner, and a certified infection control team. The CVI for all evaluated items was 1.0. The tool consists of 48 questions across 9 subsections: 11 on hand hygiene, 9 on PPE, 5 on respiratory/cough etiquette, 2 on equipment and supplies, 3 on environmental management, 2 on linen management, 11 on safe injection practices, 3 on HCW safety, and 2 on patient placement. Each item is rated on a 5-point Likert scale ranging from "not at all important" (1 point) to "very important" (5 point), with higher scores indicating more positive infection control attitudes. In Baek's [23] study, the Cronbach's ⍺ was .89 while in the current study, the Cronbach's ⍺ was .96.

4) Infection control fatigue

Infection control fatigue was measured using the infection control fatigue tool developed by Gu [15], which Jang [16] modified and validated for the ED context. The tool comprises 38 items across five subscales: complex procedures and staffing shortages, conflict and lack of support due to uncertainty, deteriorating patient conditions and lack of knowledge, difficulties due to new roles and demands, and burden due to infection concerns and excessive attention. Each item is rated on a 5-point Likert scale ranging from "not felt at all" (1 point) to 5 "felt very strongly" (5 point), with higher scores indicating higher levels of infection control fatigue. In Jang's [16] study, Cronbach's ⍺ was .94 while in the present study, the Cronbach's ⍺ was .96.

4. Data Collection

Data were collected from September 1 to 30, 2022. After obtaining permission from the nursing department of the target hospital and cooperation from the ED unit, the researcher distributed questionnaires to the nurses, along with an explanation of the study's purpose and procedures. Completed questionnaires were returned either in person or by mail and sealed in envelopes upon receipt. Each response is coded using a unique identifier. Participants received a small token of appreciation upon completion.

5. Data Analysis

Data were analyzed using SPSS Statistics 29.0, and the general characteristics were analyzed using frequencies and percentages. Participants' infection control knowledge and attitudes, infection control fatigue, and compliance with SPs were analyzed using means and standard deviations. Differences in compliance with SPs according to general characteristics were analyzed using an independent t-test, one-way Analysis of Variance (ANOVA), and Scheffé test for post-hoc tests. The correlation between each variable was analyzed using Pearson's correlation coefficient. Multiple regression analysis was used to identify factors affecting participants' compliance with SPs.

6. Ethical Considerations

This study was approved by the Institutional Review Board of the researcher's affiliated institution (CBNUH 2022-07-018-003). All participants received a written explanation of the purpose and procedures of the study and were provided with informed consent prior to participation. The consent form included information on voluntary participation, the absence of foreseeable risks, assurance of anonymity through the use of identification codes, and the exclusive use of data for research purposes.

RESULTS

1. Differences in Compliance with SPs according to General Characteristics

The mean age of the participants was 29.92±6.55 years, and the highest frequency was between the ages of 25 and under the age of 29, at 47.7% (n=72). The most frequently reported education level was a bachelor's degree, followed by associate degrees and graduate-level education or higher. The average total work experience was 6.47± 6.27 years, and those with less than 5 years had the highest frequency at 52.3% (n=79). The average ED work experience was 4.41±4.25 years, and those with less than 5 years had the highest frequency at 66.9% (n=101). Regarding the hospital type, 56.3% (n=85) were general hospitals and 43.7% (n=66) were tertiary hospitals. A total of 99.3% (n=150) of the participants reported having received infection control education.

Differences in compliance with SPs according to the general characteristics of the participants are shown in Table 1. Among the general characteristics, there were significant differences by hospital type (t=-5.01, p<.001) and by ED experience (F=3.42, p=.035). As for hospital type, compliance with SPs was significantly higher in general hospitals (4.63±0.34) than in tertiary ones (4.33±0.39). In the post-hoc analysis, compliance with SPs in the ED setting was significantly higher among those with more than 10 years of experience (4.65±0.28) than those with 5 to 10 years of experience (4.36±0.36) (Table 2).

Table 1.

Differences in Compliance with SPs According to General Characteristics (N=151)

Table 2.

Scores of Infection Control Knowledge, Attitudes, Fatigue, and Compliance with SPs (N=151)

2. Scores of Infection Control Knowledge, Attitudes, Fatigue, and Compliance with SPs

The participants' infection control knowledge, attitude, fatigue, and compliance with SPs are shown in Table 2. The mean score of infection control knowledge was 46.27 ±2.08 out of 49, that of infection control attitude was 4.74 ±0.32, and that of infection control fatigue was 3.56±0.67. Compliance with SPs had a mean of 4.50±0.39 (Table 2).

Participants correctly answered 95.4% of the questions on infection control knowledge. Respiratory and cough etiquette received the highest percentage of correct responses (98.3%), followed by HCW safety (98.0%), patient placement (98.0%), linen management (97.6%), safe injection practices (97.3%), concept of SPs (95.5%), and environmental management (92.7%). The lowest percentages of correct responses were obtained for hand hygiene (90.8%) and PPE (90.4%) (Table 3).

Table 3.

Infection Control Knowledge (N=151)

3. Correlations between Infection Control knowledge, Attitudes, and Fatigue, and Compliance with SPs

The correlations between the participants’ infection control knowledge, infection control attitude, infection control fatigue, and compliance with SPs are presented in Table 4. Infection control attitude was positively correlated with compliance with SPs (r=.65, p<.001), indicating that the more favorable the infection control attitude, the higher the compliance with SPs (Table 4).

Table 4.

Correlations among Infection Control Knowledge, Attitudes and Fatigue, and Compliance with SPs (N=151)

4. Factors Influencing Compliance with SPs

To identify the factors influencing compliance with SPs, multiple regression analysis was performed. General characteristics that showed statistically significant differences in compliance with SPs were entered as dummy variables. These included hospital type and years of experience in the ED, categorized as more than 5 years and less than 10 years. Infection control attitudes that were significant in the correlation analysis were entered as continuous variables.

For multiple regression, the autocorrelation between the independent variables was checked; the Durbin-Watson test value was 2.26, which is close to 2, indicating no autocorrelation between the independent variables. The tolerance limit for the variables was 0.92, which is greater than 0.1, and the variance inflation factor (VIF) value was 1.08, which is less than 10, confirming the absence of multicollinearity. The regression model was significant (F=64.94, p<.001), with a total explanatory power of 46%. The variables that had a significant impact on compliance with SPs were infection control attitudes (β=.59, p<.001) and hospital type (β=-.22, p<.001) (Table 5).

Table 5.

Factors Affecting Compliance with SPs (N=151)

DISCUSSION

This study explored the factors influencing ED nurses' compliance with SPs. Factors affecting compliance with SPs were infection control attitudes and hospital type; these variables explained 46% of the variance in compliance with SPs.

Infection control attitudes were the most influential variables in terms of compliance with SPs. Positive infection control attitudes were associated with better compliance with SPs. This finding is in line with a study of nurses working in a COVID-19 care unit in India [26], which revealed that the more positive the nurses' attitudes, the deeper their intention to provide care for COVID-19 patients. Other studies have shown a significant correlation between infection control attitudes and performance [27]. Hence, changing negative infection control attitudes to positive attitudes is vital to increasing compliance with SPs among ED nurses. To reduce negative attitudes toward infectious diseases and prepare for an emerging epidemic, simulation training programs tailored to the characteristics [28] may be effective, as such programs could reduce anxiety and change attitudes. In this study, attitudes toward infection control were positive, with a mean rating of 4.74 out of 5. This is higher than the score of 4.24 in another study of nurses in COVID-19-designated long-term care hospitals [29]. This finding suggests that attitudes have improved since the previous study was conducted, likely because the importance of preventing infection transmission in healthcare organizations has been emphasized since the experience with MERS [2]. For enhanced infection control of emerging infectious diseases, medical institutions have implemented specific and systematic education on infection control and have provided management guidelines based on the latest guidelines issued by the Korea Disease Control and Prevention Agency (KDCA) [4], which may have influenced the formation of positive attitudes toward infection control. Nevertheless, to overcome the obstacles that hinder compliance with SPs, education and training on how to comply with SPs and deal with emergency situations should be jointly offered to protect against infections.

The second factor influencing compliance with SPs was hospital type. Compliance with SPs was lower in tertiary hospitals, which contradicts the findings of previous studies. Prior research has indicated that nurses in small- and medium-sized general hospitals in Korea exhibit lower compliance with SPs than those in tertiary hospitals [30]. Furthermore, studies have shown that nurses in primary healthcare facilities abroad demonstrate lower compliance with SPs than those in tertiary healthcare facilities [31], which contrasts with the findings of the present study. This may be attributed to the fact that the ED of a tertiary hospital located in C Province operated the only "Infection-Safe Emergency Department" in the region during the data collection period, and this ED was the sole provider of nursing care to confirmed and suspected COVID-19 patients in critical condition who visited the emergency rooms within the province. A previous study also reported that although knowledge of infection control increased during the COVID-19 pandemic, actual implementation during work shifts was difficult owing to the nature of the job, with time constraints and excessive workload cited as major barriers [32]. Therefore, the findings of this study may reflect an increased and excessive workload compared with previous periods. This outcome differs from that of previous studies; therefore, further studies are required.

No statistically significant correlation was observed between compliance with SPs and infection control knowledge. Previous studies in South Korea and abroad [13,33] indicate that the deeper the knowledge, the greater the compliance with SPs, which contradicts the results of the present study. This could be because despite having a high level of knowledge due to extensive education on healthcare-associated infection control, the performance rate is inadequate due to the nature of nurses' work in the clinical field, resulting from overwork and emergency situations. Thus, greater knowledge may not be a prerequisite for improving compliance with SPs. The participants' level of infection control knowledge was 46.27 out of 49, and the average correct answer rate was 95.4%. Although the tool employed was not the same as that used in the present study, another study of hospital nurses found a 92.2% correct response rate [33], and another study of COVID-19 nurses noted a 78.1% correct response rate [4]. In a study of international COVID-19 hospital nurses [34], knowledge was 85.6% more accurate, which was higher than in this study. These results are difficult to compare directly due to the use of different knowledge measurement tools in each study. However, this is likely because healthcare institutions in South Korea are required under regulations, such as the Medical Service Act and the Infectious Disease Control and Prevention Act, to provide infection control education to healthcare workers at least once a year. Additionally, the strengthening of infection control measures following the emergence of novel infectious diseases such as MERS and COVID-19 is believed to have contributed to the improvement in healthcare workers' knowledge of infection control. The item "When removing a surgical mask, loosen the top strap first and then the bottom strap" (correct/false) had the lowest overall response rate. Meanwhile, the item "Personal protective equipment (e.g., gloves, gowns, etc.) is always worn at work" (correct/ false) had the lowest response rate. This may be due to un-familiarity with the use of surgical masks, which resulted from the infrequent use of these masks. The goal was to identify general principles of use as well as correct donning and doffing of PPE during education on the prevention and control of healthcare-associated infections so that SPs could be carried out based on accurate knowledge.

In the present study, compliance with SPs and infection control fatigue were not correlated, and infection control fatigue was not significantly correlated with infection control performance, as reported in a previous study [18]. ED nurses perform additional tasks such as screening and isolating suspected patients, wearing PPE, and disinfecting the environment during the outbreak of emerging infectious illnesses such as COVID-19, which has increased their workload [18]. In addition, nurses experience fatigue as they must adapt to a system that constantly adds and changes tasks as guidelines are added in response to the evolving situation both domestically and abroad [2]. Despite these challenges, nurses are professionals who make decisions in clinical situations to improve the quality of care by increasing patient safety and security [33]. Regardless of infection control fatigue, the authors believe that ED nurses generally maintain compliance with SPs, which is an essential task of ED nurses.

In this study, the average compliance score for SPs was 4.5 out of 5.0. Although no prior study has used the same tool, this score was higher than that of ED nurses before COVID-19 [35]. This is likely due to increased infection control awareness and repeated training during the pandemic. Previous studies reported that personnel and resource shortages, heavy workloads, and lack of knowledge and time hinder compliance [18,23]. Thus, structural improvements such as adequate staffing, resource support, and sufficient working hours are needed to reduce infection control fatigue among ED nurses.

This cross-sectional study included ED nurses from one tertiary hospital and six general hospitals in C province and D city. Therefore, there are limitations to the generalization and interpretation of the results. Thus, repeated studies of ED nurses in various settings are required.

CONCLUSION

This study analyzed the factors affecting ED nurses' compliance with SPs during the COVID-19 pandemic to provide a basis for exploring effective infection control strategies.

ED nurses' compliance with SPs showed a statistically significant positive correlation with their attitudes towards infection control. The factors that influenced ED nurses' compliance with SPs were infection control attitudes and hospital type. Among these factors, infection control attitudes had the greatest impact on compliance. Therefore, to enhance compliance with SPs among ED nurses, continuous education and training programs should be implemented to foster positive infection control attitudes and reinforce the perceived importance of compliance with SPs.

Notes

CONFLICTS OF INTEREST

The authors declared no conflict of interest.

AUTHORSHIP

Study conception and design acquisition - Choi SY and Park H-R; Data collection - Choi SY; Data analysis & Interpretation - Choi SY and Park H-R; Drafting & Revision of the manuscript - Choi SY and Park H-R.

DATA AVAILABILITY

Please contact the corresponding author for data availability.

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Variables	Categories	n (%) or M± SD	Compliance with SPs
Variables	Categories	n (%) or M± SD	M± SD	t or F	p	Scheffé
Age (year)	20∼24	20 (13.2)	4.57±0.40	2.63	.075
	25∼29	72 (47.7)	4.42±0.40
	≥30	59 (39.1)	4.57±0.36
		29.92±6.55
Hospital type	Tertiary hospital	66 (43.7)	4.33±0.39	−5.01	＜.001
Hospital type	General hospital	85 (56.3)	4.63±0.34
Education level	Associate degree	20 (13.2)	4.49±0.40	1.43	.242
	Bachelor's degree	118 (78.2)	4.48±0.38
	Graduate degree or higher	13 (8.6)	4.68±0.41
Total work experience (year)	＜5	79 (52.3)	4.50±0.41	2.46	.089
	5–10	43 (28.5)	4.42±0.38
	≥10	29 (19.2)	4.63±0.32
		6.47±6.27
Emergency department experience (year)	＜5^a	101 (66.9)	4.52±0.40	3.42	.035	b＜ c
	5∼10^b	33 (21.8)	4.36±0.36
	≥10^c	17 (11.3)	4.65±0.28
		4.41±4.25
Infection control educational training	Yes	150 (99.3)	4.51±0.39	0.85	.199
Infection control educational training	No	1 (0.7)	4.40±0.44

Variables	Item	M± SD	Range	Scale range
Infection control knowledge	49	46.27±2.08	36∼49	0∼49
Infection control attitudes	48	4.74±0.32	3.00∼5.00	1∼5
Infection control fatigue	38	3.56±0.67	1.08∼5.00	1∼5
Compliance with SPs	48	4.50±0.39	3.27∼5.00	1∼5

Variables	Infection control knowledge	Infection control attitude	Infection control fatigue	Compliance with SPs
Variables	r (p)	r (p)	r (p)	r (p)
Infection control knowledge	1
Infection control attitudes	.13 (.105)	1
Infection control fatigue	.04 (.616)	−.04 (.593)	1
Compliance with SPs	−.02 (.829)	.65 (＜.001)	−.08 (.330)	1

Variables	B	SE	β	t	p
(Constant)	1.16	0.37		3.16	.002
Infection control attitudes	0.72	0.08	.59	9.47	＜.001
Hospital type (tertiary hospital)^†	−0.17	0.05	−.22	−3.48	＜.001
	R²=.47 Adjusted R²=.46 F=64.94 p＜.001

Categories	Percent correct (%)
Concept of SPs	95.5
Hand hygiene	90.8
PPE	90.4
Respiratory/cough etiquette	98.3
Linen management	97.6
Environmental management	92.7
Safe injection practices	97.3
HCW safety	98.0
Patient placement	98.0
Total average	95.4