Australian Nursing Students' Infection Control Knowledge and Perceptions: Exploring the Role of Microbiology Education and Clinical Placement Experiences

Healthcare-associated infections (HAIs) have become the most common, preventable complication of healthcare delivery in the modern era. These infections have substantial health, social and economic consequences. Despite the increased awareness of HAIs and the crucial role of infection control (IC) procedures, there is a substantial body of evidence to indicate that healthcare workers (HCWs) are inconsistent in their application of IC precautions and that hand hygiene practice, in particular, is suboptimal in many healthcare settings. The ability to apply microbiology knowledge to assess a situation and respond appropriately has been identified as a component of IC competency. The guidelines for accreditation of Australian pre-registration nursing
programs, however, do not stipulate the level or amount of microbiology to be
included in the curriculum. The effect of variations in microbiology content on
graduates’ IC practice is relatively unknown. The central premise of the study was to gain further insight into the role of microbiology education and the influence of clinical placement experiences on Australian nursing students’ IC perceptions and behaviours.

A parallel mixed methods design was utilised for this project. Student perceptions and conceptions of microbiology were assessed using a longitudinal survey while semistructured interviews with IC professionals (n=8) and a single focus group of final-year students (n=9) were employed to gain insight into the cultural and social influences on nursing students’ IC perceptions and behaviour. Analysis of the longitudinal survey data indicated a persistent perception of microbiology being ‘difficult’ or ‘very difficult’ to learn and being less relevant than other nominated areas of the curriculum, with the exception of sociology. Although nursing students became more familiar with IC procedures, particularly hand hygiene, as they progressed through their pre-registration program, their knowledge and understanding of underlying microbiological concepts was not necessarily enhanced. The qualitative data further highlighted that students’ ability to transfer microbiology knowledge to practice was limited; suggesting the presence of a ‘theory-practice’ gap in relation to microbiology and that placement of theoretical microbiology content within the first-year
bioscience subject potentiated the perceived irrelevance of microbiology to
practice. Safety culture of the ward and poor role modelling of IC practice by clinical supervisors were found to have a significant influence on students’ IC intentions and behaviours.

Without an ability to apply microbiology knowledge to IC decision making (i.e. apply the knowledge in context) there is an inherent risk of incorrect application of IC practices and thus a risk to patient (and nurse) safety. The findings and
recommendations of the study will inform microbiology curriculum development, to ensure graduates are equipped with a strong foundation upon which to base their professional practice. The thesis concludes with a proposal for re-conceptualising the definition and assessment of IC competence. If adopted, these approaches would potentially enhance students' understanding and synthesis of microbiology knowledge and help build students’ IC self-efficacy to apply that knowledge to practice.