Qom University of Medical Sciences Journal

Healthcare-acquired infections (HAIs) can develop complications leading to extended hospital stays, high resistance to pathogenic organisms, high healthcare costs, and preventable deaths. For reducing the risk of HAIs, standard precautions (SPs) have been determined for the patients. The World Health Organization (WHO) reported that SPs are the practices of healthcare providers that apply the fundamental principle of infection prevention and control. Nurses are the frontline healthcare providers who deliver direct patient care. Nursing students are often exposed to HAIs during clinical training. Thus, their compliance with SPs should be investigated.
Previous studies have gained considerable interest both in the role of nursing education and practice in SPs. Educating nursing students is very important to ensure that they have the appropriate knowledge and skills for infection prevention and control. Kirkpatrick proposed a “four-level model” for evaluating the training effectiveness which includes: Level 1= Reaction, which measures participants’ satisfaction; Level 2= Learning, which evaluates the knowledge or skills of participants; Level 3= Behavior, which measures the performance of participants; and Level 4= Results, which evaluates the impact of the material on the  business, such as changes in patient’s health. Despite teaching students how to prevent HAIs, the rate of infection is still high among them; hence, it is necessary to use new methods to increase their knowledge and improve their behaviors. Therefore, the present study aims to examine the effect of teaching SPs for infection prevention and control based on Kirkpatrick’s model on the knowledge and practice of nursing students.
Methods
This is an experimental study that was performed on 70 nursing students of Khoy University of Medical Sciences and Islamic Azad University of Khoy branch in Khoy, Iran in 2021. Due to the limited study population, all final-year students were selected by a census method and randomly assigned to two groups of intervention and control using the table of random numbers. The inclusion criteria were being an undergraduate nursing student in the 7th semester and willingness to participate in the study, while the exclusion criteria were absence from some interventional sessions and unwillingness to continue participation in the study.
For the intervention group, an educational program based on Kirkpatrick’s model was presented, while for the students in the control group, an educational booklet was presented. After the training program, its effectiveness was evaluated at four levels (reaction, learning, behavior, results) based on Kirkpatrick’s model. The amount of learning was assessed using a researcher-made test conducted before and after the intervention. To evaluate the behavior or practice of students, a functional checklist was used which consisted of 8 sections and 66 tasks, including washing hands with soap and water, disinfecting hands with alcohol-based hand sanitizers, dressings, injections, oral or tracheal suctioning, and wearing masks and scrubs. The checklist was filled out before and one month after the intervention. The correct performance in each task was given 1 point, while a wrong performance was given 0 points. The total ranged from 0 to 66.
Results
Most of the students were in the age group of 22-25 years and their mean age was 22.7±2.9 years. Most of them were female (54.2%) and single (85.7%). The mean total score of students in the reaction step was 3.7± 0.4. Their mean learning and behavior scores after the educational program increased significantly.
Discussion
Nursing students have essential roles in preventing transmission and mitigating the risk of HAIs. Education based on Kirkpatrick’s model increased the knowledge and practice of nursing students in applying SPs. It can be used as a method for teaching nursing students to provide effective nursing care to patients. Nursing students are recommended to use Kirkpatrick’s model to improve their nursing practice. Nursing lecturers can use this educational model for teaching in practical environments, such as hospitals. The role of nursing lecturers in modifying learning methods is important to improve the students’ competency.
Ethical Considerations
Compliance with ethical guidelines
This article is the result of a research project approved by Khoy University of Medical Sciences and Health (Ethical Code: IR.KHOY.REC.1400.005).


Funding
Vice Chancellor of Research and Technology of khoy University of Medical Sciences has been the financial sponsor of this research.
Authors contributions
All authors contributed equally in preparing all parts of the research.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The financial support of the education, research and student support of Khoy Faculty of Medical Sciences and Healthcare Services is gratefully acknowledged. In the end, we would like to thank all the participating students who helped us in this project.