Indonesian Journal of Global Health

Research
Volume 2 Number 3, August 2020, pp. 207 -
216
e-ISSN 2715-1972; p-ISSN 2714-9749
http://jurnal.globalhealthsciencegroup.com/index.php/IJGHR

TRAINING TO IMPROVE KNOWLEDGE, SKILLS AND BEHAVIORS OF

HEALTHCARE ASSOCIATED INFECTIONS PREVENTIONS IN NURSES

Dewa Gede Baskara1, Ni Putu Emy Darma Yanti 2*, Ida Ayu Md Vera Susiladewi 3 1Prima Medika
Hospital, Jl. Raya Sesetan No.10, Dauh Puri Klod, Kec. Denpasar Barat, Kota Denpasar, Bali, Indonesia
80223
2
Nursing Management Department, Nursing School, Faculty of Medicine, Udayana University, Jl. P.B.
Sudirman, Dangin Puri Klod, Kec. Denpasar Barat, Kota Denpasar, Bali, Indonesia 80232 3Bali
Mandara Regional General Hospital, Jl. By Pass Ngurah Rai No.548, Sanur Kauh, Kec. Denpasar
Selatan, Kota Denpasar, Bali, Indonesia 80228
*emydarmayanti@unud.ac.id
ABSTRACT
Hospitals can be a source of transmission of microorganisms to patients during treatment. Infections
acquired by patients while being hospitalized are called Healthcare Associated Infections (HAIs), so
HAIs are an indicator of the quality of care provided by the hospital. The purpose of this study is to
know the effectiveness of training on the knowledge, skills, and behavior of prevention of HAIs in
nurses in the hospital. A quasi-experimental research design with a pre-test and post-test design with a
control group design on 140 nurses through purposive sampling was used. Data collection used
questionnaires (r value 0.412-0.716> r table 0.294; Cronbach Alpha 0.753) and observation sheets. The
Wilcoxon test was used to analyze the mean difference between groups because the data were not
normally distributed. The mean difference between the control and intervention groups was analyzed
using the Mann-Whitney test. The results of the study obtained shows the effect of training on
knowledge (p value <0.001), skills (p value <0.001), and behavior (p value = 0.041) on HAI prevention
in the intervention group. In fact, in the control group, it was found that there was no effect of training
on knowledge, skills and behavior of prevention of HAIs (p value> 0.005). There were differences in
knowledge, skills, and behavior of HAI prevention between the intervention group and the control
group (p value <0.001).

Keywords: behavior; health care-associated infections; knowledge; nurse; skills; training

First Received
Revised
Accepted
20 June 2020
19 August 2020
28 August 2020

Final Proof Received

Published
29 August 2020
31 August 2020

How to cite (in APA style)

Baskara, D., Yanti, N., & Susiladewi, I. (2020). Training to Improve Knowledge, Skills and Behaviors
of Healthcare Associated Infections Preventions in Nurses. Indonesian Journal of Global Health
Research, 2(3), 207-216.

INTRODUCTION
Modern medicine in health care facilities places emphasis on a wide variety of invasive
tools and procedures to treat patients and aid recovery. Infection can occur as a result of
using medical instruments and procedures, such as catheters or ventilators (CDC, 2014).
The quality of nursing services in hospitals is assessed based on various indicators. One
of them is the control of nosocomial infections which is also the standard for hospital
accreditation assessments (Atmadja, 2012).

Nosocomial infections or what is currently known as Healthcare-associated infections

(HAIs) are infections that occur when a patient receives treatment, in a hospital or other
health facility that appears after 48 hours of receiving treatment (Haque, Sartelli,
McKimm, & Bakar, 2018). HAIs are a serious problem for hospitals because they not

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only cause socio-economic losses, but can also prolong patient hospitalization, which
may even result in death (World Health Organization, 2015).

HAIs include central line-associated bloodstream infections, catheter-associated urinary

tract infections, and ventilator-associated pneumonia. Infections also may occur in the
operating area, known as surgical site infections (CDC, 2014). The risk of patients
getting HAIs is high in the intensive care unit. Nearly 30% of patients experience at
least one episode of HAIs with a high risk of morbidity and mortality (World Health
Organization, 2011). In low- and middle-income countries, the frequency of HAIs in the
ICU is at least 2-3 times higher than in high-income countries, whereas infection due to
use of tools is up to 13 times than in the United States. Although global estimates of
HAIs are not yet available, integrating the data collected by WHO, it can be concluded
that hundreds of millions of patients experience HAIs every year worldwide, with a
tendency to occur more in low and middle income countries (World Health
Organization, 2015).

HAIs must be treated as a priority problem of patient safety in a comprehensive

approach to be handled effectively including by improving the quality of reporting and
learning mechanisms (World Health Organization, 2011). Patients and health workers
are reservoirs of infection, therefore, it is necessary to be firm in implementing infection
control in order to improve patient safety (Khan et al., 2017).

Infection control in health care facilities is an important matter and is the responsibility
of all health workers. Of the various components of the infection control program,
education and training of health workers on safe and good infection prevention practices
have a vital role (Atalla, Aboalizm, & Shaban, 2016). However, knowledge of the
guides alone is not sufficient for behavior change, so the educational method is expected
not only to lecture on guides (Noto et al., 2015). There are nine main components to
preventing HAIs. The main components include education and training as well as
changing habits to improve service quality, especially prevention of HAIs (WHO, 2016).

If on average the nurses has sufficient knowledge and adherence to the HAIs guidelines,
but there is a knowledge gap between one nurse and another, it will cause problems in
implementing the guidelines (Accardi et al., 2017). All health care providers have the
same responsibility to prevent HAIs (Singh, Chaturvedi, Garg, Datta, & Kumar, 2013).
However, nurses are the leading providers of care andsupport to patients making them
an important component in infection prevention and control. To ensure this, it is very
important for nurses to keep up-to-date knowledge about infection prevention and
control (Dogra, Mahajan, Jad, & Mahajan, 2015).

Based on this, this study is important to carry out an effort to prevent the infection of
HAIs in patients. This research has never been conducted before at Prima Medika
Hospital, Denpasar, Bali. This study aims to assess the increase in knowledge, skills and
behavior of HAIs prevention among nurses by using training methods. This research is a
type of quantitative research with a quasi-experimental approach.

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METHOD
The research design was a quasi-experimental design with pre-test and post-test design
with control group design. This study involved 80 nurses at Prima Medika General
Hospital who were determined based on purposive sampling technique. The inclusion
criteria for this study were: 1) nurses who performed aseptic procedures, 2) nurses who
were not on leave, sick, on holiday, or undergoing study assignments when the research
was carried out, and 3) nurses who were willing to participate in this study by signing
an agreement sheet provided by the researcher. The criteria for drop out in this study
were nurses who did not follow all stages of the research. The nurses were then divided
into two groups using simple random sampling method so that 40 nurses were assigned
to the control group and 40 nurses as the intervention group. The dependent variables in
this studyare knowledge of HAIs, skills, and behavior to prevent HAIs. Meanwhile, the
independent variable is training on HAIs.

On the first day of the intervention, OSCE 1 examinations were carried out in the
control and intervention groups. The OSCE that is carried out is the OSCE with a
catheter insertion case background that prioritizes the principles of infection prevention
and control such as washing hands, using PPE, performing disinfection, and conducting
no-touch techniques. In addition, all study participants were given a knowledge
questionnaire while waiting their turn for the OSCE as a pre-test. OSCE observations
were carried out by an independent party, namely the experienced Medical Education
Unit staff from the Faculty of Medicine, Udayana University. On the following day,
training was conducted for the intervention group. The training was carried out in one
meeting session in the fourth week of May 2018 comprised of lecture, discussion, and
practice methods. The materials presented included: 1) Patient Safety Curriculum
Guide: HAIs, 2) Hand hygiene procedures, 3) Use of gloves, and 4) Aseptic &
Decontamination Procedures. The time allocation for each material presented is
approximately 60 minutes. After training, post-test and OSCE 2 were carried out in the
control and intervention groups. Two weeks after training, OSCE 3 was conducted for
the intervention group to measure behavior.

The data collection of knowledge about HAIs used a questionnaire consisting of 20

questions with multiple choice answers. The validity of the questionnaire has been
tested with r value 0.412-0.716> r table 0.294 and its reliability with Cronbach Alpha
0.753. HAIs prevention skills and behavior are measured using a structured observation
sheet or checklist consisting of several aspects of assessment including: 1) preparation
of tools, 2)patient identification, 3)hand hygiene, 4)use of gloves, 5)aseptic procedures.
The data collection method starts with obtaining a research permit. The researcher then
searched for a list of nurses at Prima Medika Hospital to provide research informed
consent. Researchers asked for the help of an infection control nurse as a research
assistant who had previously been given directions on how to fill out questionnaires and
methods of assessing observation sheets or infection prevention checklists. Nurses who
had been willing to become research respondents were then given a pre-test
questionnaire regarding HAIs, an assessment of infection prevention skills and behavior
was carried out before being given training interventions. Nurses in the intervention
group were given training on HAIs, while the control group was only given modules on
HAIs. After the training was completed, the respondents were again given a post-test

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questionnaire regarding HAIs, an assessment of infection prevention skills and behavior

was carried out.

Univariate analysis was conducted to describe the distribution and mean value of each
variable. The Wilcoxon test was used to analyze the mean difference between groups
because the data were not normally distributed. The mean difference between the
control and intervention groups was analyzed using the Mann-Whitney test. The
confidence interval used was 95% (α = 0.05). This study has obtained a statement of
ethical suitability from the Research Ethics Commission of the Faculty of Medicine,
Udayana University with number 1329/ UN.14.2.2.VII.14 / LT / 2020.

RESULTS
The frequency distribution of the characteristics of the respondents is described in table
1.
Table 1.
Distribution of Respondent Characteristics (n = 80)
Group
Characteristics
Intervention Total Control
(n=40) (n=40)
Gender

Male 9 (22.5%) 8 (20%) 17 (21.25%) Female 31 (77.5%) 32 (80% 63 (78.75%) Level of

education
SPK 1 (2.5%) 1 (2.5%) 2 (2.5%) D3 37 (92.5%) 36 (90%) 73 (91.25%) Ners 2 (5%) 3
(7.5%) 5 (6.25%) Age
< 40 yrs 38 (95%) 24 (60%) 62 (77.5%) > 40 yrs 2 (5%) 16 (40%) 18 (22.5%) Length of
working
< 8 yrs 15 (37.5%) 18 (45%) 33 (41.25%) > 8 yrs 25 (62.5%) 22 (55%) 47 (58.25%)

Table 2.
Scores of Knowledge, Skills, and Behavior to Prevent HAIs Before and After
Intervention (n = 80)

Variable Intervention Group Control Group n Mean SD n Mean SD

 Knowledge
Pre-test 40 6.66 1.32 40 6.52 0.80 Post-test 40 9.13 0.96 40 6.48 0.96 Skills
Pre-test 40 67.15 8.89 40 69.57 1.40 Post-test 40 97.87 3.22 40 70.4 1.42 Behavior
Pre-test 40 97.87 3.22 40 70.42 9.02 Post-test 40 98.65 2.44 40 68.67 8.15

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Table 3.
Wilcoxon Test Results Score of Knowledge, Skills, and Behavior of HAIs Prevention in
the Intervention and Control Groups Before and After the Intervention (n = 80) Variable
P value
Knowledge
Intervention Group <0.001*
Control Group 0.803
Skills
Intervention Group <0.001*
Control Group 0.052
Behavior
Intervention Group 0.041*
Control Group 0.051

Table 4.
Mann-Whitney Test Results Score of Knowledge, Skills, and Behavior of HAIs
Prevention Between the Intervention Group and the Control Group (n = 80)
Variable P value
Knowledge <0.001*
Skills <0.001*
Behavior <0.001*

Table 1 shows that the majority of respondents in both the intervention and control
groups were female, had a D3 nursing education, were under 40 years of age, and had a
workexperience of more than eight years.

Table 2 shows an increase in the score of the intervention group in knowledge, skills and
infection prevention behavior after being given the intervention. Whereas in the control
group there was a decrease in the score of knowledge and infection prevention behavior
after the post-test.

Table 3 illustrates the effect of training on knowledge (p value <0.001), skills (p value
<0.001), and behavior (p value = 0.041) on prevention of HAIs in the intervention
group. In contrast, in the control group, it was found that there was no effect of training
on knowledge, skills, and behavior of prevention of HAIs (p value> 0.005).

Table 4 shows that there are differences in knowledge, skills, and behavior of HAIs
prevention between the intervention group and the control group (p value <0.001).

DISCUSSION
The results of the study obtained shows that the value of nurses' knowledge about HAIs
after being given training in the intervention group exhibits an increase. Whereas in the
control group, the knowledge score of nurses decreased. This is in line with research
Puspasari (2015) that there is an increase in the knowledge of nurses after training in
preventing nosocomial infections.

Knowledge is the result of knowing, and this happens after people sense a certain
object. Knowledge of a new object becomes an attitude if that knowledge is

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accompanied by a readiness to act in accordance with the knowledge of that object

(Mulyana, 2015). Study shows that nurses' knowledge affects the practice of nurses in
carrying out their duties which means the better the knowledge of nurses, the better the
practice of nurses in preventing nosocomial infections (Puspasari, 2015).

Nurses can continue to increase in knowledge if the hospital continue to improve their
capabilities with various continuous training and education for all employees on all
aspects of infection prevention (Yulianti, Rosyidah, & Hariyono, 2013). Education and
training interventions have a significant impact in increasing nurses' knowledge of
infection prevention practices. Periodic education and training interventions must be
carried out to facilitate knowledge of health workers about best practices in infection
prevention and control that can reduce HAIs (Gaikwad et al., 2018). Knowledge is very
closely related to education, but increased knowledge is not solely obtained from formal
education but can be obtained from informal education including training or skill
refreshment.

According to the researchers, if all nurses are given HAIs prevention training, it is likely
that nurses' performance in controlling HAIs will be very good and of course the
incidence of HAIs can be reduced. This will also improve the image of hospital services
due to the quality of service standards, one of the indicators is the incidence of HAIs.

The evaluation of learning consists of knowledge and skills. Knowledge is positively

correlated with skills (Kirkpatrick & Kirkpatrick, 2008). This is evidenced in several
studies that have found a relationship between knowledge and attitudes and behavior of
nurses in preventing nosocomial infections (Mariana, Zainab, & Kholik, 2015;
Riswantoro, Handayani, & Andoko, 2013). In this study, evaluation of skills after HAIs
prevention training was carried out on 4 components, namely 1) Informed consent and
patient identification skills and equipment preparation, 2) hand hygiene skills, 3) use of
sterile gloves, and 4) catheter and procedure installation. aseptic.

The results of the analysis showed an increase in the score of nurses' skills regarding
HAIs prevention after being given training. After training all nurses in the intervention
group applied observation, informed consent, patient identification, and tool preparation
skills. The simulation of informed consent was carried out well, starting from
introducing himself, matching and identifying the patient's identity bracelet. Informed
consent is a process of communicating with patients about the medical actions taken in
order to obtain their permission (Wardhani, 2009).

The increase in the mean value in the intervention group indicates learning outcomes
and shows the effectiveness of the training that had been carried out. Additional
knowledge can be acquired by holding training (Atmadja, 2012). Therefore, training on
HAIs prevention and aseptic techniques should be carried out on an ongoing basis.
However, this increase in knowledge cannot be separated from the relevance of the
training material provided. One indicator of the success of a training in increasing
knowledge is the quality of training materials (Wardhani, 2009).

This increase in knowledge can be an indication that the material presented is

appropriate and relevant in the daily practice of nurses. Teaching materials in training

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must have relevance related to the training topic so that they have concrete meaning and
are relevant to the needs of participants. Training is a process of teaching certain
knowledge and skills so that employees are increasingly skilled and able to carry out
their responsibilities in accordance with standards (Wilma, 2013). Thus, training is an
effort to improve individual competence. Competent individuals have adequate abilities
to do their jobs.

One of the results of the study found that most nurses had intermediate knowledge and
skills regarding infection control (Kalantarzadeh, Mohammadnejad, Ehsani, & Tamizi,
2014). Therefore, it is necessary to develop a sustainable education system for all
nurses. Education is an effective intervention to increase compliance with HAIs
preventive measures, especially the implementation of hand hygiene (Quilab, Johnson,
Schadt, & Mitchell, 2019).

The results of the analysis showed that the scores of HAIs prevention knowledge, skills,
and behavior between the intervention group and the control group showed significant
differences. The results of other studies found that there was a significant relationship
between training and the actions of nurses in controlling HAIs (Salawati, Taufik, &
Putra, 2014). There was a significant change in scores between pre and post tests for
health workers, which indicated that education and training programs has a positive
effect on the knowledge, skills and attitudes of health workers in preventing HAIs
(Dogra et al., 2015). Effective educational interventions to increase ICU nurse
compliance with standard precautions can reduce the incidence of HAIs (Gomarverdi,
Khatiban, Bikmoradi, & Soltanian, 2019). Interventions in the form of effective
education can be recommended as further education to be applied to nursing staff
working in hospitals.

Support for a program must be followed by good management. The leadership is

responsible for implementing infection prevention and control efforts in the hospital,
one of the efforts that can be done is by increasing knowledge of human resources. The
success of infection prevention and control can improve the quality of hospital services,
and this is important in preparing for accreditation. Sustainable human resource
development is a very important effort to achieve organizational goals, which, in this
case, is excellent service (Djuwita, 2011). To carry out the best service to society,
organizations need employees who have the knowledge and skills to carry out their
work so that the work productivity of employees is high and is directly proportional to
the quality of service.

CONCLUSION
There are differences in knowledge, skills, and practices of prevention of HAIs between
the intervention group and the control group. There is an effect of training on the
knowledge, skills, and behavior of prevention of HAIs in the intervention group.
Whereas in the control group, it was found that there was no effect of training on
knowledge, skills, and behavior of prevention of HAIs.

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REFERENCES
Accardi, R., Castaldi, S., Marzullo, A., Ronchi, S., Laquintana, D., & Lusignani, M.
(2017). Prevention of healthcare associated infections: A descriptive study. Annali
Di Igiene. https://doi.org/10.7416/ai.2017.2137

Atalla, H. R., Aboalizm, S. E., & Shaban, H. A. (2016). Effect of nursing guidelines
compliance to infection control among nursing student. IOSR Journal of Nursing
and Health Science. https://doi.org/10.9790/1959-05122334

Atmadja, L. J. (2012). Analisis Perilaku Perawat dalam Pencegahan Infeksi Nosokomial

di Ruang Rawat Inap X Jakarta Tahun 2012 (Univeristas Indonesia). Retrieved
from
http://www.lib.ui.ac.id/detail?id=20321707&lokasi=lokal#parentHorizontalTab2

CDC. (2014). Types of Healthcare-associated Infections | HAI | CDC. 2014.

Djuwita, T. M. (2011). Pengembangan Sumber Daya Manusia Dan Produktivitas Kerja

Pegawai. Manjerial, 10(19), 15–21. Retrieved from Sumber daya manusia,
produktivitas kerja pegawai

Dogra, S., Mahajan, R., Jad, B., & Mahajan, B. (2015). Educational interventions to
improve knowledge and skills of interns towards prevention and control of
hospital-associated infections. International Journal of Applied and Basic Medical
Research. https://doi.org/10.4103/2229-516x.162279

Gaikwad, U. N., Basak, S., Kulkarni, P., Sande, S., Cahavan, S., Mudey, G., …
Gaikwad, N. R. (2018). Educational Intervention to Foster Best Infection Control
Practices Among Nursing Staff. International Journal of Infection.
https://doi.org/10.5812/iji.81531

Gomarverdi, S., Khatiban, M., Bikmoradi, A., & Soltanian, A. R. (2019). Effects of a
multi-component educational intervention on nurses’ knowledge and adherence to
standard precautions in intensive care units. Journal of Infection Prevention.
https://doi.org/10.1177/1757177419830780

Haque, M., Sartelli, M., McKimm, J., & Bakar, M. A. (2018). Health care-associated
infections – An overview. Infection and Drug Resistance.
https://doi.org/10.2147/IDR.S177247

Kalantarzadeh, M., Mohammadnejad, E., Ehsani, S. R., & Tamizi, Z. (2014).

Knowledge and practice of nurses about the control and prevention of nosocomial
 infections in emergency departments. Archives of Clinical Infectious Diseases.
https://doi.org/10.5812/archcid.18278

Khan, I. D., Basu, A., Kiran, S., Trivedi, S., Pandit, P., & Chattoraj, A. (2017). Device
Associated Healthcare-Associated Infections (DA-HAI) and the caveat of
multiresistance in a multidisciplinary intensive care unit. Medical Journal Armed
Forces India. https://doi.org/10.1016/j.mjafi.2016.10.008

Kirkpatrick, D. L., & Kirkpatrick, J. D. (2008). Evaluating Training Programs: The Four
Levels. In Evaluating Training Programs.

214
Indonesian Journal of Global Health Research, Vol 2 No 3, August 2020, pp. 207 -216
Global Health Science Group

Mariana, H. E. R., Zainab, & Kholik, H. S. (2015). Hubungan Pengetahuan Tentang

Infeksi Nosokomial Dengan Sikap Mencegah Infeksi Nosokomial Pada Keluarga
Pasien Di Ruang Penyakit Dalam Rsud Ratu Zalecha Martapura. Jurnal Skala
Kesehatan. https://doi.org/10.15851/jap.v3n1.379

Mulyana, M. (2015). Gambaran Pengetahuan, Pengalaman & Sikap Ibu terhadap

Tatalaksanaan Diare pada Anak Penderita Diare di Ruang Anak Bawah RSUD Dr.
Soekardjo Tasikmalaya. Jurnal Kesehatan Bakti Tunas Husada: Jurnal Ilmu-Ilmu
Keperawatan, Analis Kesehatan Dan Farmasi.
https://doi.org/10.36465/jkbth.v13i1.30

Noto, M. J., Domenico, H. J., Byrne, D. W., Talbot, T., Rice, T. W., Bernard, G. R., &
Wheeler, A. P. (2015). Chlorhexidine bathing and health care-associated
infections: A randomized clinical trial. JAMA - Journal of the American Medical
Association. https://doi.org/10.1001/jama.2014.18400

Puspasari, Y. (2015). Hubungan Pengetahuan, Sikap dengan Praktik Perawat dalam

Pencegahan Infeksi Nosokomial diruang Rawat Inap Rumah Sakit Islam Kendal.
Maret.

Quilab, M. T., Johnson, S., Schadt, C., & Mitchell, A. (2019). The effect of education on
improving hand hygiene compliance among healthcare workers. Hospice &
Palliative Medicine International Journal Literature.
https://doi.org/10.15406/hpmij.2019.03.00153

Riswantoro, Handayani, R. S., & Andoko. (2013). Hubungan pengetahuan dan sikap
dengan perilaku perawat dalam pencegahan infeksi nosocomial di Ruang Bedah
dan ICU Rumah Sakit Demang Sepulau Raya tahun 2012. Holistik Jurnal
Kesehatan, 7(1).

Salawati, L., Taufik, N. H., & Putra, A. (2014). Analisis Tindakan Keselamatan dan
Kesehatan Kerja Perawat Dalam Pengendalian Infeksi Nosokomial Di Ruang ICU
RSUD DR. Zainoel Banda Aceh. JURNAL KEDOKTERAN SYIAH KUALA,
14(3).

Singh, S., Chaturvedi, R., Garg, S. M., Datta, R., & Kumar, A. (2013). Incidence of
healthcare associated infection in the surgical ICU of a tertiary care hospital.
Medical Journal Armed Forces India. https://doi.org/10.1016/j.mjafi.2012.08.028
Wardhani, R. K. (2009). Tinjauan Yuridis Persetujuan Tindakan Medis (Informed
Consent) di Rsup Dr. Kariadi Semarang (Universitas Diponegoro). Retrieved from
https://core.ac.uk/download/pdf/11718412.pdf

WHO. (2016). Guidelines on core components of infection prevention and control

programmes at the national and acute health care facility level. In World Health
Organization.

Wilma. (2013). Faktor-Faktor yang Berhubungan dengan Pelaksanaan Pencegahan

Infeksi Nosokomial oleh Perawat Pelaksana di Rumah Sakit Umum Daerah
Makasar Tahun 2013 (Universitas Hasanudin). Retrieved from
http://repository.unhas.ac.id:4001/digilib/files/disk1/53/--wilma-2602 -1-13-

215
Indonesian Journal of Global Health Research, Vol 2 No 3, August 2020, pp. 207 -216
Global Health Science Group

wilma-8.pdf
World Health Organization. (2011). Patient Safety Curriculum Guide. WHO.

World Health Organization. (2015). Health care-associated infections Fact sheet. World
Health Organization.

Yulianti, ., Rosyidah, ., & Hariyono, W. (2013). Hubungan Tingkat Pengetahuan

Perawat dengan Penerapan Universal Precaution pada Perawat di Bangsal Rawat
Inap Rumah Sakit PKU Muhammadiyah Yogyakarta. Jurnal Kesehatan
Masyarakat (Journal of Public Health).
https://doi.org/10.12928/kesmas.v5i2.1081
216