Author Affiliations
Abstract
Background: Healthcare-associated infections remain a major concern for patient and healthcare worker safety, particularly in clinical training settings where nursing students are exposed to occupational hazards such as needle-stick injuries and contact with blood and body fluids. Inadequate knowledge and poor adherence to standard precautions can increase the risk of infection transmission.
Aim: This study aimed to evaluate the effectiveness of an infection control educational session on nursing students’ knowledge and adherence to standard precautions at Hassan College of Nursing, Swat.
Methodology: A quasi-experimental pre-test and post-test design was employed among 121 nursing students selected through convenience sampling. Data were collected using a structured questionnaire assessing demographic characteristics, knowledge of infection control, and adherence to standard precautions. An educational intervention on infection control practices was conducted. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 27, applying descriptive statistics, a paired sample t-test, and a chi-square test.
Results: Post-intervention findings revealed a significant improvement in both knowledge and adherence. Good knowledge increased from 19.8% to 60.3%, while high adherence rose from 19.0% to 59.5%. Paired t-test results indicated statistically significant improvements (p = 0.001), and a significant association between knowledge and adherence was observed (p = 0.003).
Conclusion: The educational intervention significantly enhanced nursing students’ knowledge and compliance with infection control practices.
Keywords
Infection control, Standard precautions, Nursing students, Knowledge, Educational intervention.
Introduction
Infection control can be described as a collection of practices and procedures that are employed to prevent the transmission of infections in healthcare facilities. Standard precautions are evidence-based practices or principles aimed at minimizing the spread of infectious agents during patient care.[1] Among these precautions are hand hygiene, personal protection, sharps handling, respiratory protection, and environmental cleaning. Knowledge is the status of the knowledge that people possess regarding infection prevention measures.[2] Compliance refers to how well healthcare personnel adhere to the recommended infection control practices. Nursing students are the future workers in the healthcare sector, and as a result, they are exposed to clinical settings during their training; thus, they need proper knowledge and compliance with the principles of infection control.[3]
One of the most important public health issues in the world is healthcare-associated infections. According to reports issued by international health organizations, millions of patients annually are infected with healthcare-associated infections in hospitals and clinical facilities.[4] Research has also shown that in developing nations, healthcare-associated infections occur between 5% and 15% in hospitalized patients.[5] Studies carried out in South Asian healthcare facilities indicate poor adherence to standard precautions by healthcare providers and nursing students. Inadequate training and supervision and a deficiency in infection control awareness are some of the reasons why these infections continue to be experienced in healthcare settings.[3]
Clinical placements are common in nursing courses, where students often undergo clinical placements in their studies. Clinical exposure also exposes students to actual care scenarios with patients where there are risks of infection.[6] Students do different types of nursing activities such as administering medication, wound care, and patient monitoring. Such processes increase the risk of contact with blood, body fluid, and infected equipment. Inadequate knowledge about the practice of infection control may risk exposing the healthcare provider and patient to occupational exposure and cross-infection.[7]
General precautions act as the baseline approach towards infection transmission prevention within healthcare facilities. These measures are based on universal measures irrespective of the diagnosis or the infection status of the patient. Adequate hand hygiene and wearing gloves, gowns, masks, and eye protection decreases the chances of transmitting the pathogen. Infection control also involves safe disposal of sharps and handling of contaminated materials. These practices ensure that healthcare personnel and patients remain safe against infectious diseases.[8]
Past research has shown that nursing students tend to have knowledge and compliance gaps in infection control. Other students have theoretical knowledge but cannot implement the practical recommendations in the clinical procedures.[9] Research in nursing schools indicates poor adherence to hand hygiene and the misuse of personal protective devices by nursing students. The behavior of nursing students in healthcare facilities is affected by clinical workload, lack of supervision, and inadequate training on infection control.[10]
Educational interventions have been identified as useful ways of enhancing infection control awareness and compliance. The control infection classes offer a structured learning experience that enhances the knowledge of the students on the methods of disease transmission and prevention. Demonstrations, practice sessions, and evidence-based guidelines are some of the training programs that can add knowledge and skills to students. Enhanced practice in infection prevention leads to safer clinical care and lessens the danger of healthcare-associated infections.[11]
Swat is a nursing college called Hassan College of Nursing that offers clinical education to nursing students who undergo patient care experiences during their education. Different clinical settings expose the students to diverse environments requiring adherence to infection control measures. Little local studies have investigated how structured infection control classes affect the knowledge of students and adherence to standard precautions in this environment. Educational interventions should be evaluated to understand how effectively they change infection control practices in nursing students. The evidence acquired during such studies can enable change in nursing education and improvement in patient safety in healthcare organizations.
Methodology
The research design used in this study was a quasi-experimental pretest and posttest research design to determine the impact of an infection control session on the knowledge and adherence to standard precautions among the nursing students at the Hassan College of Nursing, Swat. The structure enabled the researcher to determine the change in the level of knowledge and compliance among the participants during pre- and post-educational intervention. This was done at Hassan College of Nursing, Swat, with nursing students under the bachelor of science in nursing program. The overall time of the study was six months after the approval of the institutional review board (IRB).
The target population was formed of the students at the college of nursing who were currently enrolled in the college. The RaoSoft sample size calculator was used to calculate the sample size at a 95% confidence interval and 5% margin of error. Taking the sample population of 175 students, the sample size was 121. A simple random sampling method was applied to select the participants based on the inclusion criteria. To participate in the study, nursing students who had undergone a minimum of six months (one semester) of clinical rotation in a tertiary care hospital were eligible to participate in the study. Students who were not ready to take part on a voluntary basis were not included in the research.
Data collection procedure: A structured questionnaire was used to gather data, as it was meant to evaluate demographic factors, knowledge, and adherence to standard precautions. The questionnaire had three parts. Part A contained 11 items concerning the demographic variables, namely age, sex, academic year, and clinical experience. Part B had 20 questions that assessed adherence to standard precautions on a Likert scale that ranged between 0 (never) and 4 (always). Part C was a set of 10 dichotomous questions (Yes/No) that dealt with the knowledge of the participants about standard precautions. The questionnaire was shown to be reliable, having a Cronbach alpha coefficient of 0.87, and highly valid with a value of 0.98. The participants were asked to fill in the questionnaire at the end and the start of the educational session on infection control to assess the knowledge and compliance changes.
Data analysis procedure: The data obtained were checked, coded, and input into SPSS 27 to analyze them. The frequencies and percentages summarized the demographic characteristics and the levels of adherence to standard precautions and were employed as descriptive statistics. Knowledge and compliance composite scores were made to obtain the overall performance at the beginning of the infection control session and at the end of it. A paired t-test was applied. The chi-square test was conducted as inferential statistical analysis to test the relationship that existed between knowledge and adherence to standard precautions. A p-value that is below 0.05 is regarded as statistically significant.
Results
Demographic characteristics of participants: The demographic and professional characteristics of the participants showed that nearly half of the nursing students (46.3%) were aged between 20 and 22 years, while 37.2% were in the 23–25 years age group and 16.5% were older than 25 years. Most of the participants were male (81.0%), whereas females constituted 19.0% of the sample. Most students had more than two months of clinical experience (91.1%), while only 9.9% had less than two months of clinical experience. About 29.8% of students reported experiencing sharp injuries during the past six months, and 33.9% had exposure to blood or body fluids. A large proportion of students were aware of the infection control department (79.3%) and reported visits by infection control nurses (62.0%). Approximately 65.3% had received training on standard precautions; however, a greater proportion (76.0%) indicated a need for additional training.
| Variable | Category | Frequency (n) | Percentage (%) |
| Age (years)
|
20–22 | 56 | 46.3 |
| 45 | 37.2 | ||
| 20 | 16.5 | ||
| Gender
|
Male | 98 | 81.0 |
| 23 | 19.0 | ||
| Clinical duration (months)
|
<2 | 12 | 9.9 |
| 109 | 91.1 | ||
| Sharp injury (past 6 months)
|
Yes | 36 | 29.8 |
| 85 | 70.2 | ||
| Exposure to blood/body fluids
|
Yes | 41 | 33.9 |
| 80 | 66.1 | ||
| Awareness of the infection control department
|
Yes | 96 | 79.3 |
| 25 | 20.7 | ||
| Infection control nurse visits
|
Yes | 75 | 62.0 |
| 46 | 38.0 | ||
| Received training on standard precautions
|
Yes | 79 | 65.3 |
| 42 | 34.7 | ||
| Need for additional training
|
Yes | 92 | 76.0 |
| 29 | 24.0 |
Table 1: Demographic and professional characteristics of participants (n = 121)
Table 2 shows the level of knowledge of nursing students concerning standard precautions before and after the education intervention. In the pre-test, 34.7% indicated that they had low knowledge, 45.5% indicated that they had average knowledge, and only 19.8% indicated that they had excellent knowledge. Following the intervention, there was a considerable change in the level of knowledge. The percentage of good knowledge increased significantly to 60.3%, the percentage of moderate knowledge reduced to 31.4%, and the percentage of poor knowledge reduced considerably to 8.3%. These results show the effectiveness of educational intervention in improving the knowledge of students regarding standard precautions.
| Knowledge level | Pre-test n (%) | Post-test n (%) |
| Poor knowledge | 42 (34.7) | 10 (8.3) |
| Moderate knowledge | 55 (45.5) | 38 (31.4) |
| Good knowledge | 24 (19.8) | 73 (60.3) |
| Total | 121 (100) | 121 (100) |
Table 2: Knowledge of standard precautions (pre-test vs post-test)
Table 3 shows the levels of compliance of nursing students with standard precaution practices prior to and after the intervention. Before the educational session, low adherence was observed in 31.4% of the participants, moderate adherence was observed in 49.6% of the participants, and high adherence was observed in only 19.0% of the participants. Adherence increased significantly after the intervention. High adherence percentage rose to 59.5%, with moderate adherence declining to 33.1% and low adherence declining drastically to 7.4%. The findings indicate that the infection control educational program had a positive impact on the adherence of students to standard precaution measures.
| Adherence level | Pre-test n (%) | Post-test n (%) |
| Low adherence | 38 (31.4) | 9 (7.4) |
| Moderate adherence | 60 (49.6) | 40 (33.1) |
| High adherence | 23 (19.0) | 72 (59.5) |
| Total | 121 (100) | 121 (100) |
Table 3: Adherence to standard precautions (pre-test vs post-test)
Table 4 presents the results of comparing the mean knowledge and adherence scores at the baseline and the end of the educational intervention by the paired sample t-test. The average knowledge score has improved as well, rising from 5.82 ± 1.96 in the pre-test to 8.47 ± 1.42 in the post-test. Likewise, the adherence score increased to 3.38 ± 0.52 following the intervention in comparison to 2.11 ± 0.64. The t-values of knowledge (t = 12.36) and adherence (t = 14.28) were statistically significant with a p-value of 0.001. These results suggest that educational intervention produced a strong positive impact on knowledge and adherence to standard precautions among nursing students.
| Variable | Pre-test mean ± SD | Post-test mean ± SD | t-value | p-value |
| Knowledge score | 5.82 ± 1.96 | 8.47 ± 1.42 | 12.36 | 0.001 |
| Adherence score | 2.11 ± 0.64 | 3.38 ± 0.52 | 14.28 | 0.001 |
Table 4: Comparison of knowledge and adherence scores before and after educational intervention (paired t-test)
Table 5 provides the relationship between levels of knowledge and compliance with standard precautions among nursing students. Among the participants with poor knowledge, over half (52.4%) had low adherence, with only 11.9% having high adherence. Moderately knowledgeable students were more adherent, with 54.5% showing moderate adherence and 23.7% high adherence. The most knowledgeable (good) respondents (moderate adherence-62.5% and high adherence-20.8%) elicited a significant proportion. The chi-square test showed that there was a statistically significant relationship between level of knowledge and adherence to standard precautions (p = 0.003), with the higher the level of knowledge, the better the adherence to infection control practices.
| Knowledge level | Low adherence
n (%) |
Moderate adherence
n (%) |
High adherence
n (%) |
p-value |
| Poor knowledge | 22 (52.4) | 15 (35.7) | 5 (11.9) | |
| Moderate knowledge | 12 (21.8) | 30 (54.5) | 13 (23.7) | |
| Good knowledge | 4 (16.7) | 15 (62.5) | 5 (20.8) | 0.003 |
Table 5: Association between knowledge and adherence to standard precautions (chi-square test)
Discussion
The current research analyzed the impact of an infection control session on the knowledge level and standard precaution compliance among nursing students. The results indicated that most of the respondents were young nursing students who had clinical exposure. Most of the respondents were male and had over two months of clinical experience in the rotation. Quite a significant percentage were exposed to sharp injuries and blood or body fluids in the past six months. The same trends were reported in nursing education research carried out in clinical training institutions where the students are exposed to occupational hazards quite often in early clinical practice.[11] Such results indicate the susceptibility of nursing students to workplace exposures and provide evidence of the necessity to enhance the infection control education provided to students in the clinical training program.
The standard precautions level of knowledge increased significantly after the education intervention. The percentage of students who were well informed rose to 60.3% in the post-test after there was an increase to 19.8% in the pre-test. A smaller share of students with poor knowledge was also found. Similar gains in knowledge after a structured infection control education have been observed in articles carried out on nursing students in Asian and Middle Eastern nursing schools.[12] According to a study carried out in teaching hospitals, it was observed that specific educational interventions were very effective in enhancing awareness about infection prevention policies and safe clinical practice among students.[13] The evidence indicates that structured training programs can be used to reinforce the knowledge of nursing students in relation to infection control.
The level of adherence to standard precautions also increased significantly after the intervention. The percentage of students who had high adherence grew 19.0% before the intervention to 59.5% after the session. Reduction in the low adherence rates was noted. Like enhancements in compliance were observed in the studies assessing infection prevention training in healthcare students and novice nurses.[14] In some studies carried out in clinical training environments, it was established that educational interventions encouraged hand hygiene compliance, personal protective equipment use, and safe sharps disposal practices.[15] These findings point to the importance of the role of education in the translation of theoretical knowledge to practical infection control behavior.
The effectiveness of the intervention was also further confirmed by the paired sample t-test results. The average knowledge score rose to 8.47 as compared to 5.82, whereas the adherence scores had risen to 3.38 compared to 2.11. The improvement was statistically significant, implying that these improvements were not a result of random sampling. The same outcome was also found in the interventional studies evaluating the training on infection control among nursing students and medical workers.[16] Educational interventions on standard precautions and occupational safety have been reported to be effective in enhancing knowledge scores and clinical compliance.[17] These findings confirm the relevance of unremitting infection prevention education in nursing curricula.
The analysis of associations showed that the correlation between knowledge and adherence to the standard precautions is statistically significant. Students with a high level of knowledge were more compliant with adherence than students with poor knowledge. Less than 50 percent of the participants who were low in their knowledge had low adherence. The same relationships between knowledge and infection control practices were found in the studies that investigated compliance with standard precautions in the context of nursing students and healthcare workers.[18] Based on the results of studies conducted in hospitals, it was evident that, with greater knowledge on the benefits of infection control measures, the increase in compliance with protective steps during patient care was also evident.[19]
A significant percentage of the participants in the current study indicated exposure to occupational hazards like sharp injuries, body fluids, and blood. The results are consistent with the study carried out among nursing trainees in the developing healthcare facilities, where clinical students often suffer needlestick injuries because of the lack of experience and training.[20] Infection prevention, safe handling of sharps, and protective equipment have been suggested to have educational interventions on the reduction of occupational risks in healthcare trainees. Safety behaviors and exposure incidents have been reported to be improved and decreased, respectively, with continuous training programs among students.[21]
Most of the interviewees indicated that they require more training on usual precautions, even after going through training on infection control. The same was reported in research that assessed the infection prevention competencies in nursing students at teaching hospitals.[12] It is observed that students can attest to a lack of practical skills in infection control and that they must be reinforced with education on the same during clinical training. As demonstrated by nursing education research, the integration of organized infection prevention courses, training on infection control as simulations, and regular competency tests in nursing programs is essential to reinforce adherence to infection control practices.[22] The results highlight the importance of long-term professional training in enhancing the level of knowledge, as well as compliance with standard precautions among nursing students.
Recommendations
- Regular infection control training sessions should be incorporated into the nursing curriculum to improve students’ knowledge and compliance with standard precautions.
- Nursing institutions should organize continuous professional development workshops and refresher courses on infection prevention and control for students during their clinical rotations.
- Simulation-based training and practical demonstrations should be implemented to enhance students’ skills in hand hygiene, use of personal protective equipment, and safe disposal of sharps.
- Hospitals and clinical training sites should strengthen the role of infection control departments in monitoring and guiding nursing students during clinical practice.
- Educational institutions should establish policies to ensure regular supervision and mentorship of students to reduce occupational exposure to sharp injuries and blood or body fluids.
Conclusion
The current research measured the impact of an educational intervention on knowledge and compliance with standard precautions in nursing students after an infection control educational session. The results reported that the educational intervention was able to enhance not only the knowledge but also the compliance of the participants significantly. The percentage of students with low to moderate knowledge levels and low compliance with infection control practices was quite high. The outcomes of the post-intervention showed that there was a significant improvement in the percentage of students who had good knowledge and high adherence rates to standard precautions. The paired sample t-test showed a significant improvement in the scores in both knowledge and adherence. The study also found that there was a significant correlation between the knowledge level and compliance with the infection control practices, where students who had more knowledge were more likely to practice the standard precautions. Sharp injuries and blood or body fluids among nursing students were pointed out as occupational exposures of the students to sharp injuries and blood or body fluids, necessitating increased infection prevention training during clinical education. The results highlight positive outcomes of structured infection control sessions on reinforcing student knowledge and practice of standard precautions and are significant in driving patient safety and occupational health in clinical environments.
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Acknowledgments
The authors would like to express their sincere gratitude to Dr. Shah Hussain, Principal/Associate Professor, Janbar, College of Nursing, Swat, for his invaluable supervision, guidance, and support throughout the course of this study.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author Information
Corresponding Author:
Ahmad Ullah
Department of Nursing
Hassan College of Nursing & Allied Health Sciences, Swat, Pakistan
Email: [email protected]
Co-Authors:
Hammad Ullah Khan, Zia Ullah Khan, Numan Khan
Department of Nursing
Hassan College of Nursing & Allied Health Sciences, Swat, Pakistan
Shah Hussain
Department of Nursing,
Janbar College of Nursing, Swat, Pakistan
Authors Contributions
Ahmad Ullah and Hammad Ullah Khan contributed to data collection and data analysis. Zia Ullah Khan was involved in data collection and literature review. Numan Khan contributed to data collection, data organization, and interpretation of the findings. Dr. Shah Hussain was responsible for data analysis and interpretation.
Ethical Approval
Ethical Approval was obtained from the Hassan College of Nursing & AHS, Swat, Ref No: HCN/IRB/2026/01.
Conflict of Interest Statement
The authors declare that there is no conflict of interest regarding the publication of this paper.
Guarantor
Ahmad Ullah is the guarantor of this study and takes full responsibility for the integrity of the data and the accuracy of data analysis.
DOI
Cite this Article
Ullah A, Khan HU, Khan ZU, Khan N, Hussain S. The Effect of Infection Control Session on Nursing Students’ Knowledge and Compliance with Standard Precautions at Hassan College of Nursing, Swat. medtigo J med. 2026;4(2):e3062423. doi:10.63096/medtigo3062423 Crossref
