Instruments for evaluating compliance with infection control practices and factors that affect it: an integrative review

Aims and objectives To search for instruments to measure compliance with infection control practices and to report on which dimensions and contents the instruments evaluate, their psychometric characteristics, compliance and factors influencing compliance. Background Low compliance with infection control practices has been reported among healthcare professionals around the world over the years. Existing data concerning health professionals' compliance with standard precautions are based on measuring instruments. Design Integrative review. Methods The descriptors were identified and used separately and in combination to search in the following databases: Lilacs, PubMed (MEDLINE), ISI Web of Knowledge, Scopus and CINAHL. The selected articles complied with inclusion and exclusion criteria. Results Twenty‐three studies were analysed, resulting in the identification of 18 instruments. No instrument addressed all compliance topics, and the most commonly addressed topics were the use of personal protective equipment, hand hygiene and safe practices in the handling of cutting material. Most authors explored content validity and some performed reliability analysis by means of Cronbach's alpha and test–retest. Countries in the sample have different human development indices, and countries with medium and low human development indices show less compliance. Some variables were strong predictors of compliance: training, perceptions of safe environment, perception of obstacles to comply with standard precautions and knowledge. Conclusions Compliance is below the recommended levels. Health professionals seem to be selective in following standard precautions. Significant influences include institutional management and psychosocial variables, which deserve further study. Relevance to clinical practice Health managers and government policies and interventions should pay greater attention to this subject.