FACTORS INFLUENCING COMPLIANCE WITH STANDARD PRECAUTIONS AMONG SAUDI UNDERGRADUATE NURSING STUDENTS: A MIXED METHODS STUDY

Abstract

Background: The International Nosocomial Infection Control Consortium highlighted a disparity between the recommended infection control guidelines and their practical implementation, indicating a gap in compliance with infection control guidelines (Rosenthal, 2016). Studies conducted in the Kingdom of Saudi Arabia (KSA) have also observed this gap, which has identified low levels of compliance regarding infection control guidelines and a need to improve the ability to apply infection control practices (Alshammari et al., 2018; Colet et al., 2017; Cruz, 2019). Purpose and specific aims: The study aimed to (1) assess compliance withStandard Precautions (SP), (2) explore the factors associated with compliance with Standard Precautions , and (3) explore barriers to noncompliance with SP among those who self- reported non-compliance. Method: A mixed methods explanatory sequential design consistent with Creswell and Plano Clark’s (2018) framework was used to explore the factors that affect students’ compliance with SP among Saudi undergraduate nursing students (UGNs) enrolled in a baccalaureate or associate degree nursing program in the Kingdom of Saudi Arabia. In the quantitative phase, data were collected using an online self-administration survey. Two validated instruments were used: the Compliance with Standard Precautions Scale (CSPS) to measure self-reported compliance, and the Factors Influencing Adherence to Standard Precautions Scale – Student Version (FIASP-SV) to assess psychosocial and contextual factors influencing compliance. A convenience sample of 320 UGNSs was recruited. Data were analyzed using SPSS software and included descriptive statistics, Pearson correlation coefficients, and binary logistic regression to examine compliance levels and significant predictors. . In the qualitative phase, semi-structured interviews were conducted with a purposive, nested sample of students identified from the quantitative phase as having low compliance scores. Interviews aimed to explore perceived barriers to SP compliance. The interview guide was developed based on the results from the quantitative data. Data were analyzed thematically using Braun and Clarke’s six-phase framework. Transcripts were coded using MAXQDA software, and themes were developed collaboratively by the research team to ensure credibility and trustworthiness.

Eligibility criteria for the study were students enrolled in the nursing internship program, bridged students, and students in the third or fourth year. Students enrolled in the first and second years were excluded due to a lack of clinical practice. Conclusions: Findings from this mixed methods study revealed that undergraduate nursing students in Saudi Arabia demonstrated moderate compliance with standard precautions, with significant variability across infection control domains. Quantitative results identified justification and infection control training as key predictors of compliance, while geographic disparities and weak practice culture also influenced outcomes. Qualitative findings enriched this understanding by highlighting personal, educational, organizational, and social barriers that hinder compliance. Together, these results underscore the multifaceted nature of SP compliance and point to the need for targeted educational reforms, supportive clinical environments, and culturally responsive strategies to strengthen infection prevention behaviors among nursing students.