The goal of this clinical trial is to evaluate the effects of nurse-led education programmes on childcare workers (CCWs) in improving infection prevention and control (IPC) practices in daycare centres. The main questions it aims to answer are: 1. Is there an increase in IPC knowledge, attitudes, practices, and self-efficacy, as well as hand hygiene intention and compliance of CCWs after receiving the online or onsite IPC nurse-led education programme? 2. Do CCWs who receive the online programme exhibit higher IPC knowledge, attitudes, practices, and self-efficacy, as well as hand hygiene intention and compliance compared to those who do not receive any programme? 3. Do CCWs who receive the onsite programme exhibit higher IPC knowledge, attitudes, practices, and self-efficacy, as well as hand hygiene intention and compliance compared to those who do not receive any programme? 4. Is there a difference in IPC knowledge, attitudes, practices, and self-efficacy, as well as hand hygiene intention and compliance between CCWs who receive the online programme and those who receive the onsite programme?
Despite the crucial role of infection prevention and control (IPC) in daycare centers (DCCs), research reveals significant gaps. Based on the systematic review of the IPC programmes among childcare workers (CCWs), most studies focus mainly on hand hygiene, neglecting other IPC components like environmental cleaning, waste management, vaccination, and triage of infectious disease patients. Research on the role of nurses in developing and implementing these programmes is also limited. Existing studies often emphasize outcomes related to children and parents rather than assessing the impact on CCWs. Only two studies used a cluster randomized controlled trial (RCT) design, essential for evaluating group interventions. Additionally, the emergence of online, on-demand, and hybrid learning methods highlights a gap in IPC training, with limited exploration of online learning for IPC education. Comprehensive IPC programmes for CCWs, incorporating various IPC components, clearly defined roles for nurses, and modern educational methods, are urgently needed. These programmes should be rigorously evaluated using cluster RCT designs to provide robust evidence of their effectiveness. Therefore, this clinical trial is aimed to evaluate the effects of nurse-led education programmes on IPC knowledge, attitudes, and practices, as well as hand hygiene intention and compliance among CCWs in daycare centres in Bangkok, Thailand.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
180
The programme was designed to enhance CCWs' IPC knowledge and attitudes through lectures, interactive discussions, information sharing, and Q\&A sessions. It also aims to improve their IPC practices and self-efficacy through demonstrations, role-playing exercises, and a work assignment focused on IPC self-monitoring. The programme includes five educational sessions totalling 12 hours, along with one session for work assignment on daily self-monitoring of IPC practices over five days. The educational sessions cover the following topics: 1. General concepts of infectious diseases 2. Vaccination 3. Standard precautions: The use of personal protective equipment, environmental cleaning and disinfection, handling food and feeding, and waste management 4. Standard precautions: Hand hygiene 5. Common infectious diseases in DCCs and management.
The online version of the nurse-led education programme was conducted using an online meeting platform. It includes the same content, learning activities, and materials as the onsite delivery programme, except for the practice stations, which cannot be provided to participants in the online delivery. Additionally, all documents will be available for download via the online platform.
Suan Sunandha Rajabhat University
Bangkok, Dusit, Thailand
RECRUITINGInfection prevention and control knowledge
This questionnaire was adapted from an existing validated tool, the knowledge of preventive behaviors for communicable diseases questionnaire. It was developed based on the Disease-Free Child Care Centers Policy from the Department of Disease Control, Thailand Ministry of Public Health, to assess Thai CCWs. The original questionnaire consists of 15 dichotomous questions. The item objective congruence (IOC) was evaluated by five experts, resulting in a score of 0.744, and internal consistency was assessed with a KR-20 of 0.73 (n = 30). In this study, the researchers added five questions regarding the knowledge of using personal protective equipment, handling food and feeding, and managing waste. Therefore, the final version of this questionnaire consists of 20 dichotomous questions. The total score will be calculated by summing the correct responses, with higher scores indicating greater levels of IPC knowledge.
Time frame: From enrollment to the end of the programme at immediatly, 1 month, 3 months, and 6 months
Infection prevention and control attitudes
This questionnaire was adapted from an existing validated tool, the attitudes of preventive behaviors for communicable disease questionnaire. It was developed based on the Disease-Free Child Care Centers Policy from the Department of Disease Control, Thailand Ministry of Public Health, to assess Thai CCWs. The original questionnaire consists of 15 items with five-point Likert scales. The IOC was evaluated by five experts, resulting in a score of 0.744, and internal consistency was assessed with a Cronbach's α of 0.71 (n = 30). In this study, the researchers removed questions that were outside the conceptual definition and added questions regarding beliefs, perceptions, and feelings about the importance and necessity of IPC measures. The final version of this questionnaire still consists of 15 items, including both positive and negative statements, with five-point Likert scales. The total score will be calculated, with higher scores indicating more positive attitudes toward IPC.
Time frame: From enrollment to the end of the programme at immediatly, 1 month, 3 months, and 6 months
Infection prevention and control practices
This questionnaire was adapted from an existing validated tool, the preventive behaviours for communicable disease questionnaire. It was developed based on the Disease-Free Child Care Centers Policy from the Department of Disease Control, Thailand Ministry of Public Health, to assess Thai CCWs. The original questionnaire consists of 15 items with five-point Likert scales. The IOC was evaluated by five experts, resulting in a score of 0.744, and internal consistency was assessed with a Cronbach's α of 0.71 (n = 30). In this study, the researchers added five questions regarding practice of vaccination monitoring, the use of personal protective equipment (PPE), handling food and feeding, and waste management. Therefore, the final version of this questionnaire consists of 20 items with five-point Likert scales. The total score will be calculated, with higher scores indicating higher levels of IPC practices.
Time frame: From enrollment to the end of the programme at immediatly, 1 month, 3 months, and 6 months
Infection prevention and control self-efficacy
This questionnaire was translated and adapted from and existing validated tool, the infectious diseases prevention self-efficacy questionnaire. It was originally used to assess self-efficacy in infectious disease prevention among Korean daycare center administrators. The questionnaire consists of 15 items with five-point Likert scales. The original tool demonstrated internal consistency with a Cronbach's α of 0.91 (n = 172). In this study, the original questionnaire was translated from English to Thai by following the WHO guidelines for the process of translation and adaptation of instruments. Additionally, the researchers removed questions that were outside the conceptual definition and added items regarding confidence in the use of PPE, handling food and feeding, and waste management. The final version of the questionnaire still consists of 15 items with five-point Likert scales. The total score will be calculated, with higher scores indicating higher levels of IPC self-efficacy.
Time frame: From enrollment to the end of the programme at immediatly, 1 month, 3 months, and 6 months
Hand hygiene intention
This questionnaire was translated from an existing validated tool, the hand hygiene intention questionnaire. It was originally developed based on the Theory of Planned Behavior and identified through focus group discussions with caregivers and managers of DCCs to assess hand hygiene intention among CCWs in the Netherlands. The questionnaire consists of 2 items with seven-point Likert scales. The internal consistency was measured with a Cronbach's α of 0.90 (n = 350). The total score will be calculated, with higher scores indicating greater levels of hand hygiene intention.
Time frame: From enrollment to the end of the programme at immediatly, 1 month, 3 months, and 6 months
Hand hygiene compliance
This questionnaire was translated and adapted from and existing validated tool, the hand hygiene compliance questionnaire. It was originally developed and commonly used in hand hygiene surveys of caregivers in Netherlands DCCs. The questionnaire consists of 18 items with eleven-point rating scales. It was later used to assess hand hygiene compliance among Chinese kindergarten teachers, reporting an internal consistency with a Cronbach's α of 0.83 (n = 95).
Time frame: From enrollment to the end of the programme at immediatly, 1 month, 3 months, and 6 months
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