This study aimed to assess adherence to infection prevention and control (IPC) protocols by healthcare providers at operating rooms in NGO hospitals in Gaza. The study used questionnaires, observation checklists, and interviews to evaluate IPC practices, and the relationship between individual/organizational factors and adherence. Key findings included a positive correlation between IPC practices and providers' knowledge, attitudes, and training. The study also found differences in practices between hospital departments and professions. Recommendations focused on improving IPC training, monitoring, and guidelines to strengthen practices.

1. BY
Jehad Nasri Elmadhoun
Supervised by
Dr. Nihaya Al-Telbani

2.  Theoverall aim of this study is to
assess the adherence of healthcare
provider's practices at the operating
rooms in NGOs hospitals in Gaza
governorates to the infection
prevention and control protocols
and guidelines.

3.  To assess the infection prevention and control
practices at the operating rooms.
 To determine the relationship between the individual
factors and the infection prevention and control
practices at the operating rooms.
 To determine the relationship between the
organizational factors and the infection prevention
and control practices at the operating rooms.

4.  To explore the relationship between the physical
environmental factors and the infection prevention and
control practices at the operating rooms.
 To explore the differences in the answers of the
respondents concerning their infection prevention and
control practices.
 To develop suitable and applicable recommendations to
encourage the healthcare providers compliance with
infection prevention and control protocol.

7.  Descriptive analytical cross
sectional with triangulation
between quantitative and
qualitative approach.

8. 
 The population of the  The population of the
quantitative part of the qualitative part of the
research consisted of all
ORs physical environment research entitles
and HCPs working at the conducting in-depth
ORs in the selected NGOs
hospitals (surgeons, interviews with 6
anesthesiologists, OR selected persons from
nurses or anesthesia the different hospitals
technicians). The total
number of the HCPs at the under investigation.
ORs was 184 persons, 15 of
them were drawn to the
pilot study and the rest
(169) participated in the
study.
Quantitative Qualitative

9.  The study was conducted on 6 NGOs
hospitals in Gaza governorates according
to the inclusion criteria. The hospitals are
Al-Awda hospital, Patient's Friends
hospital, Public aid hospital, Yafa hospital,
Dar Essalam hospital and Al-Kuwait
hospital. It is important to mention that
Al-Ahli hospital refused to be included in
the study sample
Study Sample

10.  The study was conducted from February to
November 2011, it was started by preparing
research proposal and designing the data
collection instruments, and then get the
approval from the University to complete the
study, pilot study and data collection was done
in august and September and then data analysis
and completing the research in October and
November.

11. 
 The hospital which carries out 
 Workers of
Workers of the ORs, because they
the ORs, because they
general surgery haven't the
haven't the IPC knowledge to
IPC knowledge to

 The hospital that has two ORs answer the
answer the questions of this
questions of this
research.
research.
and more.

 The hospital which does the 
 The hospitals that
The hospitals that have less than
have less than
largest number of surgical
two ORs, because
two ORs, because they don’t do
they don’t do
operations (more than 100 general surgery.
general surgery.
surgeries per month).

 The hospitals that has the largest 
 The two hospitals (Al-Quds &Al-
The two hospitals (Al-Quds &Al-
number of ORs staff. Amal) which are affiliated to the
Amal) which are affiliated to the

 All the surgical team members Palestinian red crescent society
Palestinian red crescent society
(surgeons who frequently do because they are considered
because they are considered
national hospitals.
national hospitals.
operation, anesthesia team either
physicians or technicians, and
nurses) irrespective of the type

 Jordanian hospital in Gaza
Jordanian hospital in Gaza
of hiring. because it is a relief and
because it is a relief and
temporary hospital.
temporary hospital.
Inclusion criteria Exclusion criteria

12.  Self-administered questionnaire
 Observation checklist for the physical
environment
 Observation checklist for the health care
providers
 In-depth interviews for key persons

13.  Ethical approval was obtained from
Helsinki Committee to carry out the
study.
 An approval letters were obtained from
the NGOs hospitals directors .
 Informed consent was also obtained from
participants.
 Participation in the research was
optional.

15. 
 In the quantitative part, the researcher used three
instruments: self-administered questionnaire, observation
checklist for ORs, and observation check list for HCPs. All
the three data collection instruments were developed by
the researcher in the light of IPC protocols, and were
reviewed by experts. The questionnaire was filled by the
HCPs themselves under the researcher supervision. Both
of the checklists were observed by the researcher himself
three times in different times and in different working
shifts.

 In the qualitative part the researcher used in depth
interviews including 6 HCPs, whom were purposively
chosen. Those were in managerial positions such as:
hospital medical director, nursing director, and head nurse
from different NGOs hospitals. The main factors that
influence the practices of the IPC will be discussed.

17. Response rate
 Of the 169 HCPs who constitute the study
population 154 responded with a response
rate of 91%

33. P-Value (Sig.) Pearson Correlation Field
Coefficient
Knowledge
.170 0.018*
Attitudes
.237 0.002*
Training & .208 0.005*
education

34. P-Value (Sig.) Pearson Correlation Field
Coefficient
Availability of the 0.047 0.283
protocols.
Materials and equipment
5.183 0.007
Supportive policies
0.023 0.388
Supervision, Monitoring
and Evaluation -0.124 0.062
Workload and workforce
0.039 0.318

36. Dependent Independent Test value P-value(Sig.)
variable variable
Practices Hospital 0.814 0.541
Gender 1.213 0.227
Age 0.243 0.866
Marital status 1.339 0.249
Profession 2.153 0.077
Education 1.521 0.199
Experience
2.747 0.067
Current position
1.451 0.230

37. No Field Test value P-value(Sig.)
1.
2.185 0.059
Hospital name
2. Profession Mean
Surgeon
1.40
Nurse
1.56 86.642 0.000*
Anesthesiologist
0.72
Anesthesia technician
0.65

39. 1. Training courses and education sessions regarding
IPC
should be
implemented for all HCPs to increase their awareness
towards this issue.
2. More attention must be given to hepatitis B
vaccination.
3. The HCPs have to comply with SPs to protect
themselves and others.
4. NGOs hospitals must increase the coordination and
mutual cooperation with the MOH to get its role as a
supervisory body.

40. 5. Every hospital should have an IPCC to be responsible
for all activities of infection prevention and control.
6. The MOH should activate its role as it is considered the
main health care provider in Palestine.
7.The IPC protocols must be developed and updated to
meet all aspects of health care especially the procedures
at the ORs.
8. The role of management in supervising, monitoring and
evaluation the practices of IPC, must be strengthened

41. 9. At the ORs level a high quality practitioner have
to be designated to practice the
role of in-service training and education.
10. As much as possible hospitals have to modify
the physical environment of ORs to be suitable for
IPC standards.
11. Workers of the ORs must be undergoing
comprehensive training and education regarding
infection control.