CHAPTER TWO: LITERATURE REVIEW

2.0 Introduction

Infection prevention and control (IPC) has become an essential topic of concern in the health
sector due to its impact on patient safety, healthcare worker well-being, and overall public
health. Effective IPC practices are largely dependent on the knowledge, attitudes, and
compliance of healthcare workers, including student nurses. This chapter presents a review of
relevant literature, organized into theoretical and empirical sections, to provide context for the
current study.

2.1 Theoretical Review

2.1.1 Knowledge, Attitude, and Practice (KAP) Model

The Knowledge, Attitude, and Practice (KAP) model is widely used in public health research to
understand how awareness (knowledge), feelings (attitude), and behaviors (practice) influence
each other. In the context of IPC, the KAP model suggests that a student nurse’s ability to apply
infection control measures depends on their understanding of IPC guidelines (knowledge), their
perception of its importance (attitude), and the extent to which they follow protocols (practice).

According to Glanz et al. (2008), knowledge often lays the foundation for attitude development,
which then motivates behavior. For instance, when student nurses learn about the consequences
of non-compliance with IPC, they are more likely to take preventive measures seriously.
However, knowledge alone is not sufficient — institutional culture, peer influence, and
supervision also affect adherence to IPC.

2.1.2 Health Belief Model (HBM)

The Health Belief Model (HBM) also provides a framework for understanding IPC behaviors. It
postulates that individuals are likely to engage in health-related behavior if they perceive
themselves to be susceptible to a condition, believe it has serious consequences, think taking a
specific action would reduce their susceptibility, and believe the benefits of taking the action
outweigh the barriers.

In a nursing context, if student nurses perceive the risk of infection during clinical procedures as
high, and if they believe that using PPE and hand hygiene effectively reduces that risk, they are
more likely to adhere to IPC protocols.

2.2 Empirical Review

This section discusses findings from previous studies relevant to the current research objectives.
The review is categorized according to the study’s specific objectives.

2.2.1 Knowledge of Student Nurses on IPC

A study conducted by Ibrahim et al. (2021) in Nigeria assessed nursing students’ knowledge of
infection control and found that only 58% had adequate understanding of basic IPC protocols,
including hand hygiene and PPE usage. The gaps were attributed to theoretical-only training with
limited hands-on experience.

Similarly, research in Ghana by Asare et al. (2019) found that final-year student nurses had
moderate knowledge of IPC, but struggled with identifying specific procedures related to
surgical asepsis and sterilization. The authors recommended curriculum revisions to include
practical training sessions focused on IPC.

2.2.2 Attitudes of Student Nurses Towards IPC

According to Ayele and Tefera (2020) in Ethiopia, nursing students demonstrated positive
attitudes toward IPC but reported feeling discouraged due to limited availability of equipment.
Many believed that IPC practices are crucial but expressed frustration at being unable to
implement them fully in clinical settings.

In another study by Nwankwo et al. (2018), student nurses in clinical practice reported feeling
embarrassed when their peers neglected IPC protocols. This peer influence affected their attitude,
particularly when preceptors or staff nurses failed to model appropriate IPC behavior.

2.2.3 Challenges in IPC Adherence

One of the most frequently cited challenges across several studies is the lack of adequate
resources. In Kenya, Ouma et al. (2021) found that student nurses were often forced to reuse
disposable gloves or share protective gear due to stock shortages in public hospitals.

Other barriers include inadequate supervision, time constraints, and poor institutional policy
enforcement. A survey by Boateng and Appiah (2020) in Ghana revealed that student nurses
were often unsure of whom to consult about IPC-related issues, leading to inconsistent practices
during clinical placements.

2.2.4 Strategies for Improving IPC Compliance

Studies consistently recommend strengthening the nursing curriculum with more IPC simulations
and regular assessment of skills. Also, mentorship programs where experienced nurses supervise
students have shown positive results in improving IPC adherence.

Kagoya et al. (2022) emphasized the importance of monitoring and evaluation. When student
nurses received feedback on their IPC practices, they were more likely to follow protocols
correctly. Institutional accountability, according to the study, played a significant role in shaping
student behavior.