Low compliance, limited facilities, and insufficient budget funds become obstacles in the implementation of infection and prevention control programs: A phenomenology study

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"documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Clin. 2021;31 Supl 2:S41-S44" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Nurses’ experience in interacting with the infection prevention and control nurse" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "S41" "paginaFinal" => "S44" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marthalena Siahaan, Hanny Handiyani, Hening Pujasari" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Marthalena" "apellidos" => "Siahaan" ] 1 => array:2 [ "nombre" => "Hanny" "apellidos" => "Handiyani" ] 2 => array:2 [ "nombre" => "Hening" "apellidos" => "Pujasari" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S113086212030512X?idApp=UINPBA00004N" "url" => "/11308621/00000031000000S2/v2_202104141019/S113086212030512X/v2_202104141019/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "titulo" => "Low compliance, limited facilities, and insufficient budget funds become obstacles in the implementation of infection and prevention control programs: A phenomenology study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "S45" "paginaFinal" => "S49" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Mira Damayanti, Hanny Handiyani" "autores" => array:2 [ 0 => array:3 [ "nombre" => "Mira" "apellidos" => "Damayanti" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 1 => array:4 [ "nombre" => "Hanny" "apellidos" => "Handiyani" "email" => array:1 [ 0 => "honey@ui.ac.id" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Dr. Sobirin Hospital, Lubuklinggau, South Sumatra, Indonesia" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "IntroductionHealthcare-Associated Infections (HAIs) are a global problem that can result in mortality, morbidity, and incur economic losses. The WHO states that implementing Infection Prevention and Control (IPC) program is a best practice for reducing the incidence of HAIs.<a class="elsevierStyleCrossRef" href="#bib0100">1</a> The Infection and Prevention Control Nurse (IPCN) has the competence to oversee and supervise all IPC activities.<a class="elsevierStyleCrossRef" href="#bib0105">2</a> The research showed that the existence of IPCNs was effective in reducing HAIs.<a class="elsevierStyleCrossRef" href="#bib0110">3</a>The Infection and Prevention Control Link Nurse (IPCLN) has the role of connecting the IPCN with the infection control team. The IPCN can be assisted by the IPCLN from a different unit.<a class="elsevierStyleCrossRef" href="#bib0115">4</a> To close the gap and strengthen the IPC program, the role of the IPCLN was created to act as a liaison between IPCNs working in different units.<a class="elsevierStyleCrossRef" href="#bib0120">5</a>MethodA qualitative method with a descriptive phenomenology approach was used to explore the experiences of IPCNs and IPCLNs in Hospital X while implementing the IPC program. Participants consisted of nine nurses working as IPCNs and IPCLNs selected using the purposive sampling technique, with the inclusion criteria of more than one year of experience working as an IPCN or IPCLN.Data collection was conducted after obtaining ethical approval from the research ethics committee of the Faculty of Nursing Universitas Indonesia, with number SK-258/UN2.F12.DI.2.1/ETIK.FIK.2019. Each participant provided written informed consent before being interviewed. The interviews were all conducted face-to-face in a private room and lasted from 30 to 40min. The researcher used interview guidelines that contained questions related to the experience of the IPCNs and the IPCLNs while implementing the IPC program. The data were analyzed using Colaizzi's method.ResultsCharacteristics of participantsCharacteristics of participants in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> show that the age of the nine participants ranged from 39 to 55 years-of-age. The length of time the participants had been working as a nurse ranged from 10 to 30 years. The educational background of the study group was composed of 44.4% registered nurses (RN), 44.4% bachelor's degree, and 11.2% diplomas. The majority of participants were female (66.7%) with 2 years of experiences as an IPCN or IPCLN (66.7%).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Thematic analysisThe thematic analysis of the data gathered during the interviews produced five emergent themes. The themes are described as follows:Theme 1. The IPC program has been implemented in the hospitalThe first theme identified was that the IPC program had been implemented in the hospital. The following are free statements provide by participants relating to this theme (the participant is identified in parentheses after the statement using their code name):“The program includes how to do hand hygiene, effective cough, then environment hygiene” (P4)“… waste disposal, injection, then Personal Protective Equipment (PPE)“(P7)“… the standard and the isolation precaution. Infection Control Risk Assessment (ICRA) is also included. IPC education and training for all employees…“(P1)“The most prominent we did is HAIs surveillance, then outbreak investigation“(P2)Theme 2. The IPCN as the driving force in the implementation of the IPC programThe IPCN as the driving force in the implementation of the IPC program is identified as the second theme. Participant statements relating to this theme are as follows:“The IPCN in this hospital is as the driving force. The IPCN is in charge every day around the ward to monitor HAIs surveillance, waste sorting, patient placement, do socialization to all staff and to newly enrolled students. We are also carrying out scheduled surveillance activities to monitor surveillance data collection”(P1)“The IPCN monitoring the activities to prevent HAIs…”(P2)“The IPCN often come to our room to look whether the officer has performed the procedure correctly or not”(P8)Theme 3. The IPCLN assists the IPCN in the implementation of the IPC programThe third theme is that the IPCLN assists the IPCN in the implementation of the IPC program units. Below are free statements from the participants relating to this theme:“The IPC programs monitored by the IPCN with the help of the IPCLN”(P1)“The IPCLN's assignments are doing HAIs surveillance, monitoring the compliance of staffs…”(P3)“I often remind the staffs to use PPE correctly. I then remind the patient and staffs how to wash their hands and how to do cough ethics”(P9)Theme 4. Low compliance, limited facilities, and insufficient budget funds are obstaclesThe fourth theme is that low compliance, limited facilities, and insufficient budget funds become obstacles in the implementation of the IPC program. The following are statements related to the theme:“There is a certain obstacle, such as compliance”(P7)“There is no problem with the stock of safety box, but it is not standardized”(P3)“… the ventilator pipe, hospital management can’t afford to be disposable, it's sterilized and reused”(P4)“… we haven’t joined the advanced IPCN training yet. Only 200 of our employees have joined basic IPC education and training… That's because there are no funds”(P1)“Only if there is a HEPA filter. We have to make a submission, but the price is expensive, the hospital can’t afford it”(P5)Theme 5. The Expectations of the IPCNs and the IPCLNsThe fifth theme that can be identified is the expectations of the IPCNs and the IPCLNs in the implementation of the IPC program. Participants’ statements related to the theme are as follows:“…if it is possible that the financial and planning department can allocate sufficient funds to help the IPC programs provide standardize facilities”(P1)“The expectations are everyone complies with the standards and procedures”(P9)“I hope to be given full support from management, receive cooperation from other nurses, and good coordination from units”(P2)“In the future, we hope there will be a reward system in our hospital for a unit that fully supports the IPC program”(P7)DiscussionTheme 1. The IPC program has been implemented in the hospitalThe IPC program has been implemented in the hospital, but the participants have not yet mentioned the anti-microbial resistance control and the application of bundles as an IPC program. Antibiotic monitoring must be a high priority for all health care practitioners because it's very effective in preventing HAIs.<a class="elsevierStyleCrossRefs" href="#bib0125">6,7</a> The application of policies on the use of antibiotics and isolation have a relationship with a decrease in the number of MRSA patients.<a class="elsevierStyleCrossRef" href="#bib0135">8</a> The application of bundles is needed to prevent the occurrence of HAIs.<a class="elsevierStyleCrossRefs" href="#bib0115">4,9,10</a> Reducing antibiotic resistance and applying the bundles is very effective in preventing HAIs. Thus, to achieve the goal of IPC, the anti-microbial resistance control program and applying the bundles should be included as IPC program.Theme 2. The IPCN as the driving force in the implementation of the IPC programThe existence of IPCN proved effective in reducing HAIs, reducing the mortality of PICU, and improving the safety of critical patients in PICU.<a class="elsevierStyleCrossRef" href="#bib0110">3</a> The impact of an IPCN depends on age, experience working as a nurse, working experience as an IPCN, number of beds, knowledge of infection control, and education level.<a class="elsevierStyleCrossRef" href="#bib0150">11</a> The participant's statement did not mention IPCN duties in monitoring single-use medical devices that are being reused, monitoring staff exposed to infectious material or pierced by sharp objects, nor monitoring the implementation of antibiotic guidelines. The performance of IPCN must be improved to provide better service so that the goal of preventing and controlling infections can be achieved optimally.Theme 3. The IPCLNs assist the IPCNs in the implementation of the IPC programThe task of the IPCLN is to monitor the compliance of health workers’ hand hygiene for at least ten audits, identify and report matters related to IPC in work units, identify problems experienced by health workers in improving compliance, monitoring, teaching activities and implementing IPC measures.<a class="elsevierStyleCrossRefs" href="#bib0120">5,12</a> The results of the interviews didn’t described the duties of an IPCLN in coordinating with IPCN if there is a potential infection of the outbreak. The IPCLN was established as an effort to build IPCN liaisons with nurses working in direct patient care. With the help of IPCLNs, the potential to reduce HAIs is expected to be achieved.<a class="elsevierStyleCrossRef" href="#bib0120">5</a> The IPCLN is an important to connect and control programs in every unit in the hospital.Theme 4. Low compliance, limited facilities, and insufficient budget funds become obstaclesThe results show that low compliance was an obstacle in the implementation of the IPC program. The cause of poor adherence to IPC practices is a lack of resources, a low level of awareness, and an overload of patients.<a class="elsevierStyleCrossRef" href="#bib0160">13</a> Previous studies regarding non-compliance in implementing IPC practices found nurses’ disobedience.<a class="elsevierStyleCrossRef" href="#bib0165">14</a> Health workers generally know about IPC but are not aware of the situation in the hospital and so that hospital infection control practices remain poorly implemented.<a class="elsevierStyleCrossRef" href="#bib0170">15</a>Participants also stated that limited facilities become an obstacle and insufficient budget funds as a cause of not fulfilling the needs related to IPC, particularly related to education and training, facilities and infrastructure. Hospital infrastructure and design and the absence of infection control training caused the hospital outbreaks, including infections MERS-CoV.<a class="elsevierStyleCrossRef" href="#bib0175">16</a> This research shows that unstandardized facilities and the lack of competences in IPC increases the incidence of HAIs. The activities carried out in the IPC program requires special training and competences.<a class="elsevierStyleCrossRef" href="#bib0180">17</a> IPCNs must obtain additional advanced training on IPCN training, and IPCLNs must obtain additional advanced IPC training.<a class="elsevierStyleCrossRef" href="#bib0115">4</a>Theme 5. The expectations of the IPCNs and the IPCLNsParticipants expect support from management. All employees were more concerned about following procedures and hoped for rewards in response to implementing the IPC program. To be able to prevent and control HAIs effectively requires a collaborative approach that forces all health service staff to take responsibility and be involved.<a class="elsevierStyleCrossRef" href="#bib0170">15</a> The WHO stated that the implementation of IPC is a best practice in reducing the incidence of HAIs, and the best results are achieved when IPC is supported by political and managerial systems, integrated with clinical services and patient safety culture (1). The role of management is critical in helping to support the IPC program, and the decision of the hospital management to limit the PPI program only to cover specific areas has the potential to lead to new problems related to infection control.<a class="elsevierStyleCrossRefs" href="#bib0185">18,19</a> Hospital management should provide full support for the implementation of the IPC program in order to prevent and control HAIs. This includes ensuring the allocation of sufficient funds for training and supporting collaborative approaches, through the provision of compelling rewards, guidance or punishment, to ensure that all employees adhere to IPC procedures.ConclusionsThe IPCN is the driving force in the implementation of IPC programs. The IPCNs require the IPCLNs to assist in monitoring, identifying, and reporting matters related to IPC in the work unit, while guiding staff in the IPC procedures. In carrying out their duties with regards to infection prevention and control, IPCNs and IPCLNs must receive all necessary education and training. Full support from hospital management and IPC activities from all the staff are also needed in the implementation of IPC program to prevent and control HAIs.The results of this research indicate that low compliance, limited facilities, and insufficient budget funds become obstacles in the implementation of the IPC program. These findings are expected to inform the development of nursing management strategies, especially in the field of infection prevention and control in hospitals.Conflict of interestThe authors declare no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1496472" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1358833" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Method" ] 4 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Characteristics of participants" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Thematic analysis" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Theme 1. The IPC program has been implemented in the hospital" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Theme 2. The IPCN as the driving force in the implementation of the IPC program" ] 4 => array:2 [ "identificador" => "sec0040" "titulo" => "Theme 3. The IPCLN assists the IPCN in the implementation of the IPC program" ] 5 => array:2 [ "identificador" => "sec0045" "titulo" => "Theme 4. Low compliance, limited facilities, and insufficient budget funds are obstacles" ] 6 => array:2 [ "identificador" => "sec0050" "titulo" => "Theme 5. The Expectations of the IPCNs and the IPCLNs" ] ] ] 5 => array:3 [ "identificador" => "sec0055" "titulo" => "Discussion" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Theme 1. The IPC program has been implemented in the hospital" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Theme 2. The IPCN as the driving force in the implementation of the IPC program" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Theme 3. The IPCLNs assist the IPCNs in the implementation of the IPC program" ] 3 => array:2 [ "identificador" => "sec0075" "titulo" => "Theme 4. Low compliance, limited facilities, and insufficient budget funds become obstacles" ] 4 => array:2 [ "identificador" => "sec0080" "titulo" => "Theme 5. The expectations of the IPCNs and the IPCLNs" ] ] ] 6 => array:2 [ "identificador" => "sec0085" "titulo" => "Conclusions" ] 7 => array:2 [ "identificador" => "sec0090" "titulo" => "Conflict of interest" ] 8 => array:2 [ "identificador" => "xack524180" "titulo" => "Acknowledgements" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-09-15" "fechaAceptado" => "2020-09-21" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1358833" "palabras" => array:5 [ 0 => "Infection control" 1 => "Infection prevention control" 2 => "Infection prevention control link nurse" 3 => "Infection prevention control nurse" 4 => "Infection prevention control program" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "The purpose of this study is to explore the experiences of Infection and Prevention Control Nurses (IPCNs) and Infection and Prevention Control Link Nurses (IPCLNs) in implementing the Infection Prevention and Control (IPC) program. The study used a qualitative method with a phenomenology approach. Semi-structured interviews were conducted with nine nurses working as IPCNs and IPCLNs. Participants were selected using the purposive sampling technique. The data were analyzed using Colaizzi's method. Five main themes from this study emerged, indicating that low compliance, limited facilities, and insufficient budget funds become obstacles in the implementation of IPC programs. IPCNs are the driving force in the implementation of IPC programs. In carrying out their duties for IPC, IPCNs and IPCLNs must develop appropriate knowledge and competences. With the help of IPCLNs and full support from hospital management, the goal of reducing HAIs is expected to be achieved." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Peer-review under responsibility of the scientific committee of the 4th International Conference for Global Health (ICGH) in conjunction with the 7th Asian International Conference in Humanized Health Care (AIC-HHC). Full-text and the content of it is under responsibility of authors of the article." ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Code \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gender \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Length of work \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Educational background \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duty \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Length of work as IPCN/IPCLN \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IPCN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bachelor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IPCN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 year \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bachelor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IPCLN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bachelor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IPCLN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IPCLN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 year \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Man \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diploma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IPCLN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Man \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IPCLN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bachelor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IPCLN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 year \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IPCLN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 years \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2571051.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of participants." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0100" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "World Health Organization. Health care without avoidable infections: the critical role of infection prevention and control [Internet]. Geneva: World Health Organization. c2016. Available from: <a target="_blank" href="http://apps.who.int/iris/bitstream/handle/10665/246235/WHO-HIS-SDS-2016.10-eng.pdf;jsessionid=54748ADBB222C2141F21865F1DF3F187?sequence=1">http://apps.who.int/iris/bitstream/handle/10665/246235/WHO-HIS-SDS-2016.10-eng.pdf;jsessionid=54748ADBB222C2141F21865F1DF3F187?sequence=1</a> [cited 4.11.18]." ] ] ] 1 => array:3 [ "identificador" => "bib0105" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Komisi Akreditasi Rumah Sakit. Standar nasional akreditasi rumah sakit edisi 1 [Internet]. Jakarta: Komisi Akreditasi Rumah Sakit; c2017. 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Mira Damayantia,b, Hanny Handiyania,

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honey@ui.ac.id

Corresponding author.

a Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia

b Dr. Sobirin Hospital, Lubuklinggau, South Sumatra, Indonesia

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has the role of connecting the IPCN with the infection control team&#46; The IPCN can be assisted by the IPCLN from a different unit&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a> To close the gap and strengthen the IPC program&#44; the role of the IPCLN was created to act as a liaison between IPCNs working in different units&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Method</span><p id="par0015" class="elsevierStylePara elsevierViewall">A qualitative method with a descriptive phenomenology approach was used to explore the experiences of IPCNs and IPCLNs in Hospital X while implementing the IPC program&#46; Participants consisted of nine nurses working as IPCNs and IPCLNs selected using the purposive sampling technique&#44; with the inclusion criteria of more than one year of experience working as an IPCN or IPCLN&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Data collection was conducted after obtaining ethical approval from the research ethics committee of the Faculty of Nursing Universitas Indonesia&#44; with number SK-258&#47;UN2&#46;F12&#46;DI&#46;2&#46;1&#47;ETIK&#46;FIK&#46;2019&#46; Each participant provided written informed consent before being interviewed&#46; The interviews were all conducted face-to-face in a private room and lasted from 30 to 40<span class="elsevierStyleHsp" style=""></span>min&#46; The researcher used interview guidelines that contained questions related to the experience of the IPCNs and the IPCLNs while implementing the IPC program&#46; The data were analyzed using Colaizzi&#39;s method&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Characteristics of participants</span><p id="par0025" class="elsevierStylePara elsevierViewall">Characteristics of participants in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> show that the age of the nine participants ranged from 39 to 55 years-of-age&#46; The length of time the participants had been working as a nurse ranged from 10 to 30 years&#46; The educational background of the study group was composed of 44&#46;4&#37; registered nurses &#40;RN&#41;&#44; 44&#46;4&#37; bachelor&#39;s degree&#44; and 11&#46;2&#37; diplomas&#46; The majority of participants were female &#40;66&#46;7&#37;&#41; with 2 years of experiences as an IPCN or IPCLN &#40;66&#46;7&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Thematic analysis</span><p id="par0030" class="elsevierStylePara elsevierViewall">The thematic analysis of the data gathered during the interviews produced five emergent themes&#46; The themes are described as follows&#58;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Theme 1&#46; The IPC program has been implemented in the hospital</span><p id="par0035" class="elsevierStylePara elsevierViewall">The first theme identified was that the IPC program had been implemented in the hospital&#46; The following are free statements provide by participants relating to this theme &#40;the participant is identified in parentheses after the statement using their code name&#41;&#58;<span class="elsevierStyleDisplayedQuote" id="dsq0005"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8220;The program includes how to do hand hygiene&#44; effective cough&#44; then environment hygiene&#8221; &#40;P4&#41;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0010"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8220;&#8230; waste disposal&#44; injection&#44; then Personal Protective Equipment &#40;PPE&#41;&#8220;&#40;P7&#41;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0015"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8220;&#8230; the standard and the isolation precaution&#46; Infection Control Risk Assessment &#40;ICRA&#41; is also included&#46; IPC education and training for all employees&#8230;&#8220;&#40;P1&#41;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0020"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8220;The most prominent we did is HAIs surveillance&#44; then outbreak investigation&#8220;&#40;P2&#41;</span></p></span></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Theme 2&#46; The IPCN as the driving force in the implementation of the IPC program</span><p id="par0040" class="elsevierStylePara elsevierViewall">The IPCN as the driving force in the implementation of the IPC program is identified as the second theme&#46; Participant statements relating to this theme are as follows&#58;<span class="elsevierStyleDisplayedQuote" id="dsq0025"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8220;The IPCN in this hospital is as the driving force&#46; The IPCN is in charge every day around the ward to monitor HAIs surveillance&#44; waste sorting&#44; patient placement&#44; do socialization to all staff and to newly enrolled students&#46; We are also carrying out scheduled surveillance activities to monitor surveillance data collection&#8221;&#40;P1&#41;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0030"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8220;The IPCN monitoring the activities to prevent HAIs&#8230;&#8221;&#40;P2&#41;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0035"><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8220;The IPCN often come to our room to look whether the officer has performed the procedure correctly or not&#8221;&#40;P8&#41;</span></p></span></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Theme 3&#46; The IPCLN assists the IPCN in the implementation of the IPC program</span><p id="par0045" class="elsevierStylePara elsevierViewall">The third theme is that the IPCLN assists the IPCN in the implementation of the IPC program units&#46; Below are free statements from the participants relating to this theme&#58;<span class="elsevierStyleDisplayedQuote" id="dsq0040"><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8220;The IPC programs monitored by the IPCN with the help of the IPCLN&#8221;&#40;P1&#41;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0045"><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8220;The IPCLN&#39;s assignments are doing HAIs surveillance&#44; monitoring the compliance of staffs&#8230;&#8221;&#40;P3&#41;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0050"><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8220;I often remind the staffs to use PPE correctly&#46; I then remind the patient and staffs how to wash their hands and how to do cough ethics&#8221;&#40;P9&#41;</span></p></span></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Theme 4&#46; Low compliance&#44; limited facilities&#44; and insufficient budget funds are obstacles</span><p id="par0050" class="elsevierStylePara elsevierViewall">The fourth theme is that low compliance&#44; limited facilities&#44; and insufficient budget funds become obstacles in the implementation of the IPC program&#46; The following are statements related to the theme&#58;<span class="elsevierStyleDisplayedQuote" id="dsq0055"><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8220;There is a certain obstacle&#44; such as compliance&#8221;&#40;P7&#41;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0060"><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8220;There is no problem with the stock of safety box&#44; but it is not standardized&#8221;&#40;P3&#41;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0065"><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8220;&#8230; the ventilator pipe&#44; hospital management can&#8217;t afford to be disposable&#44; it&#39;s sterilized and reused&#8221;&#40;P4&#41;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0070"><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8220;&#8230; we haven&#8217;t joined the advanced IPCN training yet&#46; Only 200 of our employees have joined basic IPC education and training&#8230; That&#39;s because there are no funds&#8221;&#40;P1&#41;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0075"><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8220;Only if there is a HEPA filter&#46; We have to make a submission&#44; but the price is expensive&#44; the hospital can&#8217;t afford it&#8221;&#40;P5&#41;</span></p></span></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Theme 5&#46; The Expectations of the IPCNs and the IPCLNs</span><p id="par0055" class="elsevierStylePara elsevierViewall">The fifth theme that can be identified is the expectations of the IPCNs and the IPCLNs in the implementation of the IPC program&#46; Participants&#8217; statements related to the theme are as follows&#58;<span class="elsevierStyleDisplayedQuote" id="dsq0080"><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8220;&#8230;if it is possible that the financial and planning department can allocate sufficient funds to help the IPC programs provide standardize facilities&#8221;&#40;P1&#41;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0085"><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8220;The expectations are everyone complies with the standards and procedures&#8221;&#40;P9&#41;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0090"><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8220;I hope to be given full support from management&#44; receive cooperation from other nurses&#44; and good coordination from units&#8221;&#40;P2&#41;</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0095"><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#8220;In the future&#44; we hope there will be a reward system in our hospital for a unit that fully supports the IPC program&#8221;&#40;P7&#41;</span></p></span></p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Discussion</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Theme 1&#46; The IPC program has been implemented in the hospital</span><p id="par0060" class="elsevierStylePara elsevierViewall">The IPC program has been implemented in the hospital&#44; but the participants have not yet mentioned the anti-microbial resistance control and the application of bundles as an IPC program&#46; Antibiotic monitoring must be a high priority for all health care practitioners because it&#39;s very effective in preventing HAIs&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">6&#44;7</span></a> The application of policies on the use of antibiotics and isolation have a relationship with a decrease in the number of MRSA patients&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a> The application of bundles is needed to prevent the occurrence of HAIs&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">4&#44;9&#44;10</span></a> Reducing antibiotic resistance and applying the bundles is very effective in preventing HAIs&#46; Thus&#44; to achieve the goal of IPC&#44; the anti-microbial resistance control program and applying the bundles should be included as IPC program&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Theme 2&#46; The IPCN as the driving force in the implementation of the IPC program</span><p id="par0065" class="elsevierStylePara elsevierViewall">The existence of IPCN proved effective in reducing HAIs&#44; reducing the mortality of PICU&#44; and improving the safety of critical patients in PICU&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a> The impact of an IPCN depends on age&#44; experience working as a nurse&#44; working experience as an IPCN&#44; number of beds&#44; knowledge of infection control&#44; and education level&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a> The participant&#39;s statement did not mention IPCN duties in monitoring single-use medical devices that are being reused&#44; monitoring staff exposed to infectious material or pierced by sharp objects&#44; nor monitoring the implementation of antibiotic guidelines&#46; The performance of IPCN must be improved to provide better service so that the goal of preventing and controlling infections can be achieved optimally&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Theme 3&#46; The IPCLNs assist the IPCNs in the implementation of the IPC program</span><p id="par0070" class="elsevierStylePara elsevierViewall">The task of the IPCLN is to monitor the compliance of health workers&#8217; hand hygiene for at least ten audits&#44; identify and report matters related to IPC in work units&#44; identify problems experienced by health workers in improving compliance&#44; monitoring&#44; teaching activities and implementing IPC measures&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">5&#44;12</span></a> The results of the interviews didn&#8217;t described the duties of an IPCLN in coordinating with IPCN if there is a potential infection of the outbreak&#46; The IPCLN was established as an effort to build IPCN liaisons with nurses working in direct patient care&#46; With the help of IPCLNs&#44; the potential to reduce HAIs is expected to be achieved&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a> The IPCLN is an important to connect and control programs in every unit in the hospital&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Theme 4&#46; Low compliance&#44; limited facilities&#44; and insufficient budget funds become obstacles</span><p id="par0075" class="elsevierStylePara elsevierViewall">The results show that low compliance was an obstacle in the implementation of the IPC program&#46; The cause of poor adherence to IPC practices is a lack of resources&#44; a low level of awareness&#44; and an overload of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">13</span></a> Previous studies regarding non-compliance in implementing IPC practices found nurses&#8217; disobedience&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> Health workers generally know about IPC but are not aware of the situation in the hospital and so that hospital infection control practices remain poorly implemented&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Participants also stated that limited facilities become an obstacle and insufficient budget funds as a cause of not fulfilling the needs related to IPC&#44; particularly related to education and training&#44; facilities and infrastructure&#46; Hospital infrastructure and design and the absence of infection control training caused the hospital outbreaks&#44; including infections MERS-CoV&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a> This research shows that unstandardized facilities and the lack of competences in IPC increases the incidence of HAIs&#46; The activities carried out in the IPC program requires special training and competences&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a> IPCNs must obtain additional advanced training on IPCN training&#44; and IPCLNs must obtain additional advanced IPC training&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Theme 5&#46; The expectations of the IPCNs and the IPCLNs</span><p id="par0085" class="elsevierStylePara elsevierViewall">Participants expect support from management&#46; All employees were more concerned about following procedures and hoped for rewards in response to implementing the IPC program&#46; To be able to prevent and control HAIs effectively requires a collaborative approach that forces all health service staff to take responsibility and be involved&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a> The WHO stated that the implementation of IPC is a best practice in reducing the incidence of HAIs&#44; and the best results are achieved when IPC is supported by political and managerial systems&#44; integrated with clinical services and patient safety culture &#40;1&#41;&#46; The role of management is critical in helping to support the IPC program&#44; and the decision of the hospital management to limit the PPI program only to cover specific areas has the potential to lead to new problems related to infection control&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">18&#44;19</span></a> Hospital management should provide full support for the implementation of the IPC program in order to prevent and control HAIs&#46; This includes ensuring the allocation of sufficient funds for training and supporting collaborative approaches&#44; through the provision of compelling rewards&#44; guidance or punishment&#44; to ensure that all employees adhere to IPC procedures&#46;</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions</span><p id="par0090" class="elsevierStylePara elsevierViewall">The IPCN is the driving force in the implementation of IPC programs&#46; The IPCNs require the IPCLNs to assist in monitoring&#44; identifying&#44; and reporting matters related to IPC in the work unit&#44; while guiding staff in the IPC procedures&#46; In carrying out their duties with regards to infection prevention and control&#44; IPCNs and IPCLNs must receive all necessary education and training&#46; Full support from hospital management and IPC activities from all the staff are also needed in the implementation of IPC program to prevent and control HAIs&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The results of this research indicate that low compliance&#44; limited facilities&#44; and insufficient budget funds become obstacles in the implementation of the IPC program&#46; These findings are expected to inform the development of nursing management strategies&#44; especially in the field of infection prevention and control in hospitals&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The purpose of this study is to explore the experiences of Infection and Prevention Control Nurses &#40;IPCNs&#41; and Infection and Prevention Control Link Nurses &#40;IPCLNs&#41; in implementing the Infection Prevention and Control &#40;IPC&#41; program&#46; The study used a qualitative method with a phenomenology approach&#46; Semi-structured interviews were conducted with nine nurses working as IPCNs and IPCLNs&#46; Participants were selected using the purposive sampling technique&#46; The data were analyzed using Colaizzi&#39;s method&#46; Five main themes from this study emerged&#44; indicating that low compliance&#44; limited facilities&#44; and insufficient budget funds become obstacles in the implementation of IPC programs&#46; IPCNs are the driving force in the implementation of IPC programs&#46; In carrying out their duties for IPC&#44; IPCNs and IPCLNs must develop appropriate knowledge and competences&#46; With the help of IPCLNs and full support from hospital management&#44; the goal of reducing HAIs is expected to be achieved&#46;</p></span>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Length of work&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Educational background&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duty&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Length of work as IPCN&#47;IPCLN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IPCN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bachelor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IPCN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bachelor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IPCLN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bachelor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IPCLN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IPCLN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Man&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diploma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IPCLN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Man&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IPCLN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bachelor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IPCLN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IPCLN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2571051.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Characteristics of participants&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:19 [
            0 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "World Health Organization&#46; Health care without avoidable infections&#58; the critical role of infection prevention and control &#91;Internet&#93;&#46; Geneva&#58; World Health Organization&#46; c2016&#46; Available from&#58; <a target="_blank" href="http://apps.who.int/iris/bitstream/handle/10665/246235/WHO-HIS-SDS-2016.10-eng.pdf;jsessionid=54748ADBB222C2141F21865F1DF3F187?sequence=1">http&#58;&#47;&#47;apps&#46;who&#46;int&#47;iris&#47;bitstream&#47;handle&#47;10665&#47;246235&#47;WHO-HIS-SDS-2016&#46;10-eng&#46;pdf&#59;jsessionid&#61;54748ADBB222C2141F21865F1DF3F187&#63;sequence&#61;1</a> &#91;cited 4&#46;11&#46;18&#93;&#46;"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "2"
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