Do Knowledge, Attitudes, and Barrier Perception Affect the Prevention and Control of Healthcare-Associated Infections? A Structural Equation Modelling Approach

Purpose: Healthcare-associated infections (HCAIs) have become a global public health problem, resulting in high mortality, serious morbidity, and heavy healthcare costs. Infection prevention and control (IPC) is a significant priority for healthcare workers (HCWs) to eliminate HCAIs. However, barriers exist in the IPC implementation in daily clinical work. This study aimed to explore the relationship between HCWs' knowledge, attitudes, barrier perception, as well as their effects on IPC practice.Patients and Methods: A structured questionnaire survey was conducted among HCWs who were responsible for IPC in a large tertiary hospital in China. Cronbach's alpha, average variance extracted (AVE), composite reliability (CR), as well as confirmatory factor analyses (CFA) were performed for reliability and validity. Structural equation modelling (SEM) was applied to establish the relationship between knowledge, attitudes, barrier perception and IPC practice. A Multiple Indicators Multiple Causes (MIMIC) model was conducted to detect the effects of covariates on factor structure. Results: In total, 232 valid questionnaires were eventually collected. The average score of knowledge, attitudes, barrier perception and IPC practice were 2.95 +/- 0.75, 4.06 +/- 0.70, 3.14 +/- 0.86, and 4.38 +/- 0.45, respectively. The instrument demonstrated good reliability and validity. The SEM results showed that knowledge was positively associated with attitudes (beta=0.151, p=0.039), and attitudes had positive effects on IPC practice (beta=0.204, p=0.001), whereas barrier perception was negatively associated with attitudes and IPC practice (beta=-0.234, p<0.001; beta=-0.288, p<0.001, respectively). Additionally, time proportion spent on IPC was significantly associated with attitudes and practice (beta=0.180, p=0.015; beta=0.287, p<0.001, respectively), and training on HCAIs was a predicator for barrier perception and practice (beta=0.192, p=0.039; beta=-0.169, p=0.038, respectively).Conclusion: IPC practice was indirectly affected by knowledge through the mediation of attitudes, whereas barrier perception had a negative impact. Designing deficiency-based training programs, developing sustained IPC habits, and strengthening management support are recommended to optimize IPC practice.