Tool to Assess Knowledge of Precautions Against Transmission of Microorganisms in Brazil's Primary Health Care

Purpose: Health care workers’ adherence to Standard Precautions and Specific Precautions is essential to preventing transmission of microorganisms in both hospitals and primary health care (PHC). Little is known about the risk of infection transmission and practice of precautions in non-hospital settings, particularly in PHC. In addition, comparing the information available is problematic due to lack of standard and specific tools for PHC. This study aimed to develop and validate a tool for assessing health care workers’ knowledge of specific precautions in PHC.

Methods: Multimethod research carried out in São Carlos, Brazil, in three consecutive phases. Firstly, PHC workers participated in focal groups in order to identify relevant issues regarding the matter at hand. The second phase comprised the development of a tool to assess their knowledge and behavior. Finally, this tool was validated by thirteen expert judges by means of a 4-point Likert scale with Content Validity Index (CVI) ≥ 0.80 for approval of items. The study was approved by the Ethics Committee for Research on Human Subjects at Federal University of São Carlos.

Results: In Phase 1, analysis of the data exposed the participating professionals’ knowledge gaps as well as factors interfering with their adherence to precautions. Low awareness of risk of infection transmission, problems with hand hygiene and use of gloves, obstacles relating to pulmonary tuberculosis, and exposure to biohazards when handling sharp objects at home were identified as priority issues. The tool developed consists of two modules. Module A is aimed at assessing the participants’ knowledge of the matter in question; it has five dimensions, one for each priority issue, a total of 40 dichotomous questions. Module B contains 12 questions with five Likert-type response options, ranging from ‘never’ to ‘always,’ to assess the said professionals’ behavior in everyday work situations. During validation, every tool question was evaluated for clarity, relevance, and pertinence; only two of them — pertaining to the dimensions ‘hand hygiene’ and ‘glove use’ — obtained IVC < 0.80 and were, thus, left out. The judges suggested small changes in the phrasing of 11 items of the dichotomous questions, which was promptly done. The judges also validated the tool as a whole as regards relevance, breadth, and representativeness within the scope of the matter under investigation.

Conclusion: The tool developed was validated by the judges and is now available for use. The material was developed from lived experiences of professionals who are knowledgeable of the matter at hand and, hence, can be used in similar cultural and socioeconomic contexts. Further studies should employ this assessment tool for pre and post educational action with health care workers about precautions against microorganism transmission in PHC, already ongoing in Brazil.