Competency Level on Infection Prevention and Control Standard Protocols Among Emergency and Operating Room Nurses in the 5th District of Camarines Sur

Introduction

Globally, the impact of HAIs continues to be a significant challenge, especially in the high-pressure and unpredictable settings of the Emergency Room (ER) and Operating Room (OR). The World Health Organization (2026) consistently stress that although IPC policies are internationally well documented, nurse competency and compliance with these policies vary considerably, depending on environmental stressors, staffing, and the dynamic nature of emergency care. A recent global assessment shows that while nurses have a high level of awareness of the risk of infection, their competency needs ongoing specific training to ensure that knowledge is applied in practice (Kim & Kang, 2025).

Zooming into the national perspective, the Philippines faces its own distinct set of challenges in maintaining stringent IPC standards amid varying levels of healthcare resource availability. The DOH strictly mandates IPC measures to counteract the escalating risk of HAIs across the country. This is legally anchored in DOH Administrative Order No. 2022-0051, the Revised National Policy on Infection Prevention and Control in All Public and Private Health Facilities, which mandates all healthcare facilities to establish comprehensive IPC programs with written guidelines on hand hygiene, standard precautions, aseptic techniques, and environmental cleaning. Furthermore, Republic Act No. 11223, known as the Universal Health Care Act, which guarantees all Filipinos access to quality healthcare services while protecting them from health risks.

A recent Philippine-based study underscores the urgency of addressing these IPC competencies among nurses. Research conducted in a tertiary hospital in Baguio City evaluated the knowledge and practices of nurses regarding HAIs, revealing that while foundational knowledge is present, actual clinical adherence is heavily influenced by organizational support, working conditions, and regular performance feedback (Campo & Remon, 2025).

In the Bicol Region, particularly the province of Camarines Sur, DOH Bicol has actively promoted infection prevention and control practices through its Center for Health Development, emphasizing collaborative efforts among healthcare facilities to ensure patient safety. The Bicol Medical Center in Camarines Sur has established dedicated IPC units and has received assessments from DOH Bicol's Health Facility Development Unit, demonstrating the region's commitment to strengthening IPC programs.

Infection Prevention and Control (IPC) is the silent defender of the heart and soul of the healthcare profession. This is more than a set of clinical practices; it reflects an unwavering commitment to the ethical imperative of preserving hospitals as a place of healing, not harm. For healthcare workers, especially frontline professionals, IPC standard protocols are not just administrative tasks, they are essential, life-saving skills. It is the ultimate safeguard against the insidious threat of healthcare-associated infections (HAIs), safeguarding not only the vulnerable patients entrusted to the care of clinicians but also the unsung heroes of health care who place their own health at risk to care for others.

This critical need for strong IPC practices is in line with the United Nations Sustainable Development Goal (SDG) 3, which aims to ensure healthy lives and promote well-being for all ages. Good IPC practice is crucial to the attainment of target 3.8, which relates to universal health coverage and accessible and quality essential health-care services, and target 3.D, which focuses on strengthening capacity for early warning, risk reduction and management of national and global health risks. Competent emergency and operating room nurses are integral in strengthening robust health systems to support and fulfil these global health goals (United Nations, 2026).

Driven by these global, national, and local imperatives, this study aims to comprehensively assess the competency level on IPC standard protocols among emergency and operating room nurses in 5th District of Camarines Sur. Specifically, the research seeks to determine their current knowledge and actual clinical practices.

Methodology

The research utilizes a descriptive-correlational method to examine the relationship between the demographic profiles of nursing personnel and their competency levels regarding infection prevention and control (IPC) protocols. The study was conducted within the 5th District of Camarines Sur, specifically five private healthcare institutions: Sta. Maria Josefa Hospital Foundation, Inc., CHMSC Lourdes Hospital, Our Lady Mediatrix Hospital, VTMGHI, and the Medical Mission Group Hospital. Using purposive sampling and total enumeration, the researcher identified 70 emergency and operating room nurses as the primary respondents based on their direct involvement in high-stakes infection control environments.

Data collection is facilitated through a self-made, two-part questionnaire checklist that underwent a rigorous validation process, including expert evaluation for face and content validity and a pilot test with 10 staff nurses. Part I of the instrument establishes the demographic profile of the nurses, while Part II assesses IPC competency in areas such as hand hygiene, the use of personal protective equipment (PPE), and the prevention of needle stick injuries. The questionnaires were distributed and retrieved manually to maintain anonymity and ensure that the process did not interfere with hospital operations or patient care duties.

For the statistical treatment of data, the researcher employs percentages, rankings, and frequencies to describe the demographic characteristics of the sample. A weighted mean is calculated using a five-point Likert scale to quantify competency levels, ranging from "Not at all Competent" to "Very Highly Competent". Additionally, the Chi-square test is utilized to test the null hypothesis and determine if there are significant associations between the nurses' demographic variables and their adherence to IPC standard protocols.

Results and Discussion

Demographic Profile

As presented in Figure 1, the demographic profile shows that the 70 emergency and operating room nurses are distributed across a wide age range, with the largest group aged 25 years and below (23, 32.86%), followed by those aged 26–35 years (19, 27.14%), 36–45 years (18, 25.71%), 46–55 years (7, 10%), and 56 years and above (3, 4.29%). In terms of sex, the sample is predominantly male, with 50 nurses (71.43%) compared to 20 females (28.57%). With respect to educational attainment, most respondents hold a baccalaureate degree (57, 81.43%), while 10 (14.29%) have earned master’s units and 3 (4.28%) have completed a master’s degree, indicating that the majority possess basic professional qualifications, with a smaller proportion pursuing or having achieved graduate-level education.

Work-related profile further show that 37 nurses (52.86%) are assigned to the Emergency Room and 33 (47.14%) to the Operating Room, reflecting a nearbalanced distribution between these two critical care areas. The majority have relatively short professional tenure, with 44 (62.86%) having been in service for 5 years and below, 18 (25.71%) with 6–10 years, 5 (7.14%) with 11–20 years, and 3 (4.29%) with 21 years and above, indicating a largely earlycareer workforce. In terms of IPC training/seminar, 59 respondents (84.28%) reported no attendance in any IPCrelated training, while only a small proportion had participated in programs such as Basic Infection Prevention and Control Orientation (5, 7.14%), the DOH National Infection Prevention and Control Summit (4.29%), Zero Tolerance: Essentials of IPC (2.86%), and the PHICS Annual Convention (1.43%), underscoring a substantial gap in formal IPC training exposure among the respondents.

Figure: Demographic Profile

Competency Level on Infection Prevention and Control Standard Protocols

Hand hygiene. The data presented in Table 1 present the level of competency on Infection Prevention and Control standard protocols along hand hygiene among emergency and operating room nurses. With an AWM of 4.68, interpretated as very highly competent. Among the indicators, cleaning hands before eating ranked highest with a WM = 4.79, very high competent, followed by cleaning hands before a clean or aseptic procedure and cleaning hands after touching contaminated items or surfaces, both of which shared a WM = 4.74, very highly competent. Conversely, cleaning hands after using the restroom (WM = 4.67, very highly competent), followed by cleaning before and after touching surgical instruments or equipment and cleaning hands before touching a patient or their environment, both of which ranked the lowest at WM = 4.51, very highly competent. This pattern indicated that nurses consistently practiced exceptional adherence during explicit contamination risks and self-protection scenarios but showed a relative decrease in competency during routine patient contact and equipment handling.

Use of Personal Protective Equipment (PPE). The data presented in Table 2 show the level of competency on Infection Prevention and Control standard protocols along the Use of Personal Protective Equipment (PPE) among emergency and operating room nurses. Among the indicators, shielding eyes from splashes or sprays of bodily fluids ranked highest with a WM = 4.77, very highly competent, followed by wearing gloves when handling chemicals and/or body fluids and using respiratory protection, especially during procedures involving airborne pathogens, both of which shared a WM = 4.66, very highly competent.

Conversely, wearing an apron/gown/coveralls if hazardous or infectious substances are likely to splash and attaching straps or ties around the head/neck, adjusting the flexible band to the nose bridge for a proper fit, and performing a fit-check if necessary both shared a WM = 4.17, highly competent, followed by using a respirator when hazardous or infectious substances are airborne such as tuberculosis (WM = 4.16, highly competent), and wearing hearing protection when exposed to loud noises, such as those from equipment, ranked exposures but were slightly less competent in utilizing environmental noise protection, specialized respirator fitting procedures, and situational gowning the lowest at WM=4.15, highly competent. This pattern indicated that nurses are highly proficient in routine barrier protections against direct fluid and airborne.

Prevention of needle stick and sharp injuries. The data presented in Table 3 showed the level of competency on Infection Prevention and Control standard protocols along the prevention of needle stick and sharp injuries among emergency and operating room nurses. With an AWM of 4.19, it is interpreted as highly competent. Among the indicators, handling needles and sharps with care and keeping handling to a minimum ranked highest with a WM = 4.24, very highly competent, followed by disposing of used needles in designated sharps containers immediately after use (WM = 4.23, very highly competent), and ensuring sharps. containers are clearly labeled, puncture-proof, and leak-proof (WM=4.22, very highly competent). Conversely, using the scoop-cap method to cover syringes and using devices with safety features such as safety shields or retractable needles both shared a WM=4.17, highly competent, followed by never bending, breaking, or snapping needles before disposal (WM=4.16, highly competent), and exploring the use of needleless systems with self-sealing ports and syringes ranked the lowest at WM=4.15, highly competent. This pattern indicated that nurses consistently practiced foundational sharp safety such as immediate disposal and careful handling but were slightly less competent in adopting advanced safety-engineered devices and specific behavioral prevention techniques.

Relationship between the demographic profile and Competency Level on Infection Prevention and Control standard protocols.

The data presented in Table 4 showed the relationship between the demographic profile and the competency level on Infection Prevention and Control (IPC) standard protocols along hand hygiene, use of personal protective equipment (PPE), and prevention of needle stick and sharp injuries. Across all three domains, the computed χ² values for age (computed χ² ranging from 3.28 to 4.35; critical value = 26.30, df = 16) and sex (computed χ² ranging from 1.59 to 1.77; critical value = 9.49, df = 4) fell below their respective critical values at the .05 significance level, leading to the decision to accept the null hypothesis, interpreted as not significant. Conversely, educational attainment (computed χ² = 16.18 to 16.33; critical value = 15.51, df = 8), area of assignment (computed χ²= 9.89 to 11.79; critical value = 9.49, df = 4), length of service (computed $\chi^2$ = 21.88 to 22.38; critical value = 21.03, df = 12), and relevant trainings attended (computed χ² = 27.12 to 27.15; critical value = 26.30, df = 16) yielded computed χ² values higher than their critical limits, resulting in the rejection of the null hypothesis and an interpretation of significant across all three domains.

This pattern indicated that the clinical nurses' competency in standard protocols was profoundly influenced by acquired professional variables such as higher education, specific unit assignment, cumulative clinical experience, and targeted training rather than their inherent demographic or biological profile like age and sex.

Conclusion

The study concludes that the respondents are predominantly young to early middleaged nurses, mostly males, baccalaureate degree holders, and largely assigned to the Emergency Room, with the majority having five years and below of nursing service and no prior training related to IPC. Within this profile, emergency and operating room nurses generally demonstrate a high level of competency in IPC standard protocols, showing very high competence in hand hygiene and in the use of personal protective equipment, and adequate competence in the prevention of needlestick and sharp injuries.

Inferential analysis further indicates that age and sex are not significantly related to nurses’ competency levels in IPC standard protocols, whereas professional variables such as educational attainment, clinical area of assignment, length of service, and attendance in relevant trainings, shows significant relationship with competency. In response to the identified gaps, particularly in consistent hand hygiene practices, specialized PPE utilization, and advanced sharpsinjury prevention, a training program titled “Enhancing Infection Prevention and Control Competencies among Emergency and Operating Room Nurses in the 5th District of Camarines Sur” is proposed as a targeted intervention to strengthen occupational safety and promote highquality patient care.

Recommendations

In light of the findings and conclusions, it is recommended that hospital administrators and nursing service directors prioritize structured capacity-building initiatives in infection prevention and control (IPC), particularly for the predominantly young, early-career nursing workforce with limited formal IPC training. This may include regular in-house seminars and workshops, supported by institutional measures such as flexible scheduling and funding assistance, to facilitate participation in external courses and conventions offered by organizations like the Department of Health and PHICS. Strengthening the culture of continuous professional development in IPC will help ensure that both foundational and advanced competencies are systematically reinforced.

Given that competency levels are generally high but comparatively lower in the prevention of needle stick and sharp injuries, unit supervisors may implement periodic safety audits, targeted skills drills, and scenario-based simulations focusing on sharps handling and occupational safety. These efforts can be complemented by continuous monitoring, constructive feedback, and positive reinforcement to sustain excellent practices in hand hygiene and PPE utilization while closing remaining behavioral gaps in sharps-related safety. Furthermore, because professional variables such as educational attainment, area of assignment, length of service, and prior training significantly influence competency, nursing management may integrate these factors into staffing patterns, mentorship arrangements, and preceptorship programs. Novice nurses can be systematically paired with more experienced and highly educated preceptors, while the proposed training program, “Enhancing Infection Prevention and Control Competencies among Emergency and Operating Room Nurses in the 5th District of Camarines Sur,” may be formally adopted, regularly evaluated, and continuously refined based on staff feedback and clinical outcome indicators to sustain both occupational safety and high-quality patient care.