https://doi.org/10.15218/ejnm.2023.02 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article Nursing Staff Practices Regarding Infection Control Measures at Raparin Teaching Hospital for Children in Erbil City ABSTRACT INTRODUCTION Infection prevention and control (IPC) im- plies the policies, strategies, procedures, decisions, and activities applied to de- crease or limit the spread of infections [1]. Nosocomial infection (NI) also known as a healthcare-associated infection is one of the primary reasons of mortality and has great financial cost due to raised hospitali- zation and prognosis [2, 3]. Since NIs are serious problems, they should be prevent- ed and controlled [4]. It has been demon- strated in the literature that these . Background and objectives: Nosocomial infection is one of the main reasons of mortali- ty and has significant financial costs due to elevated hospitalization and prognosis; thus, they should be prevented and controlled. This study aimed to assess the practice of the nursing staff regarding infection control measures at Raparin Teaching Hospital for Chil- dren. Methods: A descriptive study was conducted in Raparin Teaching Hospital for Children in Erbil City, Kurdistan Region/Iraq. A purposive sample involving 81 nurses working in emergency, ICU, NICU, and surgical units at Raparin Teaching Hospital for Children who care for children was selected for the study. The researcher developed a checklist format developed by the researcher for data collection that included three parts: socio- demographic characteristics, vaccination history, and nurses’ practice regarding infec- tion control measures. The data were processed and analyzed using Statistical Package for the Social Sciences (SPSS), version 26. Results: Most (77.8%) of the nurses were living in urban areas and they showed fair per- formance (81%). The results showed that 45.5% of ICU nurses outperformed their coun- terparts in terms of performance. The results also revealed that the younger nurses were better in terms of performance. Furthermore, the results revealed that 75.3% of the nurses have fair performance, 17.3% have good performance, and 7.4% have poor performance. Conclusion: Based on the overall performance of the nurses, most of the nurses have fair infection control practices, and the minority of them have poor practices. Younger nurses showed better performance in comparison to others. Keywords: Infection control; Children; Nurses; Practice. Ramyar Mutalib Kalhury; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq . (Correspondence: ramyar_kalhury@yahoo.co.uk). Norhan Zeki Shaker; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq. 13 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Received: 07/08/2022 Accepted: 06/09/2022 Published: 30/5/2023 mailto:(Correspondence:%20ramyar_kalhury@yahoo.co.uk%20%20) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.02 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article infections substantially influence patient safety The many unfavorable results in- clude raised hospital admissions days, in- creased healthcare expenditures, econom- ic hardship for patients and their families, and sometimes even deaths [5, 6]. Howev- er, infections in any healthcare facility can be avoided if they are appropriately treat- ed or when infection prevention and con- trol measures are implemented [7]. As re- ported in a study, nurses play significant role in preventing and controlling infec- tions. Some effective IPC procedures that a nurse can employ to prevent the spread of infection include hand hygiene, steriliza- tion, and putting on personal protective equipment, such as gloves, gowns, face- masks, and head caps [3]. Since the care- givers and nurses are one of the major per- sonnel who can lead to the spread of infec- tions, solid knowledge of IPC theory and practice is essential for all healthcare pro- viders and nurses to meet professional as well as governing regulations and protect themselves and their patients from pre- ventable infections [4].The risk of healthcare-associated infection is two to about twenty times higher in developing countries than in developed countries, with five percent to ten percent of patients ad- mitted to hospitals in developed countries emerging these diseases [8]. Children in pediatric services and pediatric intensive care units, are more likely to contract NIs [9-11]. Extended stays in the hospital, inva- sive procedures, congenital abnormalities, and total parenteral nutrition are all varia- bles that raise the risk of NIs in children. NIs prevention and related mortality rate minimization in pediatric patients require an understanding of the risk factors that cause healthcare-associated infections [9, 12, 13].Understanding the nature of the interaction between organisms and the human host in hospital settings offers justi- fication for control strategies to prevent transmission and minimize the occurrence of hospital-acquired infections [14]. Hand cleanliness, including hand washing, anti- sepsis, disinfection, antiseptic wash, or an- tiseptic massage, is an important factor in preventing infection transmission [15].Gonzalez and Goldfarb conducted a pediatric study of 149 children who re- ceived a living donor liver transplant. They discovered that bloodstream infection had developed in 21% of the patients within the first 30 days [11]. Kassim and col- leagues conducted a cross-sectional study using an online survey sent to other medi- cal staff in Nineveh to assess the adher- ence of healthcare professionals and nurs- es to IPC measures in Iraq. Healthcare pro- fessionals and nurses in Iraq have suppos- edly adhered to IPC measures [16]. Howev- er, the results showed that the percentage of healthcare providers and physicians fol- lowing various IPC measures was ranged from 31% (wearing personal protective equipment) to 97% (washing and cleaning hands constantly). Recently, Daulay and co -workers conducted a study to examine the impact of infection control and preven- tion management on the compliance of nurses in adopting hand hygiene in Rantauprapat Hospital’s in-patient rooms [17]. The results revealed a relationship between infection control and prevention management and nurses’ compliance in adopting hand hygiene in Rantauprapat Hospital’s in-patient rooms. Mainly speak- ing, infectious diseases remain a significant cause of illness and death in Iraq, accord- ing to information from the Centre of Com- municable Disease Control in the Ministry of Health (MoH) [18]. There is no pub- lished study about the practice of infection control by nurses in children’s hospitals in Erbil city; thus, it is an excellent opportuni- ty to conduct a study concerning this topic. The main objectives of the study are to identify the association between the 14 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.02 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article does not perform all the practices, he or she obtains 29 scores. Based on this, the calculation of the overall nurses’ practice regarding infection control measures was categorized into three groups: poor perfor- mance (29-38), fair performance (39-48), and good performance (49-58).The data were analyzed by using Statistical Package for the Social Sciences (SPSS), version 26, for calculating descriptive statistical analy- sis: frequency and percentage. Inferential statistical analysis (Chi-square and Fisher’s exact tests) was used to determine the as- sociation between variables. The p-value is considered statistically significant if it is ≤ 0.05 which rejects the null hypothesis. Table 1 demonstrates the distribution of the eighty-one participating nurses based on their socio-demographic characteristics and professional background. Based on their age group, 58.0% of the nurses were aged between 28 and 35, and only six of the participants were between 52 - 59 years of age. More than half (55.6%) of the nurses were male, 81.5% were married, 77.8% resided in urban areas, and 55.6%) belonged to the medium class. A little less than half (48.1%) of the nurses were work- ing in the emergency unit, 23.5% in NICU, 13.6% in ICU, and 14.8% in the surgical unit. Considering education level, slightly more than half (51.9%) of the nurses were institute graduates, and 32.1% were col- lege graduates. More than half of the nurs- es (53.1%) had 1-10 years of experience and 27.2% had 11-20 years of experience. Among the total number of participating nurses, only 3.7% of them had attended training regarding infection control. Hand washing, personal protective equipment (PPE), environmental control, needles and other sharps, and bloodstream infection were the five domains of infection control practice that were observed in nurses. professional characteristics of the partici- pating nurses and their practice towards infection control at Raparin Teaching Hos- pital for Children and to find out the asso- ciation between nurses’ IC practice and some variables. This cross-sectional study was conducted in the emergency, NICU, ICU, and surgical units in Raparin Teaching Hospital for Chil- dren in Erbil City Kurdistan Region/Iraq. The population of the study was nurses caring for children. A non-probability pur- posive sample was selected for this study, which involves all the nurses who agreed to participate, working at Raparin Teach- ing Hospital for Children in Erbil City Kurdi- stan Region. The study was carried out from 1st September 2021 to 1st July 2022. A direct observation method checklist, which 11 experts validate, was designed for data collection. The checklist included three parts: i) socio-demographic data and professional background variables, ii) vac- cination history, and iii) nurses’ practice throughout infection control measures. Reliability was conducted by Cronbach Correlation (r = 0.8). Informed consent for participation was obtained from all 81 par- ticipants working at Raparin Teaching Hos- pital for Children in Erbil. Observation checklist of nurses’ practice regarding in- fection control at emergency, NICU, ICU, and surgical units involved five domains: hand washing (4 items), personal protec- tive equipment (8 items), environmental control (3 items), needles, and other sharps (6 items) and bloodstream infec- tion (8 items). Each item in the observa- tion was measured and scored on three rounds, and each round was scaled with Done and Not Done; (1) is given for Not Done and (2) is given for Done. If a nurse performs all the practices, he or she re- ceives 58 scores, and if a nurse 15 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. METHODS RESULTS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.02 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article 16 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 1: Distribution of nurses according to their socio-demographic characteristics and professional background (n=81). Variables—Socio-demographic F.(%) Age group 28 - 35 47 (58) 36 - 43 15 (18.5) 44 - 51 13(16) 52 - 59 6(7.5) Gender Male 45(55.6) Female 36(44.4) Marital status Married 66(81.5) Single 14(17.3) Divorced 1(1.2) Address Urban 63(77.8) Suburban 14(17.3) Rural 4(4.9) Economic status lower class 14(17.3) medium class 45(55.5) high class 22(27.2) Professional background Place of work Emergency 39(48.1) NCU 19(23.5) ICU 11(13.6) surgical units 12(14.8) Education level Nursing school 13(16) Institute 42(51.9) College 26(32.1) Years of experience 1- 10 43(53.1) 11-20 22(27.2) 21 -30 11(13.5) 31- 40 5(6.2) Attending training about IC Yes 3(3.7) No 78(96.3) Duration of Course 1-3 days 1(33.4) 4- 6 days 1(33.3) 7-9 days 1(33.3) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.02 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article 17 26% applied environmental control measures, 72% disposed of needles and other sharps following appropriate guide- lines, and 81% performed bloodstream infection control measures. participants, fifteen nurses aged between 36 and 43, corresponding to 18.5 %, thir- teen nurses aged between 44 and 51, cor- responding to16.0 % of the total number of participants, and only six of the partici- pants were between 52 - 59 years of their age. Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 2 displays the nurses’ overall effec- tiveness practicing and implementing in- fection control measures. According to the findings, 44% of the nurses practiced hand washing, 27% used personal protec- tive equipment, Table 3 shows the association between several studied variables and nurses’ in- fection control practice. The results showed that forty-seven of the nurses were aged between 28 - 35, correspond- ing to 58.0 % of the total number of Table 2: Overall nurses’ practices distributed in five domains of infection control measures (81 nurses). Table 3: Associations between nurses’ infection control practices and the studied varia- bles. NO. Items of infection control measures Done Not Done F.(%) F.(%) 1 Hand washing 36(44) 45(56) 2 Personal protective equipment (PPE) 22(27) 59(73) 3 Environmental control 21(26) 60(74) 4 Needles and other sharps disposal 58(72) 23(28) 5 Bloodstream infection 65(81) 16(19) Variables Levels of Practices Poor Fair Good P-Value F.(%) F.(%) F.(%) Age group 28 – 35 1(2.1) 35(74.5) 11 (23.4) 0.016 S 36 – 44 1(6.7) 12(80) 2(13.3) 44 – 51 4(30.8) 8(61.5) 1(7.7) 52 – 59 0(0) 6(100) 0(0) Residence Urban 6(9.5) 51(81) 6(9.5) 0.012 S Suburban 0(0) 8(57.1) 6(42.9) Rural 0(0) 2(50) 2(50) Place of work Emergency 2(5.1) 32(82.1) 5(12.8) 0.038 S NCU 1(5.3) 15(78.9) 3(15.8) ICU 0(0) 6(54.5) 5(45.5) Surgical unit 3(25) 8(66.7) 1(8.3) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.02 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article 18 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. DISCUSSION Figure 1 shows the breakdown of nurses’ vaccination history. The results showed that 98.8% of the nurses had been vac- cinated against bacilli Calmette-Guerin (BCG vaccine for tuberculosis disease), 64.2% had been vaccinated against hepati- tis-B (HBs vaccine), and 75.3% had received one or two doses of the COVID-19 vaccine. The overall performance of the 81 nurses at Raparin Teaching Hospital for Children who participated in the study regarding infection control practices is shown in Fig- ure 2. The results revealed that 7.4% of the nurses have poor performance, 75.3% have fair performance, and 17.3% have good performance. Figure. 1: Distribution of nurses according to their prevention measures of vaccination history (n=81). Figure 2: Distribution of nurses according to levels of infection control measures (n=81). Regarding the socio-demographic charac- teristics of the nurses, less than 10% of the nurses who participated in our study aged 52 years or older, and about three-fifths are between the ages of 28 - 35. This agrees with the results of the studies by Hussin and Idaned [19] and AL-Kerity and Naji [20], in which the percentage of nurs- es who were 50 years or older were 4% and 12.9%, respectively. Anoth- er research done by Zenbaba et al. found that 51.27% of participants were male and 48.73% were female, which agrees with the participants’ gender distribution in this study [21]. In the current study, fewer than 5% of participants were single, slight- ly more than 45% were married, and a small fraction were divorced nurses. This agrees with the results of the study by Kassim et al., in which 24%, 75%, and 1% of participants were single, married, and divorced/widowed, respectively. Most of the nurses living in urban areas showed fair performance (81%) [16]. Accounting for economic status of the participated nurses, the results of the current study revealed that 17.3% of the nurses were from low economic level. This result agrees with the result obtained by Salh and Turki where 11.8% of the nurses had an insufficient monthly income [22].The professional background results showed that one-third of the nurses in current research had a college degree, which agrees with another study’s findings of 26% [23]. The percentage of partici- pants who are graduates of an institute is likewise in agreement: slightly more than half of the participants in the current study and 56% of the participants in Rounak's study are graduates of an insti- tute. In terms of the number of years of experience the nurses had, more than half of the nurses who took part in the study https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.02 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article such materials [25].Concerning the overall performance, less than a fifth of the nurses demonstrated good performance when it came to using the infection control measures. Perhaps it is because they do not have sufficient knowledge of the infec- tion control measures or they do not pay attention to practice these measures. How- ever, just over three-quarters demonstrat- ed fair performance. The findings of ALjo- hani and Sulaiman supported our find- ings which revealed that 58.5% of partici- pants demonstrated an adequate overall level of practice pertaining to standard precautions of infection control [26], as well as those of Fashafsheh et al., which found that 91.1% of the studied sample performed well when practicing infection control measures [8]. The study by Shrestha and Thapa indicated that more than half of the nurses had poor performance overall, whereas only 7.4% of the nurses who participated in the current study had poor performance over- all regarding infection control procedures [27]. Around quarter of the nurses who took part in the study employed environmental control techniques, and many of them fol- lowed bloodstream infection control guidelines. It can be concluded that the overall performance of the 81 nurses who participated in the study regarding infec- tion control practices was fair. It was also found that younger nurses performed better than elder nurses. had 1 - 10 years of experience. Only a few nurses had taken part in infection control training, and this result is in disagreement with the result Rounak obtained in her study where 18% of the nurses had taken a course on infection prevention and con- trol methods [23].According to the present study, more than a quarter of the nurses had received an anti-HBs vaccination which agrees with the result obtained by Hussin and Idaned who evaluated the rate of needle stick and sharp object injuries among the Iraqi nursing staff at Kindy Teaching Hospital and found 36% of the nurses had received the hepatitis B vac- cination [19]. According to Bonanni et al., widespread use of the hepatitis B vaccine has decreased hepatitis B virus infection in medical professionals in Italy from 48% to 18% over 10 years [24]. This percentage is considerable because hepatitis B is one of the sources of the spread of infectious dis- eases. According to the overall perfor- mance findings, 44% of the nurses gener- ally practiced hand washing hygiene. Since hand washing is one of the main methods for preventing the spread of infectious dis- eases, this percentage should to be higher. A little bit more than 25% of the partici- pants used full personal protective equip- ment as require. On the other hand, in the study by Zenbaba et al., 70.10% of the par- ticipants donned the required personal protective equipment [21]. A little more than a quarter of the nurses used environ- mental control strategies. The findings al- so showed that slightly fewer than three- quarters of nurses appropriately disposed of needles and other sharps and followed bloodstream infection prevention proce- dures, respectively. The results in the cur- rent study showed that 28% of the nurses do not dispose of needles and other sharps which disagrees with the results acquired by Thazha et al. where only 5.1% of the nurses disagreed to dispose of 19 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. CONCLUSION https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.02 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article Springer, Cham. [12] Aktar F, Tekin R, Güneş A, Ülgen C, Tan I, Ertuğrul S, et al. Determining the independ- ent risk factors and mortality rate of noso- comial infections in pediatric patients. Bio- Med Research International. 2016 Feb. [13] Li K, Li X, Si W, Cui Y, Xia H, Sun X, et al. Pre- operative and operation-related risk factors for postoperative nosocomial infections in pediatric patients: A retrospective cohort study. PloS One. 2019 Dec 23; 14 (12):e0225607. [14] Lawal, W. U. & Nwolisa, E. Prevention and Control of Infectious Diseases. In: JC Az- ubuike, Nkanginieme; Paediatric and Child Health in a Tropical Region. Educational Printing and Publishing (Publishers). Su- rulere, Lagos. 3rd Edition. 2016. ISBN: 978- 81906735-01. Page 494-543. [15] Gravel D, Gardam M, Taylor G, Miller M, Simor A, McGeer A, et al. Canadian Noso- comial Infection Surveillance Program. Infec- tion control practices related to Clostridium difficile infection in acute care hospitals in Canada. American Journal of Infection Con- trol. 2009 Feb 1; 37(1):9-14. [16] Kassim ZA, Al-Mulaabed SW, Younis SW, Abutiheen AA. Infection prevention and con- trol measures for COVID-19 among medical staff in Nineveh Governorate, Iraq. Journal of Contemporary Medical Sciences| Vol. 2020 Jul; 6(4):150-155. [17] Daulay FC, Sudiro S, Amirah A. Management analysis of infection prevention: Nurses’ compliance in implementing hand hygiene in the inventories of Rantauprapat hospital. Journal of Scientific Research in Medical and Biological Sciences. 2021 Feb 28; 2(1):42-49. [18] Alwan AD. Health in Iraq: The current situa- tion, our vision for the future and areas of work. Baghdad: Ministry of Health. 2004 Dec 2. [19] Hussin BK, Idaned ZK. Incidence of Needle Stick and Sharp Items Injuries Among Nurses At Al-Kindy Teaching Hospital. Pakistan Jour- nal of Medical & Health Sciences. 2022 Jun 1; 16(04):961-963. [20] Al-Kerity SH, Naji AB. Evaluation of Healthcare workers' Practices Concerning Infection Control Measures at Primary Health Care Centers. Scientific Journal of Medical Research. 2017; 1(2):63-68. [21] Zenbaba D, Sahiledengle B, Bogale D. Prac- tices of healthcare workers regarding [1] World Health Organization. Infection pre- vention and control: guidance to action tools. World Health Organization. Regional Office for Europe. 2021. Available from: https://apps.who.int/iris/ handle/10665/341107. [Accessed 23rd Oct 2021]. [2] Buowari OY. Universal Precautions: a re- view. Nigerian Health Journal. 2012; 12 (3):68-74. [3] Chisanga CP. Knowledge, attitudes and practices of nurses in infection prevention and control within a tertiary hospital in Zambia (Master’s thesis, Stellenbosch: Stellenbosch University). 2017. [4] Wynn MO. Understanding the principles of infection prevention and control. Nursing Standard. 2021 Apr 26; 36(5):61-66. [5] Klevens RM, Edwards JR, Richards Jr CL, Horan TC, Gaynes RP, Pollock DA, et al. Estimating health care-associated infec- tions and deaths in US hospitals, 2002. Public health reports. 2007 Mar; 122 (2):160-166. [6] Kaye KS, Anderson DJ, Sloane R, Chen LF, Choi Y, Link K, et al. The effect of surgical site infection on older operative patients. Journal of the American Geriatrics Society. 2009 Jan; 57(1):46-54. [7] Cavalcante SS, Mota E, Silva LR, Teixeira LF, Cavalcante LB. Risk factors for develop- ing nosocomial infections among pediatric patients. The Pediatric Infectious Disease Journal. 2006 May 1; 25(5):438-445. [8] Fashafsheh I, Ayed A, Eqtait F, Harazneh L. Knowledge and Practice of Nursing Staff towards Infection Control Measures in the Palestinian Hospitals. Journal of Education and Practice. 2015;6(4):79-90. [9] Moore DL. Essentials of paediatric infec- tion control. Paediatrics and Child Health. 2001 Oct 1; 6(8):571-579. [10] Alemayehu T, Tadesse E, Ayalew S, Nigussie B, Yeshitila B, Amsalu A, et al. High burden of nosocomial infections caused by multi-drug resistant pathogens in pediatric patients at Hawassa university comprehensive specialized hospital. Ethio- pian Medical Journal. 2019:45-55. [11] Gonzalez BE, Goldfarb J. Nosocomial Infec- tions in Pediatric Solid Organ Transplanta- tion. In Healthcare-Associated Infections in Children. 2019; (pp. 301-321). x 20 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. REFERENCES https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.02 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article infection prevention in Bale Zone Hospi- tals, Southeast Ethiopia. Advances in Pub- lic Health. 2020 Oct; 1-7. [22] Salh N, Turki S. Assessment of Causes of Wounds Infection (WI) after Caesarean Section at Al-Batol Teaching Hospital in Iraq. Kufa Journal for Nursing Sciences. 2022 Jun 14; 12(1). [23] Rounak, N. A. (2005). Assessment of Infec- tion Control Process at Hemodialysis and Peritoneal Dialysis Units in Kurdistan Re- gion (Master’s thesis, University of Hawler, College of Nursing). [24] Bonanni P, Pesavento G, Bechini A, Tiscione E, Mannelli F, Benucci C, et al. Impact of universal vaccination pro- grammes on the epidemiology of hepatitis B: 10 years of experience in Italy. Vaccine. 2003 Jan 30; 21(7-8):685-691. [25] Thazha SK, Cruz JP, Alquwez N, Scaria B, Rengan SS, Almazan JU. Infection preven- tion and control awareness, attitudes, and practices among healthcare professionals in South India. The Journal of Infection in Developing Countries. 2022 Apr 30;16 (04):659-67. [26] ALjohani HS, Sulaiman AA. Assessment of Health Care Workers’ Knowledge and Prac- tice Toward Infection Standard Precau- tions in Primary Health Care setting, Burai- dah, Saudi Arabia. Middle East Journal of Family Medicine. 2021 Aug 1; 7(10):81. [27] Shrestha GN, Thapa B. Knowledge and practice on infection prevention among nurses of Bir Hospital, Kathmandu. Journal of Nepal Health Research Council. 2018 Nov 2; 16(3):330-335. 21 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/