Infection control hazards and near misses reported by nursing students

Hazard and near-miss reporting has been integrated into the curriculum for postbaccalaureate bachelor of science in nursing/master of science in nursing degree students at our institution through a Web-based reporting system since 2006. The system is used during their 25-week clinical rotations of 2 days per week in community, medical-surgical, obstetrics, pediatrics, and psychiatric settings. The purpose of this article is to describe the frequency and types of hazard and near-miss comments about infection control issues over 3 years of data collection.

For each clinical rotation, students were required to complete 2 entries per week into a structured electronic hazard and near-miss reporting system. Three years worth of comments associated with these reports (2006-2009) were extracted and analyzed by 3 independent reviewers (κ statistic = 0.85). Seven categories of infection control problems were identified.

Five hundred nursing students submitted 3492 comments related to hazards and near misses. Of these, 886 responses (25.4%) were related to infection control practices. The most common category was nonadherence to isolation precautions (27.6%), followed by contamination of the environment or equipment (18.5%), breaks in aseptic technique (17.2%), hand hygiene (15.9%) or gloving failures (11.5%), and occupational risks (8.2%).

Infection control hazards and near misses were commonly reported across clinical settings by nursing students. Awareness of such problems among clinicians is necessary before work flow process changes can be made, but clinical change require systems-level change. To be effective and sustainable, reporting methods must be easy to use and available in real time.