Knowledge, Attitudes, and Compliance About Infection Prevention and Control in Nursing Students: A Systematic Review

Healthcare-associated infections (HAIs) remain a major preventable challenge in healthcare systems worldwide. Nursing students play a key role in infection prevention during clinical training; therefore, adequate education in hand hygiene (HH), standard precautions (SPs), and infection prevention and control (IPC) is essential. This systematic review aimed to evaluate nursing students' knowledge of HAI prevention according to international recommendations and to identify factors associated with higher knowledge levels.

A systematic review was conducted following Joanna Briggs Institute methodology and PRISMA guidelines. Searches were performed in MEDLINE (PubMed), CINAHL, Cochrane Library, Embase, Scopus, and Web of Science. Observational studies assessing nursing students' knowledge of HH, SPs, or IPC were included. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal checklist for analytical cross-sectional studies.

Fifty-two studies involving 13,912 nursing students across five continents were included. Most studies focused on HH, followed by SPs and IPC. The WHO Five Moments for Hand Hygiene (14 of 26 (53.8%)) was the most frequently used instrument for HH assessment, while the Compliance with Standard Precautions Scale (5/11 (45.5%)) was the most used for SPs. Regarding IPC, most studies (5/7 (71.4%)) evaluated it by study-specific questionnaires developed/adapted by the researchers. Higher knowledge and compliance levels were generally associated with advanced academic year, prior training, positive attitudes, and supportive clinical environments. However, substantial heterogeneity was identified across study designs, assessment instruments, outcome measures, and methodological quality.

Continued and updated education in HH, SPs, and IPC appears essential for improving nursing students' knowledge and preventive practices. Greater standardization of assessment methods is needed to improve comparability across studies.