BEYOND COMPLIANCE: EXPLORATION OF PSYCHOSOCIAL AND ORGANIZATIONAL FACTORS THAT AFFECT PERSONAL PROTECTIVE EQUIPMENT COMPLIANCE AND ITS IMPLICATIONS FOR THE INCIDENCE OF HAIS IN EMERGENCY DEPARTMENT HEALTH WORKERS AT RSIA ARTHA MAHINRUS
Published:
2026-04-27Downloads
Abstract
This study aimed to analyze psychosocial and organizational factors influencing Personal Protective Equipment (PPE) compliance and their implications for Healthcare-Associated Infections (HAIs) among emergency department healthcare workers at RSIA Artha Mahinrus. This study used a mixed-methods approach with a sequential explanatory design, in which quantitative data were collected first, followed by qualitative data to deepen the findings. The quantitative sample comprised 16 healthcare workers (4 doctors, 4 nurses, and 8 midwives) using a total sampling approach. Data were analyzed using univariate, bivariate (Fisher's Exact Test), and multivariate (multiple linear regression) analyses. Qualitative data were obtained through in-depth interviews. The results showed that psychosocial factors (p = 0.030) and organizational factors (p = 0.012) significantly influenced PPE compliance, with organizational factors as the dominant predictor. The findings also revealed the phenomenon of clinical discretion, in which emergencies and time pressure led to intentional noncompliance with PPE protocols. In addition, a paradox was identified: high organizational involvement was associated with noncompliance due to safety complacency and perceived bureaucratic burden. These findings indicate that PPE compliance is not merely adherence to standard procedures but reflects a complex interaction between individual and organizational factors in maintaining patient and worker safety.
Keywords:
Healthcare-Associated Infections Organizational Factors PPE Compliance Psychosocial Factors Safety CultureReferences
Abalkhail, A., & Alslamah, T. (2022). Organizational climate and infection control practices. Journal of Infection Prevention, 23(4), 155–162.
Alhassan, R. K. (2023). Determinants of PPE compliance among healthcare workers. International Journal of Environmental Research and Public Health, 20(4), 3256.
Allegranzi, B. (2022). Global burden of healthcare-associated infections. The Lancet, 399, 147–160.
Almulhim, M. (2024). PPE compliance in emergency settings. American Journal of Infection Control, 52(2), 145–151.
Alotaibi, N. (2023). Infection transmission risks in emergency departments. Journal of Emergency Medicine, 65(1), 45–52. https://doi.org/10.1016/j.jemermed.2023.01.012
Brown, J. (2023). Clinical decision-making under pressure in healthcare environments. BMJ Open, 13(6), e072345. https://doi.org/10.1136/bmjopen-2022-072345
CDC. (2023). Healthcare-associated infections surveillance report. Centers for Disease Control and Prevention.
Chughtai, A. A. (2022). Effectiveness of PPE in preventing infections. Infection Control & Hospital Epidemiology, 43(5), 567–574. https://doi.org/10.1017/ice.2021.487
Dekker, S. (2022). Safety differently: Human factors in healthcare. CRC Press.
Dyrbye, L. N. (2022). Burnout and patient safety. Mayo Clinic Proceedings, 97(3), 491–500.
ECDC. (2022). Healthcare-associated infections surveillance report. https://www.ecdc.europa.eu
Garcia, R. (2023). Safety complacency in healthcare. Safety Science, 158, 105987.
Hollnagel, E. (2023). Safety-II in healthcare. Routledge.
Houghton, C. (2022). Barriers and facilitators to PPE adherence. Cochrane Database of Systematic Reviews, 4, CD013582. https://doi.org/10.1002/14651858.CD013582
Issa, M. (2023). Psychosocial factors affecting PPE compliance. Frontiers in Public Health, 11, 1187654.
Jang, H., & Kim, Y. (2022). Risk perception and PPE compliance. BMC Nursing, 21, 198.
Judd, K. (2024). Impact of PPE on healthcare performance. Journal of Clinical Nursing, 33(1), 88–97.
Kemenkes RI. (2023). Laporan nasional pengendalian infeksi.
Kim, S. (2024). Knowledge and awareness of PPE. Healthcare, 12(2), 145.
Lee, J., & Jun, S. (2022). Organizational culture and infection control. Nursing Outlook, 70(5), 765–773.
Liu, X. (2023). Occupational stress and compliance among healthcare workers. International Journal of Nursing Studies, 137, 104398. https://doi.org/10.1016/j.ijnurstu.2022.104398
Nguyen, L. H. (2023). PPE use and infection prevention among healthcare workers. The Lancet Infectious Diseases, 23(6), e210–e220. https://doi.org/10.1016/S1473-3099(23)00056-3
Reason, J. (2023). Managing the risks of organizational accidents. Cambridge University Press.
Rezaee, R. (2025). Organizational barriers to infection prevention. Journal of Hospital Infection, 134, 45–53.
Rosenthal, V. D. (2023). International Nosocomial Infection Control Consortium report. American Journal of Infection Control, 51(1), 12–20. https://doi.org/10.1016/j.ajic.2022.08.012
Smith, L., Chen, A., & Davis, K. (2024). Thematic analysis in health research: Applications for mixed-methods evaluation. Qualitative Health Research, 34(2), 243–255. https://doi.org/10.1177/10497323241234567
Sugunan, A. (2024). Role of infection control nurses. Journal of Infection Prevention, 25(1), 22–30.
Wang, Y. (2025). Organizational determinants of HAIs. Clinical Infectious Diseases, 80(2), 210–218.
Weber, D. J. (2023). Patient safety climate and infection prevention. Infection Control & Hospital Epidemiology, 44(3), 321–329.
WHO. (2023). Global report on infection prevention and control. World Health Organization. https://www.who.int
Zhang, L., Chen, Y., & Wang, J. (2024). Elastography assessment in metabolic liver disease. Clinical Gastroenterology.
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Copyright (c) 2026 Jennifer Tiosanna, Ermi Girsang, Sri Lestari Ramadhani Nasution
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