•  
  •  
 

ORCID ID

Subki Ahmad: 0009-0000-6712-2545

Ermie Abdull Hamid: 0009-0007-9990-426X

Normah Awang: 0000-0002-3772-2088

Anuar Ithnin: 0000-0003-2750-9897

Nurul Farahana Kamaludin: 0000-0002-2202-5917

Noraizah Muhd Nor: 0009-0001-7034-0989

Abstract

Background: Biological hazards in health clinics may lead to acute or chronic health issues for healthcare workers. This study aims to identify potential biological hazards within health clinics, with a focus on the knowledge, attitude, and practice (KAP) of healthcare workers, in order to improve their safety.

Methods: Samples from environmental surfaces were collected and cultured to identify bacterial pathogens. A cross-sectional study involving 203 healthcare workers was conducted using a questionnaire derived from CDC-adapted guidelines. Descriptive analysis and multivariate regression were used to assess KAP.

Results: Bacterial growth was observed in all clinics. The Kruskal-Wallis Test indicated significant differences in Aerobic Colony Count across sampling sites, but not between clinics. Healthcare workers demonstrated good knowledge and attitudes but exhibited poor practices, mainly influenced by management responsibilities rather than individual actions. Pearson correlations revealed a very weak correlation between knowledge and practices, as well as between attitude and practices. Regression analysis indicated that higher practice scores were predicted by the workers' occupations.

Conclusions: Biological hazards were found in all clinics, and poor practices had a greater significant impact on safety than a lack of knowledge or negative attitudes. Mandatory training, real-time audits, strict rules, and enhanced monitoring are essential strategies for improving worker safety.

References

  1. Centers for Disease Control and Prevention. Work-Related Risks and Hazards-Biological Hazards. USA: Centers for Disease Control and Prevention, 2022.
  2. Escobar D, Pegues D. Healthcare-associated infections: Where we came from and where we are headed. BMJ Qual Saf. 2021;30:440–3.
  3. World Health Organization. Report on the Burden of Endemic Health Care-Associated Infection Worldwide. A systematic review of the literature. New York: World Health Organization, 2011.
  4. Centers for Disease Control and Prevention. Current HAI Progress Report-2023 National and State Healthcare-Associated Infections Progress Report. USA: Centers for Disease Control and Prevention, 2024.
  5. Centers for Disease Control and Prevention. Healthcare-Associated Infections (HAIs)-Related organisms & infections. USA: Centers for Disease Control and Prevention, 2025.
  6. Janssona L, Akela Y, Erikssonc R, Lavanderc M, Hedman J. Impact of swab material on microbial surface sampling. J Microbiol Methods. 2020;176:106006.
  7. Rizwana MM, Parvathi S, Appalaraju B. Prevalence of Vancomycin Resistant Enterococci carriers from rectal swabs among high-risk patients in a tertiary care hospital. National J Lab Med. 2020;9:ML01–ML02.
  8. Supriatin Y, Sumirat VA, Herdiani M. Growth analysis of Escherichia coli and Salmonella typhi on MacConkey agar. J Phys: Conf Ser. 2021;1764:012207.
  9. Mohamed MA, Hussein HAM, Raway M, Afifi MM. Prevalence and antimicrobial susceptibility profile of Methicillin-Resistant Staphylococcus aureus among patients in various intensive care units. Egypt J Bot. 2025;65:259–67.
  10. Nai GA, Martelli CAT, Medina DAL, Oliveira MSC, Caldeira ID, Henriques BC, et al. Fractal dimension analysis: A new tool for analyzing colony-forming units. MethodsX. 2021;8:101228.
  11. Ferdous MZ, Islam MS, Sikder MT, Mosaddek ASM, Zegarra-Valdivia JA, Gozal D. Knowledge, attitude, and practice regarding COVID-19 outbreak in Bangladesh: An onlinebased cross-sectional study. PLoS One. 2020;15:e0239254.
  12. Ogoina D, Pondei K, Adetunji B, Chima G, Isichei C, Gidado S. Knowledge, attitude and practice of standard precautions of infection control by hospital workers in two tertiary hospitals in Nigeria. J Infect Prev. 2015;16:16–22.
  13. Desta M, Ayenew T, Sitotaw N, Tegegne N, Dires M, Getie M. Knowledge, practice and associated factors of infection prevention among healthcare workers in Debre Markos referral hospital, Northwest Ethiopia. BMC Health Serv Res. 2018;18:465.
  14. Mark E, Udod G, Skinner J, Jones M. Knowledge, attitudes, and practices [KAP] toward COVID-19: A cross-sectional study in the New York Metropolitan Area and California Bay Area. PLoS One. 2022;17: e0271212.
  15. Chua YP. Asas Statistik Penyelidikan. Kuala Lumpur: McGraw Hill Education; 2006.
  16. García K, Duran OC, Pérez TA, Jiménez AV, Pérez EM, Martínez-Ávila MC, et al. A rare case of meningitis caused by Alcaligenes faecalis in an immunocompetent patient. Case Rep Med. 2022;2022:1559360.
  17. Horváth A, Dobay O, Sahin-Tóth J, Juhász E, Pongrácz J, Iván M, et al. Characterisation of antibiotic resistance, virulence, clonality and mortality in MRSA and MSSA bloodstream infections at a tertiary-level hospital in Hungary: A 6-year retrospective study. Ann Clinical Microbiol Antimicrob. 2020;19:17.
  18. Nandhini P, Kumar P, Mickymaray S, Alothaim AS, Somasundaram J, Rajan M. Recent developments in methicillin-resistant Staphylococcus aureus (MRSA) treatment: A review. Antibiotics. 2022;11:606.
  19. Silva V, Araújo S, Monteiro A, Eira J, Pereira JE, Maltez L, et al. Staphylococcus aureus and MRSA in livestock: Antimicrobial resistance and genetic lineages. Microorganisms. 2023;11:124.
  20. Jabeen I, Islam S, Hassan AKMI, Tasnim Z, Shuvo ZR. A brief insight into Citrobacter species-a growing threat to public health. Front Antibiot. 2023;2:1276982.
  21. Nurjadi D, Scherrer M, Frank U, Mutters NT, Heininger A, Späth I, et al. Genomic investigation and successful containment of an intermittent common source outbreak of OXA-48-producing Enterobacter cloacae related to hospital shower drains. Microbiol Spectr. 2021;9:e0138021.
  22. García-Solache M, Rice LB. The Enterococcus: A Model of Adaptability to Its Environment. Clin Microbiol Rev. 2019;32:e00058-18.
  23. Guillier L, Fravalo P, Leclercq A, Thébault A, Kooh P, Cadavez V, et al. Risk factors for sporadic Yersinia enterocolitica infections: A systematic review and meta-analysis. Microb Risk Anal. 2021;17:100141.
  24. Thankam T, Goswami YP. Knowledge attitude and practice of health care workers towards hospital acquired infection prevention in Joseph Hospital, Tamil Nadu, India. Int J Life Sci. 2021;10:31–7.
  25. Ikramullah I, Shah A, Mehmood D, Alam S, Alam A, Ullah B, et al. Knowledge and Infection Control practices Regarding Healthcare-Associated Infection among Healthcare Workers. Pak Med Health Sci. 2023;17:92–5.
  26. Zeb S, Ali TS. Factors associated with the compliance of standard precaution. J Pak Med Assoc. 2021;71:713–7.
  27. Rajdev S, Mullan S. Assessment of knowledge, attitudes & practices among doctors, Nurses & ward aids on nosocomial infections in tertiary care hospital. IP Int J Med Microbiol Trop Dis. 2020;5:222–5.
  28. Saraswathy T, Nalliah S, Rosliza AM, Ramasamy S, Jalina S, Kadir Shahar H, et al. Applying interprofessional simulation to improve knowledge, attitude and practice in hospital- acquired infection control among health professionals. BMC Med Educ. 2021;21:482.
  29. Balami LG, Ismail S, Saliluddin SM, Garba SH. Role of knowledge and attitude in determining standard precaution practices among nursing students. Int J Community Med Public Health. 2017;4:560–4.
  30. Luo Y, He G-P, Zhou J-W, Luo Y. Factors impacting compliance with standard precautions in nursing, China. Int J Infect Dis. 2010;14:e1106–14.

Creative Commons License

Creative Commons Attribution-Share Alike 4.0 International License
This work is licensed under a Creative Commons Attribution-Share Alike 4.0 International License.

Download

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.