Data were collected using a quantitative survey (see Supplementary file 1 ). The survey was administered online with university-based software, KeySurvey. Participants were sent personalized emails with a link to the survey. Reminder emails were sent at 2 weeks and 1 month after the initial email. The survey instructions informed participants that its purpose was to measure their opinions and attitudes about infection prevention and control practices and the support they receive in their hospital. This research was undertaken with approved ethical clearance by the University and the Hospitals’ Human Research Ethics Committees.
All of the ICPs in 50 of the largest public hospitals in Australia were invited to participate in the study. 153 of the 215 people invited completed the survey, giving an overall response rate of 71 %. There was representation from all states and territories. Half of the ICP sample was from hospitals in New South Wales and Victoria (50 %, n = 77). Approximately one third of the sample was from hospitals in Queensland, South Australia and Western Australia (38 %, n = 59). Ninety-three per cent of the sample was female, reflecting the natural gender differences in the profession seen in other studies involving ICPs in Australia . The ages of the participating ICPs ranged from 26 to 65 years, with a median of 44 years. The ICPs had an average of 22.5 years nursing experience, ranging from 5 to 44 years. All participating IPCs had at least 6 months of work experience in their current hospital; this was deemed necessary to ensure they had the minimum knowledge and experience of their workplace and infection control practices required to answer the survey questions meaningfully.
The first part of the survey consisted of demographic and background questions including age, number of years of experience in nursing, number of years working in infection control, staff supervisory responsibilities and involvement in hand hygiene auditing. The second part of the survey asked questions on nine key constructs: two main outcome variables of job satisfaction and emotional burnout, and seven predictor variables of perceived organizational support (POS), communication, support from senior management, time pressure, job control, cognitive demands and safety climate. All of these questions are from existing surveys which are available and free for academic use. The survey can been seen in Supplementary file 1.
Two key outcome variables were measured in this study: job satisfaction and emotional burnout.
Job satisfaction was evaluated using a one-item measure developed by . Participants were asked, ‘How do you feel about your job, all things considered?’ Participants answered this question using a five-point Likert scale, from ‘not at all satisfied’ (1) to ‘extremely satisfied, couldn’t be more satisfied’ (5).
Emotional burnout was evaluated using a validated one-item measure developed by . Participants were asked to select one statement on a scale of ‘I enjoy my work…’ (1) to ‘I feel completely burned out and often wonder if I can go on…’ (5). This question was designed to assess participants’ self-perceived level of burnout based on symptoms such as stress, exhaustion and frustration, etc. . We thus refer to this construct as emotional burnout. This non-proprietary measure has also been validated against the single item measure of emotional burnout on the widely used and cited Maslauch Burnout Inventory [23, 24].
In addition to these two key outcome variables, seven predictor variables were measured in this study: POS, communication, support from senior management, time pressure, job control, cognitive demands and safety climate.
Perceived organizational support (POS)
To measure POS, an 8-item scale was used; this was a shortened version of the full 36-item scale developed by . The scale asked participants to rate eight items on a seven-point Likert scale, from ‘strongly disagree’ (1) to ‘strongly agree’ (7). Items included: ’The hospital really cares about my wellbeing’ and ‘My hospital would forgive an honest mistake on my part’.
Communication about infection prevention and control practices was measured using four items taken from scales developed by [26,27,28]. The questions asked participants to rate items on a five-point Likert scale, from ‘strongly disagree’ (1) to ‘strongly agree’ (5). Items include: ‘I know the proper channels to direct questions regarding hand hygiene’ and ‘Good communication flow exists down the chain of command regarding hand hygiene’.
Support from senior management
Perceived support from senior management was measured using eight items taken from scales developed by [26, 27]. The questions asked participants to rate items on a five-point Likert scale, from ‘strongly disagree’ (1) to ‘strongly agree’ (5). Items include: ‘Senior management has a clear picture of the risk associated with poor hand hygiene’ and ‘My suggestions about hand hygiene would be acted upon if I expressed them to senior management’.
To measure time pressure, three questions were taken from a tool developed by . The questions asked participants to rate items on a seven-point Likert scale, from ‘never’ (1) to ‘always’ (7). Items included: ‘I have unachievable deadlines’ and ‘I have to neglect some tasks because I have too much to do’.
To measure job control, three questions were taken from a tool developed by . The questions asked participants to rate items on a seven-point Likert scale, from ‘never’ (1) to ‘always’ (7). Items included: ‘I have a choice in deciding what I do at work’ and ‘I have a choice in how I do my work’.
Cognitive demand was measured using four questions taken from a tool developed by . The questions asked participants to rate items on a seven-point Likert scale, from ‘never’ (1) to ‘always’ (7). Items include: ‘Do you have to concentrate all the time to watch for things going wrong?’ and ‘Do you have to react quickly to prevent problems arising?’
Hospital safety climate
Hospital safety climate was measured using a 16-item questionnaire developed by . The questions asked participants to rate items on a six-point Likert scale, from ‘strongly disagree’ (1) to ‘strongly agree’ (6). Items include: ‘My hospital reacts quickly to solve the problem when told about infection-related risks’ and ‘My hospital tries to continually improve hand hygiene compliance in each ward’.
All scale reliabilities were determined using Cronbach’s statistic. Two separate multiple regression analyses were conducted to predict job satisfaction and emotional burnout. The seven predictor variables: POS, time pressure, job control, communication, hospital level safety climate, cognitive demands, and support from senior management were added to the model simultaneously in one block. Age and years of experience in infection control were entered into the model when they were significant with the outcome variable. Results are presented separately for each outcome measure in the following section. A series of one-way ANOVAs (analysis of variance) were used to test for state/territory differences in all of the measures but there were no notable differences between the states/territories. We used Green’s rule of thumb (medium effect) to test the necessary sample size for the entire model: n = 50 + 8*predictors = 50 + 8*9 = 122 . We included 9 predictors when there are only 7 used in order to allow for the demographic variables. Our sample is therefore an adequate sample size to test the model and the significance of the predictors.