The impact of educational interventions in improving safety practices of healthcare workers: A systematic review

References

1. lists of all included articles. The electronic search strategy was guided by a well-structured combination of specific search terms such as: “Educational Intervention”, “educational programs”, “training programs”, “Safety practices”, “infection prevention”, “infection control”, “standard precaution”, “Health workers”, “healthcare personnel”, “healthcare professionals”. Alternative terms for the search elements were also taken into account. Boolean operators (AND, OR) were applied to construct search queries to yield relevant articles related to the research topic. The search covered literature published up to the year 2024. All identified and retrieved studies were organized and managed using EndNote X7 reference management software."
2. Eligibility criteria The study inclusion and exclusion criteria were clearly defined using the relevant PICOS elements 33,34 hence, the inclusion criteria for this study were as follows: (1) Intervention studies that that evaluated changes in at least one safety practice such as hand hygiene, use of personal protective equipment (PPE), sharps (needle) management, disinfection procedures, and safe waste disposal—among healthcare workers; (2) studies employing quasi- experimental designs (e.g., before-after or pre-post), (3) research conducted specifically on healthcare workers; and (4) both published and unpublished works (including theses) were considered. The exclusion criteria included the following:" (1) studies conducted on populations other than healthcare workers (2) qualitative studies, Case reports, reviews, opinion papers, and editorials.
3. Study selection The selection of studies from electronic databases was conducted in two stages Stage 1: All the retrieved articles the through search strategy were imported into EndNote. The duplicate articles were removed, after which the reviewers screened the remaining articles based on their titles and abstracts. Full-text versions of potentially relevant articles were then assessed to determine their eligibility. Studies that did not meet the inclusion criteria were promptly excluded. To minimize the risk of over-inclusion, careful measures were taken during this stage. The clarity of the review question, along with the defined inclusion and exclusion criteria, facilitated the efficient identification and rejection of ineligible studies. Articles were rejected if: they are not relevant, and fail on one or more criteria such as population, intervention, outcome, or design (including those that address the topic of interest). Stage 2: For studies that meet the inclusion criteria, the full paper was obtained for detailed assessment against the inclusion criteria The PRISMA flow diagram to summarize the study selection processes.(Figure 1)
4. Data collection process Data from all included studies were extracted using a standardized and pre-tested data extraction form. Study characteristics such as the author’s name, geographic region, year of publication, study design, setting, participant details, sample size, data collection methods, sampling techniques, and outcome measures were systematically recorded. Outcome measures focused on various safety practices, including hand hygiene, correct use of gloves and gowns, sharps management, disinfection and cleaning procedures, and safe waste disposal.
5. Quality assessment The methodological quality of each study was assessed, and the risk of bias was judged by the author, using the revised JBI critical appraisal tool for quasi-experimental studies. 35 This tool has been extensively utilized in literature to assess quantitative research studies. 36,37 The author conducted a quality assessment of the included articles independently. Any disagreements encountered during the quality assessment process were resolved through discussion with the involvement of the co-author. Studies that achieved a quality score above 60% were deemed to be of good quality and were included in the final systematic review.
6. Measurement of outcome variables The outcome of this review was the safety practices of health workers towards infection prevention. The Infection prevention practices of health workers were assessed by observing changes in actual safety practices related to infection prevention and safety protocols such as hand hygiene and the use of personal protective equipment (e.g., gloves, gowns), management of sharps (needles), disinfection practices, and safe waste disposal. The primary outcome variable was defined as effective infection prevention practices across five categories, as reported in each original study. 298 Olalekan and Alsaidi / Indian Journal of Microbiology Research 2025;12(3):295–305 Figure 1: The flow diagram of the article selection and screening process
7. Results
8. Overview of selected studies Through comprehensive searching, 445 articles were identified from the search databases (PubMed: n=118, Google Scholar: n=201, Scopus: n=80, ScienceDirect: n=46). One hundred-three duplicate studies were excluded, and the remaining 281 articles were screened based on their titles, abstracts, and full texts. Ultimately, 7 studies met the inclusion criteria and were incorporated into this systematic review. These 7 studies were used to synthesize data on infection prevention practices."
9. Characteristics of studies All included studies employed a quasi-experimental design (before-after/pre-post) and were published between 2015 and
10. Geographically, seven studies were conducted in Africa, five in Egypt, 38-42 and two in Nigeria, 43,44 while four were carried out in Asia, including one in China, 45 two in India, 46,47 and one in Nepal. 48 Most studies involved healthcare workers across various clinical departments; however, three studies focused exclusively on nurses, 42,48 and one study targeted only laboratory technicians. 47 Overall, the total number of participants included across all studies was 1038 health workers. This includes 159 Doctors, 630 Nurses, Olalekan and Alsaidi / Indian Journal of Microbiology Research 2025;12(3):295–305 299 and 69 Lab workers among others. All the included studies were published in peer-reviewed journals. The sample sizes of these studies varied, ranging from 40 to 170 participants. 38,47 Most of the studies employed self- administered questionnaires as their data collection method. 38-48 3 used self-administered questionnaires with observation, 40-42 and one used a self-administered questionnaire with key informant interviews. 44 More than half of the included studies employed a simple random sampling technique. 38,39,43-47 Two convenience sampling, 40,48 one statified 42 sampling, one purposive, 41 and one cluster sampling. 45 (Table 1)
11. The effect of educational interventions This systematic review included seven studies that examined the impact of educational intervention programs on healthcare workers' safety practices in preventing occupational exposure to blood-borne infections. Analysis of the data demonstrated that these interventions positively influenced compliance with safety protocols aimed at minimizing exposure to infectious pathogens. Safety practices were evaluated using various methods, including direct observations, 40-42 self-administered questionnaires, 38-48 key informant interviews, 44 or a combination of these approaches. The effects of the educational programs on healthcare workers’ practices were categorized into five main areas: hand hygiene, use of personal protective equipment (such as gloves and gowns), sharps management (e.g., needles), disinfection or cleaning practices, and safe waste disposal. Hence, the following outcome measures were surveyed to evaluate the effect of the intervention.
12. Hand hygiene practices After reviewing different articles, 5 Studies have reported significant differences between pre- and post-education interventions with improvement in hand hygiene practices among health workers as well as hand washing techniques. 38,40,42,47,48 This includes washing hands Before and after attending to each patient, washing hands after removing gloves, washing hands after handling contaminated items, removing watches and jewelry, soap application, rinsing hands from fingertips upwards and drying with a clean towel, etc. After educational intervention, the practice of safety practice improved for hand washing. The studies demonstrated significant improvements in handwashing compliance following educational interventions, indicating their positive impact. For instance, one study reported a statistically significant increase in handwashing compliance, with the median score rising from Mdn = 20.0 before the intervention to Mdn = 50.0 after the intervention, accompanied by a large effect size (p < 0.001, r = .78). 40 Similarly, a significant increase (p <0.001) in the practice of hand washing dealing with patients was reported post-health education from 34.6% to 67.9. 38 A significant improvement in practice (p < .0001) was observed following the educational session, particularly in correct hand hygiene behaviors. Notable improvements included washing hands with soap and water after collecting samples (p < .02), immediate handwashing after contact with blood, body fluids, or contaminated items (p < .02), and the routine use of alcohol-based hand rub for hand hygiene (p < .04). 47 However, no significant improvement was reported in washing hands after removing gloves. 42,47
13. Use of personal protective equipment (PPE) The effect of educational intervention on the adherence of use of personal protective equipment (PPE) was observed in seven studies. 38,40,42,43,45,47,48 The results demonstrated that the use of PPE such as gloves, masks, gowns, protective eyewear for routine clinical systems increased after the educational program compared with the use of PPE prior to implantation of the program. A notable improvement in the routine use of gloves was observed following the educational intervention. Specifically, 141 out of 153 participants (92%) were observed using gloves consistently post-intervention. 43 Similarly, there was a significant increase in glove use during waste handling, with compliance rising from 25.0% to 65.0% (p < 0.001). 38 Another study reported a significant difference in glove-wearing compliance before and after the intervention, with the median score increasing from Mdn =
14. 0 pre-intervention to Mdn = 66.7 post-intervention, accompanied by a large effect size (p < 0.001, r = .74). 40 Additionally, the implementation of the educational program significantly improved the practice scores related to glove use, which increased from a range of 44.44 to 100.00 (Mean = 73.26 ± 4.45 SD) before the intervention to 80.55 to 100.00 (Mean = 92.00 ± 2.09 SD) after the intervention, with a statistically significant difference (p = 0.000). 48 However, wearing gowns remained the least practiced safety measure among healthcare workers, showing no statistically significant change between the pre- and post-intervention periods. 40 Emphasizing the need for continuous education on standard precautions to address areas for improvement in wearing gowns in future training.
15. Management of sharps (needles) Seven studies in this review examined the effect of education on the handling of sharp needles against percutaneous injuries. 38,40-43,47,48 These studies reported that the behavior of health workers changed positively as far as taking measures against sharp and needle stick injuries after educational training. And statistically significant difference regarding compliance with avoiding recapping needles was reported. For instance, on the practice of universal precautions of proper handling of needles, before educational intervention, the mean score for handling needles was reported to be
16. 53±0.34 (mean ±SD). After educational intervention, the handling of needles improved to 87.78±0.25 (mean ±SD). Similarly, there was a significant improvement (P< 0.001) in the measures against “recapping of a needle “among health workers before and after educational intervention. 38 Also, 300 Olalekan and Alsaidi / Indian Journal of Microbiology Research 2025;12(3):295–305 reports on compliance with safety practices after educational intervention revealed safety measures against “recapping of needles” had the best median score of all safety practices observed (Mdn=100) post-intervention phase with a large effect (P<0.001 r=39). 40 Furthermore, significant improvements (p-value <0.001*) in safety practice were detected after one month of educational intervention at
17. 96±0.41 Post-intervention (mean ±SD). 41 Finally, health education was also shown to have significantly improved workers' practice regarding sharp waste disposal, 38 where the percentage of workers who practiced safe disposal of sharps and needles increased from 55.1% (n=86) to 78.7% (n=123).
18. Disinfection and cleaning practices Two studies included in this review examined the effect of educational programs on practice regarding disinfection and cleaning. There was a highly significant improvement in the actions against accidental spillage (disinfection). Moreover, health workers' practice regarding instruments/equipment processing (Cleaning) also increased at the post-program stage. 42 It also was observed that the recommended first action and correct responses of protective and control measures after accidental exposure of the body to biohazards within health care facility were taken, with statistically significant improvement among the disinfection and cleaning practices.
19. Safe waste disposal In the studies analyzed, the effect of educational programs on practices on waste management and disposal was observed in five studied. As observed, health workers’ practices regarding safe waste disposal were statistically significantly improved in post post-program phase. For instance, a significant improvement was observed (p=.01) in the disposal of biomedical waste in appropriate color-coded containers after education intervention from 75% (n=30) to 95% (n=38). 47 A similar trend was observed in a self-reported practice for infectious waste collection and disposal. 40 The study indicated that there was a statistically significant improvement from pre- (Mdn=33.3) and post-intervention waste disposal (Mdn=100) with a large effect size (p<0.001 r=.53). 40 Furthermore, a significant improvement (p<0.001) in worker’s practice regarding sharp waste disposal after health education was also observed, 38 where the percentage increased from 55.1% (n=86) to 78.85 (n=123). The same trend was also observed in another study, which indicated a significant increase in the post-intervention practice scores by about 20% (p<0.001). 39 This finding may be due to active participation in training programs that positively affected health workers' practices regarding safe waste disposal.
20. Effect of educational intervention based on profession When observing the variations in outcomes based on professional groups such as nurses, doctors, and laboratory technicians, one of the studies revealed that nurses significantly had better self-reported practice score than that achieved by doctors and assistant nurses. 41 Nurses in this study found to have a significant better self-reported compliance score than that achieved by doctors and assistant nurses which is in agreement with the results of Labrague et al. and Kim et al. who reported that student nurses have a high compliance of standard precautions. 49,50 Similar data were found in another study with nursing staff. 51 Table 1: Provides details regarding the 7 studies included in this review Author Year of Publication Title Pre-intervention Post-intervention Lin, Hua 2020 A management program for preventing occupational blood- borne infectious exposure among operating room nurses Practices: baseline results showed that the lowest preventive behavior scores were for wearing gloves while giving intravenous or subcutaneous injections. It was found that the 6-month program significantly improved OBE preventive behavior. The average scores for preventive behavior after the intervention were higher than those before the intervention, and these differences were significant (t ¼ 53.94, respectively; P< 0.05). Akamike, Ifeyinwa Chizoba 2020 Evaluation of the effect of an educational intervention on knowledge and adherence to HIV guidelines among frontline health workers in Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria Practice: This study also revealed that all the respondents had good practice of the guidelines at pre-intervention. The total mean score for practice was
21. 5 and a standard deviation of 0.5. The intervention in this study proved effective in enhancing compliance with HIV practice guidelines. Olalekan and Alsaidi / Indian Journal of Microbiology Research 2025;12(3):295–305 301 Table 1 Continued…. Mohamed, Rehab Ali 2016 Effect of Education Intervention on Prevention of Bloodborne Infections for Health Care Workers in Family Medicine Centers, Suez Canal University in Ismailia City, Egypt Practice: A statistically significant improvement in compliance was observed for 6 out of the 7 standard precautions (SPs) studied between the pre- and post- intervention phases. The highest median (Mdn) compliance scores were recorded for "no needle recapping" (Mdn = 100) both before and after the intervention, showing a large effect size (p < 0.001, r = .78), and for "waste disposal" (Mdn = 100) in the post- intervention phase, also with a large effect size (p < 0.001, r = .53). "Wearing gowns" remained the least practiced precaution among healthcare workers, with no statistically significant difference observed between the pre- and post-intervention periods. Practice: There was a statistically significant improvement in compliance with 6 out of the 7 standard precautions (SPs) following the intervention. The highest median (Mdn) scores were observed for "no needle recapping" (Mdn = 100) in both the pre- and post-intervention phases, with a large effect size (p < 0.001, r = .78), and for "waste disposal" (Mdn = 100) in the post-intervention phase, also showing a large effect size (p < 0.001, r = .53). "Wearing gowns" remained the least adhered to practice among healthcare workers, with no statistically significant difference between pre- and post-intervention compliance. Bassyouni, Rasha H. 2016 The fundamental role of educational intervention in improving health care workers’ knowledge, attitude, and practice towards infection control precautions Practice: 80.8% had desirable good practice. Self- reported practice in this study was unsatisfactory for re- sheathing of needles as
22. 29% recap needles. Sixty- seven percent (67.2%) recap needles. High significant improvements in practice were detected after one month of educational intervention. Shrestha, Indra 2015 Impact of Educational Intervention on Knowledge and Practice of Universal Precautions among Nurses Practice: The individual practice score revealed that 12 had a moderate level (60.0% to 80.0%) of practice in the pre-test Educational intervention had a significant role in increasing the level of practice of universal precaution among nurses. Practice: After the educational intervention the practice of UP improved for handling of needles, washing hands, and use of gloves, and 12 had a high level (>80.0%) of practice in the post-test respectively. Mehta, Abhishek 2020 Impact of Educational Intervention on Knowledge, Attitudes, and Practices of Laboratory Technicians regarding Universal Work Precautions at a Tertiary Health Care Center in Central India Before the training, the majority of participants (60%) demonstrated poor levels of practice, 30% showed moderate levels, and only 10% exhibited good practice. Following the training, 40% of participants achieved a good level of practice, 35% displayed moderate levels, and just 25% remained at a poor level of practice. After training, 40% of the study subjects were found to exhibit a good level of practice, 35% showed moderate levels, and only 25% showed poor levels of practice. 302 Olalekan and Alsaidi / Indian Journal of Microbiology Research 2025;12(3):295–305 Table 1 Continued…. Heba Nasser Rayan 2021 Effect of Training Program Regarding Occupational Health Hazards on Nurse Interns’ Knowledge and Practice A minority (33.0%) had a satisfactory practice level regarding occupational health hazards at the preprogram phase. There was a highly significant improvement in total nurse practice during the program phases (94.5%), and a slight decline (85.7%) in the follow- up phase however the levels remained significantly high compared with the preprogram phase.
23. Discussion This review intended to highlight the effectiveness of educational interventions in improving safety practices of healthcare workers regarding exposure to blood-borne infections across diverse geographical contexts. By employing a systematic approach, this review identified numerous studies that implemented a targeted educational intervention to increase safety practice levels of health workers regarding occupational health hazards. As evident from the results of these studies, there was a remarkably significant improvement in the practice of safety precautions after the implementation of the educational intervention/training sessions. Educational interventions yielded positive results, with significant improvements observed in post-intervention practices across several studies. These improvements encompassed various aspects of safety precautions, including hand hygiene practices, needle recapping avoidance, use of personal protective equipment (PPE), waste disposal, and disinfection/cleaning practices. Highlighting the efficacy of educational interventions in enhancing practices related to safety precautions among health workers. These findings support the effectiveness of educational interventions as a predominant strategy to address deficiencies in practices among healthcare workers and its importance in reinforcing safe practices in healthcare settings. Educational intervention has emerged as one of the prevalent approaches to improving the practices of healthcare workers and ensuring their compliance with safety regulations. These interventions, which are predominantly focused on improving workers' practices, play a significant role in strengthening safety precaution practices among health workers, thereby contributing to the prevention of blood-borne pathogen infections. It improves knowledge and instills a positive attitude towards universal precaution in health workers, which translates into behavioral changes in attitude and practices that would help reduce the incidence of exposure to blood infections and hospital-acquired infections. This is supported by Arcanjo et al. found a strong positive correlation between the implementation of educational intervention and the improvement of knowledge and change in preventive practices about occupational risks by nursing professionals in the experimental group. 52 Also, the Elbilgahy et al. study demonstrated the effect of educational intervention in improving nurses’ knowledge and practice, as it was reported that, a significant difference among knowledge and practice pre/post-implementing nursing guidelines about hazards prevention was observed. 53 Remarkably, educational interventions have exhibited a significant positive impact on enhancing workers' practices concerning blood-borne pathogens, consequently mitigating exposure risks. This is supported by Afdar and Abad who reviewed 26 studies involving diverse healthcare worker populations and various educational programs, finding a statistically significant reduction in infection rates in 21 of the studies following the interventions. 54 These positive outcomes in safety practices highlight the effectiveness of educational programs focused on occupational hazards and infectious disease exposure. Such programs enhance knowledge, which fosters a positive attitude and ultimately leads to improved behavior and safer practices. However, the implementation of these interventions may be constrained by certain limitations and associated costs, despite their demonstrable efficacy. Hence, a cost-effective analysis is warranted to inform decision- making regarding the adoption of educational interventions.
24. Conclusion According to the study findings, it can be concluded that the implementation of educational interventions leads to a significant improvement in safety precaution practices among health workers regarding occupational exposures to hazards and blood infection, thereby contributing to the prevention of blood-borne pathogen infections.
25. Recommendation According to the findings from this study, it is recommended that education training and intervention programs be provided for health workers regarding occupational hazards, especially on the protective measures against exposures to blood and body fluids. Also, the dissemination and development of policies and rules of safety practices among health workers is suggested, as well as the availability of psychological counseling and therapy for health workers is recommended. Olalekan and Alsaidi / Indian Journal of Microbiology Research 2025;12(3):295–305 303
26. Limitations There are some limitations to this review that warrant consideration.
27. Limited number of included studies A notable limitation is the small number of studies included in the final review. Only 7 out of 445 initially identified articles met the inclusion criteria. This limited pool of evidence restricts the generalizability of the findings across broader healthcare settings and populations. While the review aimed to maintain methodological rigor by focusing on quasi- experimental studies with clear pre- and post-intervention data on safety practices, such stringent criteria may have inadvertently excluded other relevant studies that could contribute meaningful insights, such as observational studies or mixed-methods research. Future systematic reviews may consider expanding the inclusion criteria to incorporate high- quality observational or cohort studies and interventions targeting a broader range of healthcare workers or safety practices. This would provide a more comprehensive understanding of the effectiveness and adaptability of educational interventions across diverse healthcare contexts.
28. Over-reliance on self-reported data A significant limitation in the included studies is the widespread reliance on self-administered questionnaires to assess healthcare workers’ practices. While this method is cost-effective and convenient for data collection, it is prone to response bias, particularly social desirability bias, where participants may overreport adherence to safety practices to align with perceived expectations. As a result, reported improvements in post-intervention safety behaviors may not accurately reflect actual changes in real-world practice. This overreliance on self-reporting limits the reliability of outcome measures and may overestimate the effectiveness of educational interventions. To strengthen the validity of future studies, it is strongly recommended that direct observational methods be employed—either alone or in combination with questionnaires. Checklist-based onsite assessments can provide a more accurate and objective evaluation of behavior change and adherence to standard precautions in clinical settings.
29. Study design limitations Additionally, all the studies included in this review were quasi-experimental in design and lacked control groups, which presents a limitation in terms of internal validity. Without a control group, it becomes difficult to attribute observed improvements in safety practices solely to the educational interventions, as other confounding factors— such as concurrent policy changes, increased supervision, or broader institutional efforts—may have contributed to the outcomes. This limits the ability to draw causal inferences about the effectiveness of the interventions. While pre- and post-intervention comparisons offer valuable insights, they are more vulnerable to threats such as maturation effects, selection bias, and the Hawthorne effect. To strengthen the evidence base, future studies should consider incorporating randomized controlled trials (RCTs) or controlled before- and-after designs, which offer greater methodological rigor and improve confidence in the attribution of observed effects to the intervention itself.
30. Geographical limitations Another important limitation of this review is the geographic concentration of the included studies. All seven studies were conducted in low- and middle-income countries (LMICs), specifically within Africa and Asia, with no representation from high-income countries (HICs). This regional focus may limit the applicability of findings to healthcare systems in more developed settings, where baseline infrastructure, resource availability, infection control protocols, and institutional culture may differ significantly. Educational interventions that prove effective in LMICs may require adaptation to be relevant or impactful in HICs, where safety practices and training protocols may already be more advanced or institutionalized. Therefore, caution should be exercised when extrapolating these findings to high-income healthcare systems, and future research should include studies across a wider range of geographic and economic contexts to enhance the generalizability of results. Despite these limitations, this review provides valuable insights into effective strategies for enhancing healthcare workers' practices related to blood-borne infection exposure, ultimately promoting occupational safety and reducing the risk of infectious disease transmission. By highlighting the effectiveness of educational interventions and identifying gaps for future investigation, this review offers a foundation for guiding policy development and improving practices in occupational health and safety.
31. Source of Funding None.
32. Conflict of Interest None. References
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