Competency Based Training Program regarding Preventive Measures of Multidrug-Resistant Klebsiella for nurses in NICU

Competency Based Training Program regarding Preventive Measures of Multidrug-Resistant Klebsiella for nurses in NICU | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Competency Based Training Program regarding Preventive Measures of Multidrug-Resistant Klebsiella for nurses in NICU Rania Ismail, Safy Salah Eldin Al-Rafay, Salma Elsayed Hassan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7038639/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aim: This study aims to evaluate the effect of a training program for nurses regarding preventive measures of multidrug-resistant klebsiella in neonatal intensive care units. Methodology: Quasi-experimental research design was used to examine the effectiveness of a training program on nurses knowledge, and practice for prevention of MDR-klebsiella. A total of 90 nurses and 40 neonates participated in the study. Results: This study revealed that there were statistical significant differences between studied nurses knowledge pre/ post training program regarding preventive measures of MDR-klebsiella (p<0.001) as well as their practice. Conclusion: Depending on the findings of this study, the competency based training program for nurses regarding prevention of MDR klebsiella in NICU improved the nurses knowledge and practice regarding prevention of MDR klebsiella. Additional research using a large sample size should be carried out to examine the effects of preventative measures programs in various health associations Preventive measures MDR-klebsiella Nurses Neonatal intensive care unit Figures Figure 1 Figure 2 Introduction Antimicrobial-resistant infections caused by MDR Klebsiella are to blame for hundreds of thousands of fatalities worldwide ( 1 ). Drug-resistant infections killed more people in 2019 than HIV/AIDS (864,000 deaths) or malaria (643,000 deaths), with 1.27 million fatalities directly attributable to MDR bacteria and 4.95 million deaths from illnesses in which bacterial MDR had a role ( 2 ). A survey conducted in Egypt revealed a significant incidence of Enterobacteriaceae that produce extended-spectrum β-lactamase (ESBL) (35–100% of MDR-klebsiella) (Sharaf et al., 2024). Egypt's MDR Gram-negative infection prevalence Multidrug-resistant bacteria, or MDR bacteria, are reported to be prevalent in Egypt ( 3 ). One of the most urgent public health issues facing the globe today is the misuse and abuse of antibiotics. Antimicrobials intended to kill organisms are rendered useless by infectious organisms that develop resistance to them ( 4 ). Multidrug-resistant Klebsiella infections in newborns increase the likelihood of longer, more costly hospital stays and perhaps increase the risk of infection-related death ( 5 ). Low birth weight, lower gestational age immaturity, inefficiency, and insufficient antibody levels are risk factors for multidrug-resistant (MDR) Klebsiella infections in neonates ( 6 ). The neonatal intensive care unit is the hospital's department that treats premature newborns who are not yet fully grown and cannot survive without the help of monitoring equipment ( 7 ). The presence of invasive medical devices including ventilators and cannulas, parenteral nutrition, prolonged hospital stays and poor hand hygiene compliance are among the care-related risk factors in NICUs that raise the chance of contracting MDR Klebsiella ( 8 ). MDR Klebsiella arises when the bacteria evolve over time and lose their ability to react to antibiotics ( 9 ), making infections more difficult to cure and raising the possibility of disease transmission, serious sickness and even death. Antimicrobial medications lose their effectiveness due to antibiotic resistance, and treating infections becomes challenging or impossible ( 10 ). The ability to cure infections is threatened by the formation and spread of MDR Klebsiella that have developed new resistance mechanisms ( 11 , 12 ). MDR Klebsiella outbreaks have become more frequent, although they can be avoided by enforcing stringent infection control protocols, particularly through an efficient stewardship program ( 13 ). A number of strategies are used to stop MDR Klebsiella from spreading in the NICU. Implementing antimicrobial stewardship programs, practicing hand hygiene, standard precautions, implementing contact precautions, disinfecting and cleaning incubators between neonates, cleaning the surroundings and teaching nurses are some of these techniques ( 14 ). Method Quasi-experimental research design was employed for this study. Data were collected from neonatal intensive care units at Children's Hospital. The study included convenience sample of 90 neonatal nurses and a purposive sample composed of 40 neonates. Inclusion criteria included neonates have MDR-klebsiella in NICU. Exclusion criteria included premature infants with major health problems (i.e., necrotizing enterocolitis, a congenital anomaly, or with hemorrhagic/ischemic brain injury) and those who need surgery. The survey consists of two parts that include knowledge and practice toward prevention of MDR-klebsiella. Pre-designed Questionnaire designed by the authors after reviewing the related literature (CDC, 2019 and WHO, 2022) , for gathering data in relation to the neonatal nurses' knowledge regarding preventive measures of MDR klebsiella (28 items). To assess nurses knowledge the total scores of the items were categorized into two groups: scored with a single point for correct answer while as the incorrect answer scored with zero point. These scores summed and converted into a percent score. Total scores classified into 2 categories: Satisfactory if score ≥ 85%, or Unsatisfactory if score < 85%, following the format established by Cao et al. in 2023. Nursing Observation Checklist adopted from (CDC, 2019), Core Elements of Hospital Antibiotic Stewardship Programs observational checklist : Hand hygiene observation. Cleaning and disinfection of incubator observation checklist: This tool consists of steps of cleaning and disinfection of incubator. Contact isolation precaution observation checklist: This tool consists of steps of contact isolation precaution. To assess nurses practice, the total scores of the items were categorized into two groups: nurses scored as ( 1 ) scores for each step "done correctly" and (0) score for those steps "not done or done incorrectly". Scores of each observation summed up and calculated separately and total practices of nurses calculated from all observational checklist. The total levels of practices calculated as the following: consider "competent" if the percent score is ≥ 90% and consider "incompetent" if the percent score is < 90% following the format established ( 15 ). Data collection The researcher attended the study setting for 2 days/week (Monday and Thursday) over 6 months between (September 2023 and February 2024). The researcher available from 9 am to 2 pm in the previously mention setting to gather the necessary data of the study, each nurse interviewed individually. The researcher explained the aim of the study and the components of the tools to the studied nurses. Questionnaire filled by the researcher after asking the subjects and take time consuming 30 minutes and checklist take 30 minutes in waiting time of NICU. The researcher distributed questionnaire to studied nurses for assessing their knowledge and the researcher assessed their practices by observational checklist. Interventions The competency based educational program for nurses regarding MDR-klebsiella infection was developed based on the actual needs assessment and implemented for nurses. The intervention phase was achieved through 12 sessions at a period of ( 12 ) weeks for competency based educational program implementation. Nurses were divided into 10 groups and each group contained 9 nurses to acquire the related program content. The total number of sessions were ( 12 ) and they were divided into five sessions for theoretical and seven sessions for practical parts. The theoretical sessions of the competency based educational program include knowledge about the neonate, MDR-klebsiella bacteria and points of prevention of MDR-klebsiella infection. The practical sessions of the competency based educational program include routine hand washing, antiseptic hand washing, cleaning and disinfection of incubator, cleaning and disinfection of environment. The time of each session took about 45 minutes, total time of these sessions was ( 9 ) hours (five for theoretical and seven for practical sessions). Ethical Consideration The study received ethical approval from the institutional review board of the Faculty of Nursing under the ID NUR1.July.2023. Participation in the study was entirely voluntary. Nurses were given the freedom to withdraw from the study at any point. Written informed consent was obtained from nurses after explaining the study's objectives and the tools involved. The researchers refrained from applying any pressure or incentives to encourage questionnaire completion. Respondents filled out the questionnaire anonymously, and the collected data were treated with strict confidentiality and exclusively utilized for research purposes. Data analysis The collected data were organized, categorized, tabulated and statistically analyzed using the statistical package for social science (SPSS) version ( 20 ) to assess the pre assessment counseling suffering from autism. Data were presented in tables. The statistical analysis included; percentage, the arithmetic mean, standard deviation. Proportion probability of error (P-value). The observed differences and associations were considered as follows: P > 0.05 non significance (No difference). P ≤ 0.05 significance difference. P < 0.001 highly significance difference. Results Demographic characteristics of studied nurses mean age 27.28 ± 3.91 years, while less than two third (62.3%) of them had technical institute of nursing. Moreover, half of the studied nurses had 1 < 5 years of experience See Table 1. Demographic characteristics of studied neonates gestational age < 37 weeks with mean gestational age 36.35±1.62 weeks, and less than three quarter (70%) of studied neonates had age < 10 with mean age 9.80±6.04 days.. While more than half (52.5%) of neonatal gender were males See Table 2. Distribution of studied nurses according to their total knowledge regarding preventive measures of MDR-klebsiella there were highly statistical significance differences pre/ post- training program (P ≤ 0.001) regarding total knowledge of studied nurses about MDR klebsiella See Table 3. Distribution of studied nurses according to their total knowledge pre and post-training program more than one third (38.9%) of studied nurses had satisfactory level of knowledge in pre-training program implementation compered to three quarters (81.1%) of them had satisfactory level of knowledge in post-training program implementation See Fig. 1. Distribution of studied nurses' total practices regarding preventive measures of MDR-klebsiella there were highly statistical significance differences pre/ post- educational program (P ≤ 0.001) regarding total practice of studied nurses about core elements of antibiotic stewardship See Table 4. Distribution of studied nurses’ total practices level pre and post-training program implementation more than two fifth (41.1%) of studied nurses had competent level of practice in pre-educational program implementation compared with more than three quarters (78.9%) of them had competent level of practice in post-educational program implementation See Fig. 2. Correlation coefficient between total knowledge and total practices scores of studied nurses at pre and post-training program implementation Moderate positive correlation between studied nurses total knowledge and total practice score pre and post training program (p ≤ 0.001) See Table 5. Table (1) Characteristics of studied nurses (n = 90) Items No % Age (Years) 20 ˂ 25 19 21.1 25 < 30 49 54.5 30 < 35 18 20 35 years and more 4 4.4 Mean ± SD 27.28 ± 3.91 Academic qualification Secondary school nursing education 15 16.7 Technical Institute of Nursing 56 62.3 Bachelor of Nursing science 17 18.8 Postgraduate studies in Nursing science 2 2.2 Gender Female 72 80 male 18 20 Years of experience in (NICU) < 1 10 11.1 1 < 5 45 50 5- < 10 30 33.3 ≥ 10 5 5.6 Attended training courses regarding preventive measures of multidrug resistant klebsiella in neonatal intensive care units No 90 100 Table (2) Characteristics of studied neonates (n = 40) Items No % Gestational age (week) < 37 25 62.5 ≥ 37 15 37.5 Mean ± SD 36.35±1.62 Age of neonate (days) < 10 28 70.0 10 < 20 9 22.5 20–30 3 7.5 Mean ± SD 9.80±6.04 Weight (gram) < 2000 18 45.0 2000 < 3000 15 37.5 ≥ 3000 7 17.5 Mean ± SD 2300.00±541.83 Neonate ranking first 17 42.5 second 19 47.5 third 4 10.0 fourth 0 0.0 Neonatal gender Male 21 52.5 Female 19 47.5 Table (3): Distribution of studied nurses according to their total knowledge regarding preventive measures of MDR-klebsiella in neonatal intensive care units pre and post-training program implementation (n = 90). Knowledge items Pre- intervention Post-intervention X2 P value No % No % knowledge regarding MDR klebsiella infection Satisfactory 35 38.9 74 82.2 35.37 0.000** Unsatisfactory 55 61.1 16 17.8 knowledge regarding preventive measures of MDR klebsiella Satisfactory 38 42.2 79 87.8 41.05 0.000** Unsatisfactory 52 57.8 11 12.2 knowledge regarding cleaning and disinfection to prevent MDR klebsiella Satisfactory 32 35.6 68 75.6 29.16 0.000** Unsatisfactory 58 64.4 22 24.4 ** Highly statistically significance Р-value ≤ 0.001. Figure (1): Distribution of studied nurses according to their total knowledge pre and post-training program (n = 90). Table (4): Distribution of studied nurses' total practices regarding preventive measures of multidrug resistant-klebsiella in neonatal intensive care units at pre and post-training program Practices items Pre- intervention Post-intervention X2 P value No % No % Practices regarding core elements of antibiotic stewardship Competent 30 33.3 57 63.3 16.21 0.000** Incompetent 60 66.7 33 36.7 Practices regarding hand washing with soap and water Competent 48 53.3 77 85.6 22.01 0.000** Incompetent 52 46.7 13 14.4 Practices regarding antiseptic hand washing Competent 46 51.5 75 83.3 21.20 0.000** Incompetent 44 48.9 15 16.7 Practices regarding 5 moment for hand hygiene Competent 34 37.8 80 88.9 50.62 0.000** Incompetent 56 62.2 10 11.1 Practices regarding cleaning and disinfection of incubator Competent 44 48.9 79 87.8 31.45 0.000** Incompetent 46 51.1 11 12.2 Practices regarding contact isolation precaution Competent 36 40.0 64 71.1 17.64 0.000** Incompetent 54 60.0 26 28.9 ** Highly statistically significance Р-value ≤ 0.001 Figure (2): Distribution of studied nurses’ total practices level pre and post-training program implementation (n = 90). Table (5): Correlation coefficient between total knowledge and total practices scores of studied nurses at pre and post-training program implementation (n = 90). Variables Total knowledge Pre-intervention Post-intervention r P-value r P-value Total practices 0.584 0.000** 0.693 0.000** ** Highly statistically significance Р-value ≤ 0.001. Discussion The purpose of our study was to assess how well neonatal nurses responded to a competency-based training program about MDR Klebsiella prevention in NICU. The study found that none of the nurses under investigation had taken any training on how to avoid contracting an MDR-klebsiella infection. According to Lee & Yang ( 15 ), over three-quarters of the sample under study did not attend training sessions on MDR-klebsiella prevention. This result was consistent with their findings. Karampatakis et al. ( 16 ) found that over half of the sample under study took part in training sessions on preventing MDR-klebsiella infections, which contradicted this finding. The findings of the current study shed light on the nurses' knowledge of MDR-klebsiella infection, revealing that over half of the nurses in the study gave inaccurate answers about their familiarity with MDR-klebsiella infection. Following the implementation of the training program, most of the nurses who were studied had the right answers for the identical questions. These results were comparable to those of Mittal et al. ( 17 ), who found that most nurses in the study gave false information regarding MDR-klebsiella infection prior to the program intervention, while the majority of nurses in the study gave accurate information following the educational program intervention. The majority of the nurses in the study had mediocre understanding about MDR-klebsiella infection in NICU pre-educational program intervention, according to Karampatakis et al. ( 16 ), which refuted these findings. Regarding nurses' knowledge of MDR-klebsiella infection prevention, the results of this study showed that over half of the nurses in the study gave inaccurate answers about MDR-klebsiella infection prevention during the pre-training program. Following the implementation of the training program, most of the nurses who were studied had accurate answers for the identical questions. These findings were consistent with those of Yang et al. ( 18 ), who discovered that, in the pre-intervention phase, fewer than half of the sample under study knew insufficiently about the successful intervention of multidrug-resistant organisms. However, during the post-intervention period, the investigated sample's understanding of how to effectively treat infections caused by multidrug-resistant organisms significantly improved. These findings contradicted those of Branstetter et al. ( 19 ), who stated that, more than half of the participants in the study possessed mediocre knowledge on NICU MDR-organism prevention at the post-intervention phase. According to the current study, almost half of the nurses who were studied gave inaccurate answers when asked about their knowledge about cleaning and disinfection measures to avoid MDR-klebsiella during the pre-training program's implementation. The majority of the nurses who were studied had the right response during the post-training program. These results were comparable to those of Kalu et al ( 20 ), who found that most of the nurses in the study gave accurate answers regarding cleaning and disinfection to prevent infection in the post-educational program intervention, while the majority of the sample gave incorrect answers in the pre-program intervention. These results were in conflict with those of Al Bizri et al. ( 21 ), who discovered that over half of the sample under study possessed inaccurate cleaning expertise and cleaning in a neonatal intensive care unit to avoid infection. Regarding total score of the studied nurses' knowledge, the results of current study represented that, more than one third of studied nurses had satisfactory total score of knowledge in pre-training program implementation. While more than three quarter of the studied nurses had satisfactory total percentage score of knowledge in post-training program implementation. These findings congruent to Asiri et al ( 22 ) who reported that 42% of subjects had poor knowledge score in the pre-intervention phase and 67% of subjects had good knowledge score in the post-intervention phase. On the other hands, these results were contrary to García et al ( 14 ) reported that, majority of studied nurses had average knowledgeable about successful control of MDR-klebsiella pneumoniae in neonatal intensive care unit in the post-intervention educational program. Regarding the nurses' practices, the results of the current study showed that there was a statistically significant difference (P ≤ 0.001) between the items of the nurses' practice that were examined before and after the implementation of the training program with relation to core elements of antibiotic stewardship. These results were comparable to those of Mascarenhas et al ( 23 ), who came to the conclusion that the practice of antimicrobial stewardship programs in the analyzed sample had improved statistically significantly. Furthermore, these findings were corroborated by Pace et al ( 24 ), who found that, when comparing the practices of the examined sample before and after implementation, there was a statistically significant improvement in the antimicrobial stewardship program. The current study's findings regarding the nurses' hand washing practices with soap and water showed a statistically significant difference (P ≤ 0.001) between the items of the nurses' hand washing practices before and after the training program was implemented. These results were consistent with those of Arunakumar et al ( 25 ), who demonstrated that following an educational program intervention, health care personnel's hand washing practices with soap and water improved statistically significantly. Furthermore, these results were consistent with a study by Bansode et al ( 26 ), that discovered statistically significant variations in nurses' hand washing practices with soap and water in the educational program that followed the intervention. The current study's findings regarding the nurses' antiseptic hand washing practices showed a statistically significant difference (P ≤ 0.001) between the items of the nurses' practices about antiseptic hand washing before and after the implementation of the training program. These results were consistent with those of Mathew et al ( 27 ), who demonstrated a statistically significant improvement in the examined sample's antiseptic hand washing practices after the intervention as compared to before. These results also aligned with a study by Bhanu et al ( 28 ), which discovered statistically significant variations between the studied sample's antiseptic hand washing practices in the post-intervention compared with the pre-intervention. The results of the current study revealed that nurses' practices regarding the five moments of hand hygiene had improved statistically significantly after the training program was implemented, as compared to the results obtained before the training program was implemented (P < 0.001). These results were consistent with those of Jansen et al ( 29 ), who discovered statistically significant variations in the practices of healthcare workers with respect to five moments in the teaching program. According to the current study's findings, nurses' practices regarding the cleaning and disinfection of incubators showed a statistically significant improvement after the implementation of an educational program (P < 0.001). Ali et al ( 30 ), provided confirmation for these findings, stating that 95% of nurses effectively sterilize and clean neonatal incubators throughout the post-intervention phase. These findings also aligned with Washeel's ( 31 ), findings, which demonstrated a highly statistically significant improvement in nurses' incubator care practice in the post program. When compared to the results of the pre-training program, the study's findings showed a statistically significant improvement in nurses' contact isolation precaution practices after the training program was implemented (P < 0.001). This result was consistent with that of Diekema et al ( 32 ), who found that nurses' practices substantially improved with regard to contact isolation precaution. Additionally, Hanna et al ( 33 ), provided support for this finding by demonstrating that there were highly statistically significant variations in the post-intervention phase of nurses' practices with relation to contact isolation precaution. Less than half of the nurses in the current study had competent practice total scores regarding MDR-klebsiella prevention in pre-training program implementation, according to the study's findings regarding nurses' overall level of practice regarding preventative measures of MDR-klebsiella infection in NICU. However, when it came to the implementation of the post-training program, over three-quarters of the nurses in the study had competent total scores. These findings somewhat supported those of Abuhammad et al ( 34 ), who discovered that the adoption of the instructional program enhanced the overall practice score. Additionally, Josi et al ( 35 ) demonstrated that after the educational program intervention, the majority of the sample under study had competent practice. Regarding the correlation between the total knowledge and total practice scores of the nurses who were studied and the preventive measures they had taken to prevent MDR-klebsiella infection, the findings of this study showed that, when comparing the post-training program implementation to the pre-training program implementation, there was a statistically significant positive correlation (p ≤ 0.001) between the total knowledge and total practice scores of the nurses. The results of this study were in line with those of a study conducted by El-Sayed et al ( 36 ), which demonstrated a favourable association between the overall practice score and the total knowledge of the nurses under study in the post-program intervention. Furthermore, the current study's findings support those of Abuhammad et al ( 34 ), who reported a substantial association between the post-educational total knowledge score and the total practice score. Conclusion It could be concluded that the neonatal nurses had knowledge deficit and incompetent practice about prevention of MDR-klebsiella in NICU. The study recommended that Provide educational programs for nurses regarding prevention of MDR- klebsiella in neonatal intensive care unit Further studies with large number of sample should be conducted to study the impact of preventive measures program in different and other health association. Declarations Author contributions Authors Contributions: Rania ismail, Dr.safy salah eldin, Dr.Salma elsayed was participated in writing and analyzing data. All the participants were participated in all steps of this study. Funding No funding was received for this study. Data availability Data will be available upon reasonable request. Ethics approval and consent to participate The study was approved by the ethics committee of the Faculty of Nursing, Ain Shams University. Written informed consent was obtained from all participating nurses. All procedures performed in this study involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments.. Consent to participate All participants sign consent to participate in the study. Consent for publication Not Applicable. Consent to publish Not Applicable. Competing interests The authors declare no competing interests. Author details 1 Rania ismail is a researcher at the Faculty of Nursing, Ain Shams University, Cairo, Egypt. 2 Dr.safy salah eldin, Dr.Salma elsayed are Professors of Pediatric Nursing, Faculty of Nursing, Ain Shams University, Cairo, Egypt References Bodake PL, Mahajan SM, Sutar NG, Bairagi S, Alam MS, Nainwal P et al. Microbiome-Modulating Natural Products: A Promising Strategy to Address Antibiotic Resistance. 2024. Plague AM. Antimicrobial Resistance. 2025. 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Effect of Hands-on Training on Infection Prevention to Prevent Hospital-acquired Infection in Neonatal Intensive Care Unit at Tertiary Health Care Center of Western India. Pediatr Infect Disease. 2025;7(1):9–14. El-Sayed SAE-S, Khalil AA, Elkazaz R. Effect of an Educational Program for Nurses about Prevention of Ventilator Associated Pneumonia in Neonatal Intensive Care Units. Port Said Sci J Nurs. 2023;10(3):236–62. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7038639","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":481798261,"identity":"c27584f2-ce6c-4824-b789-0aebb9f70380","order_by":0,"name":"Rania Ismail","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDklEQVRIiWNgGAWjYBAC+wYGhgMMDBYMDBIQATkQceABHi0GB8BaJOBajMFaEghoYUDWktgAIvFqOX724IEfFRLy8rO7Ex983HE4fX7Y4YdAW+zkdBtw+KUnL+FgzxkJww13zm42nHnmcO7G22kGQC3JxmYHsGuxY8gxOMDbJsG4QSJ3mzRvG1DL7ASQlgOJ23BoMeZ/Y3Dw7z8J+/kzIFrSDWenf8CrxXBGjsFh3gaJxIYbEC0J8tI5+G0xuPHG4LDMMYnkDTdygX5pSzfcIJ1TcCDBALdfDM7nGH98U2NjC3TYxgcf26yBQZe++cOHCjs5XFrQQTM0pgyIUw4CdQzyDcSrHgWjYBSMgpEBAJLFa/UeWVVqAAAAAElFTkSuQmCC","orcid":"","institution":"Ain Shams University","correspondingAuthor":true,"prefix":"","firstName":"Rania","middleName":"","lastName":"Ismail","suffix":""},{"id":481798264,"identity":"9bb56c47-9c81-4631-a0c6-f4c9b08e635d","order_by":1,"name":"Safy Salah Eldin Al-Rafay","email":"","orcid":"","institution":"Ain Shams University","correspondingAuthor":false,"prefix":"","firstName":"Safy","middleName":"Salah Eldin","lastName":"Al-Rafay","suffix":""},{"id":481798265,"identity":"69270dcc-0e41-4ca7-a592-5a37a057ff8c","order_by":2,"name":"Salma Elsayed Hassan","email":"","orcid":"","institution":"Ain Shams University","correspondingAuthor":false,"prefix":"","firstName":"Salma","middleName":"Elsayed","lastName":"Hassan","suffix":""}],"badges":[],"createdAt":"2025-07-03 13:23:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7038639/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7038639/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86309347,"identity":"756a086d-76ac-4a52-bfa1-f014b7121c06","added_by":"auto","created_at":"2025-07-09 07:54:28","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":126468,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of studied nurses according to their total knowledge pre and post-training program (n = 90).\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7038639/v1/8d7acbad0835f9b0b88153c5.png"},{"id":86309348,"identity":"5ebb8f68-d4a9-47e0-b610-fe7728a16845","added_by":"auto","created_at":"2025-07-09 07:54:31","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":272000,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of studied nurses’ total practices level pre and post-training program implementation (n=90).\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7038639/v1/ad9eaf23685784ffdd385c7f.jpeg"},{"id":87111752,"identity":"d904f251-4d3e-4006-a216-cead28ae118d","added_by":"auto","created_at":"2025-07-19 19:01:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1580923,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7038639/v1/9b93431c-a862-46b7-b612-a41e56c892b4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Competency Based Training Program regarding Preventive Measures of Multidrug-Resistant Klebsiella for nurses in NICU","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAntimicrobial-resistant infections caused by MDR Klebsiella are to blame for hundreds of thousands of fatalities worldwide (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Drug-resistant infections killed more people in 2019 than HIV/AIDS (864,000 deaths) or malaria (643,000 deaths), with 1.27\u0026nbsp;million fatalities directly attributable to MDR bacteria and 4.95\u0026nbsp;million deaths from illnesses in which bacterial MDR had a role (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA survey conducted in Egypt revealed a significant incidence of Enterobacteriaceae that produce extended-spectrum β-lactamase (ESBL) (35–100% of MDR-klebsiella) (Sharaf et al., 2024). Egypt's MDR Gram-negative infection prevalence Multidrug-resistant bacteria, or MDR bacteria, are reported to be prevalent in Egypt (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOne of the most urgent public health issues facing the globe today is the misuse and abuse of antibiotics. Antimicrobials intended to kill organisms are rendered useless by infectious organisms that develop resistance to them (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMultidrug-resistant Klebsiella infections in newborns increase the likelihood of longer, more costly hospital stays and perhaps increase the risk of infection-related death (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eLow birth weight, lower gestational age immaturity, inefficiency, and insufficient antibody levels are risk factors for multidrug-resistant (MDR) Klebsiella infections in neonates (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The neonatal intensive care unit is the hospital's department that treats premature newborns who are not yet fully grown and cannot survive without the help of monitoring equipment (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe presence of invasive medical devices including ventilators and cannulas, parenteral nutrition, prolonged hospital stays and poor hand hygiene compliance are among the care-related risk factors in NICUs that raise the chance of contracting MDR Klebsiella (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMDR Klebsiella arises when the bacteria evolve over time and lose their ability to react to antibiotics (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), making infections more difficult to cure and raising the possibility of disease transmission, serious sickness and even death. Antimicrobial medications lose their effectiveness due to antibiotic resistance, and treating infections becomes challenging or impossible (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The ability to cure infections is threatened by the formation and spread of MDR Klebsiella that have developed new resistance mechanisms (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMDR Klebsiella outbreaks have become more frequent, although they can be avoided by enforcing stringent infection control protocols, particularly through an efficient stewardship program (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). A number of strategies are used to stop MDR Klebsiella from spreading in the NICU. Implementing antimicrobial stewardship programs, practicing hand hygiene, standard precautions, implementing contact precautions, disinfecting and cleaning incubators between neonates, cleaning the surroundings and teaching nurses are some of these techniques (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eQuasi-experimental research design was employed for this study. Data were collected from neonatal intensive care units at Children's Hospital. The study included convenience sample of 90 neonatal nurses and a purposive sample composed of 40 neonates. Inclusion criteria included neonates have MDR-klebsiella in NICU. Exclusion criteria included premature infants with major health problems (i.e., necrotizing enterocolitis, a congenital anomaly, or with hemorrhagic/ischemic brain injury) and those who need surgery. The survey consists of two parts that include knowledge and practice toward prevention of MDR-klebsiella.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePre-designed Questionnaire designed by the authors after reviewing the related literature (CDC, 2019 and WHO, 2022)\u003c/b\u003e, for gathering data in relation to the neonatal nurses' knowledge regarding preventive measures of MDR klebsiella (28 items). To assess nurses knowledge the total scores of the items were categorized into two groups: scored with a single point for correct answer while as the incorrect answer scored with zero point. These scores summed and converted into a percent score. Total scores classified into 2 categories: Satisfactory if score ≥ 85%, or Unsatisfactory if score \u0026lt; 85%, following the format established by Cao et al. in 2023.\u003c/p\u003e\u003cp\u003e\u003cb\u003eNursing Observation Checklist adopted from (CDC, 2019), Core Elements of Hospital Antibiotic Stewardship Programs observational checklist\u003c/b\u003e: Hand hygiene observation. Cleaning and disinfection of incubator observation checklist: This tool consists of steps of cleaning and disinfection of incubator. Contact isolation precaution observation checklist: This tool consists of steps of contact isolation precaution. To assess nurses practice, the total scores of the items were categorized into two groups: nurses scored as (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) scores for each step \"done correctly\" and (0) score for those steps \"not done or done incorrectly\". Scores of each observation summed up and calculated separately and total practices of nurses calculated from all observational checklist. The total levels of practices calculated as the following: consider \"competent\" if the percent score is ≥ 90% and consider \"incompetent\" if the percent score is \u0026lt; 90% following the format established (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe researcher attended the study setting for 2 days/week (Monday and Thursday) over 6 months between (September 2023 and February 2024). The researcher available from 9 am to 2 pm in the previously mention setting to gather the necessary data of the study, each nurse interviewed individually. The researcher explained the aim of the study and the components of the tools to the studied nurses. Questionnaire filled by the researcher after asking the subjects and take time consuming 30 minutes and checklist take 30 minutes in waiting time of NICU. The researcher distributed questionnaire to studied nurses for assessing their knowledge and the researcher assessed their practices by observational checklist.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInterventions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe competency based educational program for nurses regarding MDR-klebsiella infection was developed based on the actual needs assessment and implemented for nurses. The intervention phase was achieved through 12 sessions at a period of (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) weeks for competency based educational program implementation. Nurses were divided into 10 groups and each group contained 9 nurses to acquire the related program content. The total number of sessions were (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) and they were divided into five sessions for theoretical and seven sessions for practical parts. The theoretical sessions of the competency based educational program include knowledge about the neonate, MDR-klebsiella bacteria and points of prevention of MDR-klebsiella infection. The practical sessions of the competency based educational program include routine hand washing, antiseptic hand washing, cleaning and disinfection of incubator, cleaning and disinfection of environment. The time of each session took about 45 minutes, total time of these sessions was (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) hours (five for theoretical and seven for practical sessions).\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical Consideration\u003c/b\u003e\u003c/p\u003e\u003cp\u003e The study received ethical approval from the institutional review board of the Faculty of Nursing under the ID NUR1.July.2023. Participation in the study was entirely voluntary. Nurses were given the freedom to withdraw from the study at any point. Written informed consent was obtained from nurses after explaining the study's objectives and the tools involved. The researchers refrained from applying any pressure or incentives to encourage questionnaire completion. Respondents filled out the questionnaire anonymously, and the collected data were treated with strict confidentiality and exclusively utilized for research purposes.\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eThe collected data were organized, categorized, tabulated and statistically analyzed using the statistical package for social science (SPSS) version (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) to assess the pre assessment counseling suffering from autism. Data were presented in tables. The statistical analysis included; percentage, the arithmetic mean, standard deviation. Proportion probability of error (P-value).\u003c/p\u003e\u003cp\u003eThe observed differences and associations were considered as follows:\u003c/p\u003e\u003cp\u003eP \u0026gt; 0.05 non significance (No difference).\u003c/p\u003e\u003cp\u003eP ≤ 0.05 significance difference.\u003c/p\u003e\u003cp\u003eP \u0026lt; 0.001 highly significance difference.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eDemographic characteristics of studied nurses\u003c/b\u003e\u003c/p\u003e\u003cp\u003emean age 27.28\u0026thinsp;\u0026plusmn;\u0026thinsp;3.91 years, while less than two third (62.3%) of them had technical institute of nursing. Moreover, half of the studied nurses had 1\u0026thinsp;\u0026lt;\u0026thinsp;5 years of experience See Table\u0026nbsp;1.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDemographic characteristics of studied neonates\u003c/b\u003e\u003c/p\u003e\u003cp\u003egestational age\u0026thinsp;\u0026lt;\u0026thinsp;37 weeks with mean gestational age 36.35\u0026plusmn;1.62 weeks, and less than three quarter (70%) of studied neonates had age\u0026thinsp;\u0026lt;\u0026thinsp;10 with mean age 9.80\u0026plusmn;6.04 days.. While more than half (52.5%) of neonatal gender were males See Table\u0026nbsp;2.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDistribution of studied nurses according to their total knowledge regarding preventive measures of MDR-klebsiella\u003c/b\u003e\u003c/p\u003e\u003cp\u003ethere were highly statistical significance differences pre/ post- training program (P\u0026thinsp;\u0026le;\u0026thinsp;0.001) regarding total knowledge of studied nurses about MDR klebsiella See Table\u0026nbsp;3.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDistribution of studied nurses according to their total knowledge pre and post-training program\u003c/b\u003e\u003c/p\u003e\u003cp\u003emore than one third (38.9%) of studied nurses had satisfactory level of knowledge in pre-training program implementation compered to three quarters (81.1%) of them had satisfactory level of knowledge in post-training program implementation See Fig.\u0026nbsp;1.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDistribution of studied nurses' total practices regarding preventive measures of MDR-klebsiella\u003c/b\u003e\u003c/p\u003e\u003cp\u003ethere were highly statistical significance differences pre/ post- educational program (P\u0026thinsp;\u0026le;\u0026thinsp;0.001) regarding total practice of studied nurses about core elements of antibiotic stewardship See Table\u0026nbsp;4.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDistribution of studied nurses\u0026rsquo; total practices level pre and post-training program implementation\u003c/b\u003e\u003c/p\u003e\u003cp\u003emore than two fifth (41.1%) of studied nurses had competent level of practice in pre-educational program implementation compared with more than three quarters (78.9%) of them had competent level of practice in post-educational program implementation See Fig.\u0026nbsp;2.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCorrelation coefficient between total knowledge and total practices scores of studied nurses at pre and post-training program implementation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eModerate positive correlation between studied nurses total knowledge and total practice score pre and post training program (p\u0026thinsp;\u0026le;\u0026thinsp;0.001) See Table\u0026nbsp;5.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;(1) Characteristics of studied nurses (n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eItems\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eAge (Years)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e20 ˂ 25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e25\u0026thinsp;\u0026lt;\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e54.5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e30\u0026thinsp;\u0026lt;\u0026thinsp;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e35 years and more\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e27.28\u0026thinsp;\u0026plusmn;\u0026thinsp;3.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAcademic qualification\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSecondary school nursing education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eTechnical Institute of Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e62.3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eBachelor of Nursing science\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePostgraduate studies in Nursing science\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e\u003cb\u003e80\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYears of experience in (NICU)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e1\u0026thinsp;\u0026lt;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e50\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e5- \u0026lt; 10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e33.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAttended training courses regarding preventive measures of multidrug resistant klebsiella in neonatal intensive care units\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;(2) Characteristics of studied neonates (n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItems\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eGestational age (week)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;37\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e62.5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e36.35\u0026plusmn;1.62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge of neonate (days)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt; 10\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e70.0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u0026thinsp;\u0026lt;\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e9.80\u0026plusmn;6.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWeight (gram)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;2000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e45.0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2000\u0026thinsp;\u0026lt;\u0026thinsp;3000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;3000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e2300.00\u0026plusmn;541.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNeonate ranking\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003efirst\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003esecond\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e47.5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ethird\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003efourth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNeonatal gender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e52.5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;(3): Distribution of studied nurses according to their total knowledge regarding preventive measures of MDR-klebsiella in neonatal intensive care units pre and post-training program implementation (n\u0026thinsp;=\u0026thinsp;90).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eKnowledge items\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ePre- intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ePost-intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eX2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eknowledge regarding MDR klebsiella infection\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSatisfactory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e82.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e35.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.000**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnsatisfactory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eknowledge regarding preventive measures of MDR klebsiella\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSatisfactory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e87.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e41.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.000**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnsatisfactory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eknowledge regarding cleaning and disinfection to prevent MDR klebsiella\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSatisfactory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e75.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e29.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.000**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnsatisfactory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e** Highly statistically significance Р-value\u0026thinsp;\u0026le;\u0026thinsp;0.001.\u003c/p\u003e\u003cp\u003eFigure (1): Distribution of studied nurses according to their total knowledge pre and post-training program (n\u0026thinsp;=\u0026thinsp;90).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;(4): Distribution of studied nurses' total practices regarding preventive measures of multidrug resistant-klebsiella in neonatal intensive care units at pre and post-training program\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePractices items\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ePre- intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ePost-intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eX2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003ePractices regarding core elements of antibiotic stewardship\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompetent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e63.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e16.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.000**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncompetent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e36.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003ePractices regarding hand washing with soap and water\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompetent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e85.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e22.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.000**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncompetent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003ePractices regarding antiseptic hand washing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompetent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e83.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e21.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.000**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncompetent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003ePractices regarding 5 moment for hand hygiene\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompetent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e88.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e50.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.000**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncompetent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003ePractices regarding cleaning and disinfection of incubator\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompetent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e87.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e31.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.000**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncompetent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003ePractices regarding contact isolation precaution\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompetent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e71.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e17.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.000**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncompetent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e28.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e** Highly statistically significance Р-value\u0026thinsp;\u0026le;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFigure (2): Distribution of studied nurses\u0026rsquo; total practices level pre and post-training program implementation (n\u0026thinsp;=\u0026thinsp;90).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;(5): Correlation coefficient between total knowledge and total practices scores of studied nurses at pre and post-training program implementation (n\u0026thinsp;=\u0026thinsp;90).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eTotal knowledge\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ePre-intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ePost-intervention\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal practices\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.584\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.000**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.693\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.000**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e** Highly statistically significance Р-value\u0026thinsp;\u0026le;\u0026thinsp;0.001.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe purpose of our study was to assess how well neonatal nurses responded to a competency-based training program about MDR Klebsiella prevention in NICU. The study found that none of the nurses under investigation had taken any training on how to avoid contracting an MDR-klebsiella infection. According to Lee \u0026amp; Yang (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), over three-quarters of the sample under study did not attend training sessions on MDR-klebsiella prevention. This result was consistent with their findings. Karampatakis et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) found that over half of the sample under study took part in training sessions on preventing MDR-klebsiella infections, which contradicted this finding.\u003c/p\u003e\u003cp\u003eThe findings of the current study shed light on the nurses' knowledge of MDR-klebsiella infection, revealing that over half of the nurses in the study gave inaccurate answers about their familiarity with MDR-klebsiella infection. Following the implementation of the training program, most of the nurses who were studied had the right answers for the identical questions. These results were comparable to those of Mittal et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), who found that most nurses in the study gave false information regarding MDR-klebsiella infection prior to the program intervention, while the majority of nurses in the study gave accurate information following the educational program intervention. The majority of the nurses in the study had mediocre understanding about MDR-klebsiella infection in NICU pre-educational program intervention, according to Karampatakis et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), which refuted these findings.\u003c/p\u003e\u003cp\u003eRegarding nurses' knowledge of MDR-klebsiella infection prevention, the results of this study showed that over half of the nurses in the study gave inaccurate answers about MDR-klebsiella infection prevention during the pre-training program. Following the implementation of the training program, most of the nurses who were studied had accurate answers for the identical questions. These findings were consistent with those of Yang et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), who discovered that, in the pre-intervention phase, fewer than half of the sample under study knew insufficiently about the successful intervention of multidrug-resistant organisms. However, during the post-intervention period, the investigated sample's understanding of how to effectively treat infections caused by multidrug-resistant organisms significantly improved. These findings contradicted those of Branstetter et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), who stated that, more than half of the participants in the study possessed mediocre knowledge on NICU MDR-organism prevention at the post-intervention phase.\u003c/p\u003e\u003cp\u003eAccording to the current study, almost half of the nurses who were studied gave inaccurate answers when asked about their knowledge about cleaning and disinfection measures to avoid MDR-klebsiella during the pre-training program's implementation. The majority of the nurses who were studied had the right response during the post-training program. These results were comparable to those of Kalu et al (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), who found that most of the nurses in the study gave accurate answers regarding cleaning and disinfection to prevent infection in the post-educational program intervention, while the majority of the sample gave incorrect answers in the pre-program intervention. These results were in conflict with those of Al Bizri et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), who discovered that over half of the sample under study possessed inaccurate cleaning expertise and cleaning in a neonatal intensive care unit to avoid infection.\u003c/p\u003e\u003cp\u003eRegarding total score of the studied nurses' knowledge, the results of current study represented that, more than one third of studied nurses had satisfactory total score of knowledge in pre-training program implementation. While more than three quarter of the studied nurses had satisfactory total percentage score of knowledge in post-training program implementation. These findings congruent to Asiri et al (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) who reported that 42% of subjects had poor knowledge score in the pre-intervention phase and 67% of subjects had good knowledge score in the post-intervention phase. On the other hands, these results were contrary to Garc\u0026iacute;a et al (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) reported that, majority of studied nurses had average knowledgeable about successful control of MDR-klebsiella pneumoniae in neonatal intensive care unit in the post-intervention educational program.\u003c/p\u003e\u003cp\u003eRegarding the nurses' practices, the results of the current study showed that there was a statistically significant difference (P\u0026thinsp;\u0026le;\u0026thinsp;0.001) between the items of the nurses' practice that were examined before and after the implementation of the training program with relation to core elements of antibiotic stewardship. These results were comparable to those of Mascarenhas et al (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), who came to the conclusion that the practice of antimicrobial stewardship programs in the analyzed sample had improved statistically significantly. Furthermore, these findings were corroborated by Pace et al (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), who found that, when comparing the practices of the examined sample before and after implementation, there was a statistically significant improvement in the antimicrobial stewardship program.\u003c/p\u003e\u003cp\u003eThe current study's findings regarding the nurses' hand washing practices with soap and water showed a statistically significant difference (P\u0026thinsp;\u0026le;\u0026thinsp;0.001) between the items of the nurses' hand washing practices before and after the training program was implemented. These results were consistent with those of Arunakumar et al (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), who demonstrated that following an educational program intervention, health care personnel's hand washing practices with soap and water improved statistically significantly. Furthermore, these results were consistent with a study by Bansode et al (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), that discovered statistically significant variations in nurses' hand washing practices with soap and water in the educational program that followed the intervention.\u003c/p\u003e\u003cp\u003eThe current study's findings regarding the nurses' antiseptic hand washing practices showed a statistically significant difference (P\u0026thinsp;\u0026le;\u0026thinsp;0.001) between the items of the nurses' practices about antiseptic hand washing before and after the implementation of the training program. These results were consistent with those of Mathew et al (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), who demonstrated a statistically significant improvement in the examined sample's antiseptic hand washing practices after the intervention as compared to before. These results also aligned with a study by Bhanu et al (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), which discovered statistically significant variations between the studied sample's antiseptic hand washing practices in the post-intervention compared with the pre-intervention.\u003c/p\u003e\u003cp\u003eThe results of the current study revealed that nurses' practices regarding the five moments of hand hygiene had improved statistically significantly after the training program was implemented, as compared to the results obtained before the training program was implemented (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These results were consistent with those of Jansen et al (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), who discovered statistically significant variations in the practices of healthcare workers with respect to five moments in the teaching program.\u003c/p\u003e\u003cp\u003eAccording to the current study's findings, nurses' practices regarding the cleaning and disinfection of incubators showed a statistically significant improvement after the implementation of an educational program (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Ali et al (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), provided confirmation for these findings, stating that 95% of nurses effectively sterilize and clean neonatal incubators throughout the post-intervention phase. These findings also aligned with Washeel's (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), findings, which demonstrated a highly statistically significant improvement in nurses' incubator care practice in the post program.\u003c/p\u003e\u003cp\u003eWhen compared to the results of the pre-training program, the study's findings showed a statistically significant improvement in nurses' contact isolation precaution practices after the training program was implemented (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This result was consistent with that of Diekema et al (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), who found that nurses' practices substantially improved with regard to contact isolation precaution. Additionally, Hanna et al (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), provided support for this finding by demonstrating that there were highly statistically significant variations in the post-intervention phase of nurses' practices with relation to contact isolation precaution.\u003c/p\u003e\u003cp\u003eLess than half of the nurses in the current study had competent practice total scores regarding MDR-klebsiella prevention in pre-training program implementation, according to the study's findings regarding nurses' overall level of practice regarding preventative measures of MDR-klebsiella infection in NICU. However, when it came to the implementation of the post-training program, over three-quarters of the nurses in the study had competent total scores. These findings somewhat supported those of Abuhammad et al (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), who discovered that the adoption of the instructional program enhanced the overall practice score. Additionally, Josi et al (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) demonstrated that after the educational program intervention, the majority of the sample under study had competent practice.\u003c/p\u003e\u003cp\u003eRegarding the correlation between the total knowledge and total practice scores of the nurses who were studied and the preventive measures they had taken to prevent MDR-klebsiella infection, the findings of this study showed that, when comparing the post-training program implementation to the pre-training program implementation, there was a statistically significant positive correlation (p\u0026thinsp;\u0026le;\u0026thinsp;0.001) between the total knowledge and total practice scores of the nurses. The results of this study were in line with those of a study conducted by El-Sayed et al (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), which demonstrated a favourable association between the overall practice score and the total knowledge of the nurses under study in the post-program intervention. Furthermore, the current study's findings support those of Abuhammad et al (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), who reported a substantial association between the post-educational total knowledge score and the total practice score.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIt could be concluded that the neonatal nurses had knowledge deficit and incompetent practice about prevention of MDR-klebsiella in NICU. The study recommended that Provide educational programs for nurses regarding prevention of MDR- klebsiella in neonatal intensive care unit Further studies with large number of sample should be conducted to study the impact of preventive measures program in different and other health association.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors Contributions: Rania ismail, Dr.safy salah eldin, Dr.Salma elsayed was participated in writing and analyzing data. All the participants were participated in all steps of this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData will be available upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study was approved by the ethics committee of the Faculty of Nursing, Ain Shams University. Written informed consent was obtained from all participating nurses. All procedures performed in this study involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments..\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants sign consent to participate in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 Rania ismail is a researcher at the Faculty of Nursing, Ain Shams University, Cairo, Egypt.\u003c/p\u003e\n\u003cp\u003e2 Dr.safy salah eldin, Dr.Salma elsayed are Professors of Pediatric Nursing, Faculty of Nursing, Ain Shams University, Cairo, Egypt\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBodake PL, Mahajan SM, Sutar NG, Bairagi S, Alam MS, Nainwal P et al. Microbiome-Modulating Natural Products: A Promising Strategy to Address Antibiotic Resistance. 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePlague AM. Antimicrobial Resistance. 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEl-Kholy A, El-Mahallawy HA, Elsharnouby N, Abdel Aziz M, Helmy AM, Kotb R. Landscape of multidrug-resistant gram-negative infections in Egypt: survey and literature review. Infect drug Resist. 2021:1905\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWasan H, Singh D, Reeta K, Gupta YK. Landscape of push funding in antibiotic research: current status and way forward. Biology. 2023;12(1):101.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoreno Ruiz YP, de Almeida Campos LA, Alves Agreles MA, Galembeck A. Mac\u0026aacute;rio Ferro Cavalcanti I. Advanced hydrogels combined with silver and gold nanoparticles against antimicrobial resistance. 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A nationwide population-based study of Escherichia coli bloodstream infections: incidence, antimicrobial resistance and mortality. Clin Microbiol Infect. 2022;28(6):879. e1-. e7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKoli SV, Mali SV, Geevarghese J. Global divide in carbapenem resistance and hypervirulence of Klebsiella pneumonia: comparing trends in India and developed nations-a comprehensive review. J Antibiot. 2025:1\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGarcia LR. Successful control of a large outbreak of colonization and infection by carbapenem-resistant klebsiella pneumoniae carbapenemase producer in ill neonates. 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee S-H, Yang I-S. Enhancing competency in infection prevention and control: identifying priorities for clinical nurse educational needs. Nurse Educ Today. 2024;134:106085.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKarampatakis T, Tsergouli K, Roilides E. Infection control measures against multidrug-resistant Gram-negative bacteria in children and neonates. Future Microbiol. 2023;18(11):751\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMittal N, Deswal H, Mittal R, Sharma S, Kaushik P. An educational program on antimicrobial resistance and stewardship for staff nurses in a public tertiary care hospital in India. Infect Disease Health. 2023;28(3):202\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYang Y, Tang T-t, Lin J, Gan C-l, Huang W-z, Fang Y. The effect of a full-time infection control nursing service in the prevention of multidrug-resistant organism in the orthopedic ward. BMC Infect Dis. 2022;22(1):348.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBranstetter JW, Barker L, Yarbrough A, Ross S, Stultz JS. 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Instructional guidelines and group discussion effects on new nurses\u0026rsquo; competency regarding nursing care of preterm infants. Heliyon. 2024;10(11).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMascarenhas D, Ho MSP, Ting J, Shah PS. Antimicrobial stewardship programs in neonates: a meta-analysis. Pediatrics. 2024;153(6):e2023065091.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePace D, Mack SJ, Chan S, Mumford SJ, Fuchs L, Shapiro C, et al. Antimicrobial stewardship in neonates with necrotizing enterocolitis: a quality improvement initiative. J Pediatr Surg. 2023;58(10):1982\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArunakumar SPK, BG R, Ramabhatta S, Puli KR, Chaudhary R. Improving \u0026lsquo;Hand-Hygiene Compliance\u0026rsquo;among the Health Care Personnel in the Special Newborn Care Unit. 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AIP Conference Proceedings; 2024: AIP Publishing.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJansen SJ, Broer SD, Hemels MA, Visser DH, Antonius TA, Heijting IE, et al. Central-line-associated bloodstream infection burden among Dutch neonatal intensive care units. J Hosp Infect. 2024;144:20\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAli AS, Abedlgadir WI, Abd Elbagy A. The Effect of Training Program on Nurses Competencies regarding Prevention/Control of Neonatal Sepsis in Selected Governmental Hospitals. North Kurdufan State-Sudan; 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWasheel OF, Hassan AOS, Kadhim ST. The Effectiveness of an Instructional Program on Nurses Knowledge and Practice Infection Control and the care of neonate. Univ Thi-Qar J Sci. 2023;10(1 SI):183\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDiekema DJ, Nori P, Stevens MP, Smith MW, Coffey K, Morgan DJ. 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Effect of Hands-on Training on Infection Prevention to Prevent Hospital-acquired Infection in Neonatal Intensive Care Unit at Tertiary Health Care Center of Western India. Pediatr Infect Disease. 2025;7(1):9\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEl-Sayed SAE-S, Khalil AA, Elkazaz R. Effect of an Educational Program for Nurses about Prevention of Ventilator Associated Pneumonia in Neonatal Intensive Care Units. Port Said Sci J Nurs. 2023;10(3):236\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Preventive measures, MDR-klebsiella, Nurses, Neonatal intensive care unit","lastPublishedDoi":"10.21203/rs.3.rs-7038639/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7038639/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e This study aims to evaluate the effect of a training program for nurses regarding preventive measures of multidrug-resistant klebsiella in neonatal intensive care units.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology:\u003c/strong\u003e Quasi-experimental research design was used to examine the effectiveness of a training program on nurses knowledge, and practice for prevention of MDR-klebsiella. A total of 90 nurses and 40 neonates participated in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e This study revealed that there were statistical significant differences between studied nurses knowledge pre/ post training program regarding preventive measures of MDR-klebsiella (p\u0026lt;0.001) as well as their practice.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Depending on the findings of this study, the competency based training program for nurses regarding prevention of MDR klebsiella in NICU improved the nurses knowledge and practice regarding prevention of MDR klebsiella. Additional research using a large sample size should be carried out to examine the effects of preventative measures programs in various health associations\u003c/p\u003e","manuscriptTitle":"Competency Based Training Program regarding Preventive Measures of Multidrug-Resistant Klebsiella for nurses in NICU","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-09 07:53:18","doi":"10.21203/rs.3.rs-7038639/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2109e30e-5d60-4359-83ea-3e599c74dba9","owner":[],"postedDate":"July 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-19T18:53:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-09 07:53:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7038639","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7038639","identity":"rs-7038639","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}