Abstract
Background
Healthcare-acquired infections (HAIs) remain a significant cause of preventable morbidity and mortality in pediatric care, particularly in low-resource and conflict-affected settings such as Palestine. Pediatric nurses play a critical role in infection prevention and control (IPC); however, deficiencies in knowledge, attitudes, practices (KAP), and perceived institutional support may undermine effective HAI prevention.
Objective
This study aimed to evaluate the effectiveness of a structured educational workshop in improving pediatric nurses’ KAP, and perceptions of institutional support related to HAI prevention.
Methods
A one-group pre–post quasi-experimental design was conducted in 2024 at a specialized pediatric hospital in Palestine. A total of 54 pediatric nurses participated in a two-week educational workshop comprising four interactive sessions focused on core IPC principles. Data were collected using a validated self-administered questionnaire assessing KAP and perceived institutional support. Paired-sample t tests were performed to compare pre- and postintervention scores.
Results
Statistically significant improvements were observed across all outcome domains following the intervention (p ≤ .001). Mean knowledge scores increased from 52.9 ± 3.3 to 61.9 ± 4.1, attitude scores from 44.1 ± 4.1 to 52.6 ± 3.4, and practice scores from 42.1 ± 5.7 to 53.3 ± 3.1. The proportion of nurses reporting good perceived institutional support increased from 40.7% pre-intervention to 98.1% postintervention.
Conclusion
The structured, context-specific educational workshop significantly improved pediatric nurses’ IPC-related competencies and perceptions of institutional support. Integrating continuous professional education with organizational engagement is essential for strengthening HAI prevention in pediatric settings within resource-constrained healthcare systems.
Keywords
Introduction
Healthcare-acquired infections (HAIs) remain a major global patient safety concern and a leading cause of preventable morbidity, mortality, prolonged hospitalization, and increased healthcare costs. HAIs are defined as infections acquired during the process of healthcare delivery that were neither present nor incubating at the time of admission. Despite substantial advances in infection prevention and control (IPC), the global burden of HAIs remains disproportionately high in low- and middle-income countries, where limitations in infrastructure, workforce capacity, and continuous professional education persist (Allegranzi et al., 2011; Haque et al., 2018; World Health Organization [WHO], 2022).
Pediatric populations are particularly vulnerable to HAIs because of immature immune systems, frequent exposure to invasive procedures, and prolonged hospital stays, especially in neonatal and pediatric intensive care units. These risks are further exacerbated in resource-constrained and conflict-affected settings, where overcrowding, shortages of trained staff, and inconsistent implementation of IPC policies are common. In such contexts, preventable infections continue to contribute significantly to adverse clinical outcomes and increased strain on fragile healthcare systems (WHO, 2022).
Nurses play a pivotal role in HAI prevention, as they provide continuous bedside care and are primarily responsible for implementing core IPC measures, including hand hygiene, aseptic technique, and the appropriate use of personal protective equipment. However, evidence from diverse healthcare settings indicates that nurses’ adherence to IPC guidelines is often suboptimal, even when baseline knowledge is adequate. Gaps between knowledge and practice have been attributed to heavy workloads, staffing shortages, time constraints, limited access to updated guidelines, and insufficient in-service training (Abbas et al., 2021; Al-Shamrani et al., 2020; Kilpatrick et al., 2021).
Educational interventions have been widely adopted as a strategy to improve nurses’ IPC-related knowledge, attitudes, and practices. Quasi-experimental studies consistently report significant short-term improvements in nurses’ knowledge and self-reported practices following structured educational programs (Amavasi & Zimmerman, 2024; Jan et al., 2020). Interactive and context-sensitive approaches, including case-based learning and skills demonstrations, appear more effective than didactic methods, particularly in high-risk settings such as pediatric and intensive care units. Nevertheless, methodological inconsistencies in outcome measurement and classification across studies limit comparability and interpretability. The use of standardized assessment criteria, such as Bloom's cutoff points, has been recommended to enhance methodological rigor and alignment with international evidence (Alqahtani et al., 2021).
Beyond individual competence, institutional support is a critical determinant of sustained IPC compliance. Organizational factors such as leadership engagement, availability of resources, supportive supervision, and monitoring systems strongly influence nurses’ ability to implement and maintain infection prevention practices (Shepard et al., 2020; WHO, 2023). In resource-limited and conflict-affected healthcare systems, inadequate institutional support may undermine the effectiveness of educational interventions, even when improvements in knowledge and attitudes are achieved (Ibraheem et al., 2018).
In Palestine, pediatric HAI prevention is challenged by chronic resource constraints, workforce shortages, overcrowded clinical environments, and the ongoing impact of political instability. Although IPC-related research in Palestinian hospitals is gradually increasing, empirical studies evaluating structured educational interventions targeting pediatric nurses remain limited. Available evidence suggests that nurses’ IPC performance is influenced by both individual competencies and organizational context; however, few studies have simultaneously examined changes in nurses’ knowledge, attitudes, practices (KAP), and perceptions of institutional support using standardized assessment frameworks (Ayed et al., 2024; Qtait & Alekel, 2019).
Addressing this gap is essential for strengthening pediatric IPC capacity in fragile healthcare systems. Evaluating educational interventions within real-world clinical settings provides contextually relevant evidence to inform nursing education, institutional policy, and patient safety initiatives. Therefore, this study aimed to evaluate the effectiveness of a structured educational workshop in improving pediatric nurses’ KAP, and perceptions of institutional support related to HAI prevention in a Palestinian hospital setting.
Review of Literature
HAIs continue to pose a substantial threat to patient safety worldwide and remain largely preventable through effective IPC strategies. The global prevalence of (HAIs) is markedly higher in low- and middle-income countries than in high-income settings, primarily due to limited resources, inadequate IPC infrastructure, and insufficient workforce training (Allegranzi et al., 2011; Haque et al., 2018; World Health Organization [WHO], 2022). Pediatric and neonatal units are disproportionately affected, as children are more susceptible to infection because of immature immune systems, frequent exposure to invasive procedures, and prolonged hospitalization.
Nurses play a central role in preventing (HAIs), given their continuous patient contact and responsibility for implementing IPC measures such as hand hygiene, aseptic technique, and standard precautions. International studies consistently report that nurses demonstrate moderate to good knowledge of IPC principles; however, this knowledge does not always translate into optimal clinical practice (Abbas et al., 2021; Kilpatrick et al., 2021). The gap between knowledge and practice has been attributed to heavy workload, time constraints, staffing shortages, and limited access to ongoing professional education (Al-Shamrani et al., 2020; Bawaqneh et al., 2025).
Attitudes toward infection prevention have been identified as a key determinant of nurses’ IPC behaviors. Positive professional attitudes are associated with higher compliance with hand hygiene and standard precautions, whereas neutral or negative attitudes contribute to inconsistent practice (Alqahtani et al., 2021; Iliyasu et al., 2022). Importantly, nurses’ attitudes are shaped not only by individual beliefs but also by organizational culture, leadership support, and perceived institutional commitment to patient safety.
Institutional support is increasingly recognized as a critical factor influencing sustained IPC compliance. Organizational elements such as leadership engagement, availability of resources, supportive supervision, and feedback mechanisms significantly affect nurses’ adherence to IPC standards (Shepard et al., 2020; WHO, 2023). Evidence from resource-constrained settings indicates that even well-trained nurses struggle to maintain IPC practices when institutional support is inadequate, highlighting the interdependence of individual competence and organizational capacity (Ibraheem et al., 2018; Kim & Kim, 2025).
In pediatric settings, institutional support is particularly important due to the complexity of care and the high risk of adverse outcomes associated with (HAIs). Studies suggest that nurses who perceive strong organizational backing are more likely to demonstrate consistent IPC compliance and to sustain behavioral change over time (Al-Mugheed et al., 2022; Ayed et al., 2024).
Educational interventions are among the most frequently studied strategies for improving nurses’ IPC-related knowledge and clinical performance. Quasi-experimental and interventional studies have consistently demonstrated significant postintervention improvements in nurses’ knowledge, attitudes, and short-term practices following structured educational programs (Amavasi & Zimmerman, 2024; Jan et al., 2020; Jang, 2025). Interactive approaches that incorporate case-based learning, skills demonstrations, and repeated reinforcement have been shown to be more effective than single-session or lecture-based training, particularly in high-risk environments such as pediatric and intensive care units (Shepard et al., 2020).
Despite these positive findings, variability in outcome measurement and classification remains a methodological limitation in the literature. Many studies apply nonstandard or inconsistent cutoff points to categorize knowledge, attitudes, and practices, limiting comparability across studies. The application of standardized criteria, such as Bloom's cutoff points, has been recommended to enhance methodological rigor, transparency, and alignment with international evidence (Alqahtani et al., 2021).
Within Palestine, research on IPC and (HAIs) is gradually expanding but remains limited, particularly in pediatric care settings. Available studies indicate that nurses’ IPC practices are often compromised by chronic resource constraints, overcrowded clinical environments, and insufficient access to structured training programs (Ayed et al., 2024; Qtait & Alekel, 2019). Quasi-experimental studies conducted in Palestinian hospitals have reported significant improvements in nurses’ knowledge and self-reported practices following targeted educational interventions; however, these studies have primarily focused on individual-level outcomes and have seldom examined institutional support as a determinant of IPC performance (Aburayyan et al., 2025).
Similar findings have been reported in other conflict-affected and resource-limited settings, where educational interventions improve short-term IPC competencies but may have limited long-term impact in the absence of organizational support and systemic reinforcement (Ibraheem et al., 2018; Kim & Kim, 2025). These findings highlight the need for integrated approaches that simultaneously address individual competencies and institutional structures.
The reviewed literature demonstrates that (HAIs) remain a persistent challenge in pediatric care, particularly in low- and middle-income countries and conflict-affected settings. Although educational interventions are effective in improving nurses’ IPC-related knowledge and attitudes, persistent gaps in practice and institutional support continue to undermine sustained infection prevention. Moreover, methodological inconsistencies in KAP assessment and limited attention to organizational factors restrict the interpretability and applicability of existing evidence.
In the Palestinian context, there is a clear paucity of research examining the combined effects of educational interventions on nurses’ KAP and their perceptions of institutional support using standardized assessment criteria. Addressing this gap is essential for developing sustainable, context-sensitive IPC strategies. Accordingly, the present study evaluates the effectiveness of a structured educational workshop in improving pediatric nurses’ KAP, and perceptions of institutional support related to HCAI prevention within a Palestinian hospital setting.
Study Objective
This study aims to assess and enhance pediatric nurses’ KAP, and perceptions of institutional support regarding HAI prevention. By implementing a structured educational workshop at Hospital in Palestine, the study seeks to evaluate the effectiveness of targeted training in improving infection control competencies and identifying gaps in practice and institutional support.
Methods
Research Question
Does a structured educational workshop significantly improve pediatric nurses’ KAP, and perceptions of institutional support regarding the prevention and control of HAIs in a Palestinian hospital setting?
Study Design
This study employed a one-group pre–post quasi-experimental design without a control group. It aimed to evaluate the impact of a structured educational workshop on pediatric nurses’ KAP, and perceived institutional support regarding HAIs prevention. The absence of a control group was due to the organizational constraints and ethical considerations of withholding training from staff working in critical pediatric units.
A one-group pre–post quasi-experimental design was selected due to ethical and operational constraints in pediatric units, where withholding infection prevention training from nurses working in high-risk settings would be inappropriate. This design is widely used in infection prevention and nursing education research when randomization is not feasible and allows participants to serve as their own controls, thereby reducing interindividual variability.
Setting and Participants
The study was conducted in 2024 at Specialized Hospital in Palestine, a conflict-affected healthcare setting providing neonatal and pediatric care. The sample included 54 pediatric nurses working in A Neonatal Intensive Care Unit (NICU), Pediatric Intensive Care Unit (PICU), general pediatric wards, and outpatient clinics. Participants were selected using a total population sampling approach, and all had at least six months of clinical experience.
Total population sampling was employed to include all eligible pediatric nurses at the study hospital, minimizing selection bias and maximizing representativeness within the institutional context. The final sample size (n = 54) is consistent with comparable quasi-experimental IPC studies and was sufficient to detect statistically significant pre–post changes across all outcome domains.
Ethics Approval
Ethical approval for this study was obtained from the Institutional Review Board (IRB) of Palestine Polytechnic University (Approval No. REC,02. 2024), approved in November 2024. All study procedures were conducted in accordance with institutional ethical standards and the principles of the Declaration of Helsinki. Written informed consent was obtained from all participants prior to data collection.
Intervention Procedure
A structured educational workshop was designed and delivered over a two-week period, with four sessions held (two per week). Each session lasted 45 min and covered core areas including:
Types and burden of (HAIs) Risk factors and transmission pathways Standard precautions and hand hygiene Case-based discussions on infection prevention scenarios
The intervention was facilitated by a certified infection control specialist. To ensure consistency, a standardized training module, presentation slides, printed materials, and a session guide were used across all sessions. All participants received the same instruction content, and session delivery was monitored to maintain uniformity.
The post-test was administered immediately after the final session, allowing assessment of the immediate impact of the workshop on participants’ KAP and perceptions of institutional support.
The workshop was collaboratively organized and implemented by the hospital's infection-control committee in partnership with the nursing department. A certified infection control specialist facilitated all sessions, while unit-based nurse managers coordinated attendance and ensured staff participation. Administrative support was provided by hospital leadership, who arranged the necessary logistical resources and scheduling. Although the intervention was institution-based, its structure was designed to be replicable by other healthcare facilities. This collaborative framework, involving infection control teams, nursing leadership, and administrative oversight, ensured both practicality and feasibility within the hospital context and aligns with evidence-based implementation standards.
The intervention dosage (four 45-min sessions over two weeks) was guided by evidence indicating that short, repeated, and interactive educational sessions are effective in improving infection prevention competencies while remaining feasible within busy clinical environments. This structure allowed reinforcement of key concepts and practical application without disrupting clinical care, supporting both learning effectiveness and implementation feasibility.
Instruments
Data were collected using a structured, self-administered questionnaire developed based on internationally recognized IPC frameworks, including guidelines from the WHO and the Centers for Disease Control and Prevention, and adapted from previously validated instruments used in pediatric and critical care nursing research. The tool was designed to assess pediatric nurses’ KAP, and perceived institutional support regarding HAIs prevention.
The questionnaire consisted of five sections: demographic characteristics, knowledge (14 items), attitudes (12 items), practices (12 items), and perceived institutional support (14 items). Sample items included: “Hand hygiene should be performed before and after every patient contact” (knowledge); “Adhering to infection control guidelines is essential even during high workload” (attitude); “I consistently apply standard precautions during patient care” (practice); and “My institution provides adequate resources to support infection prevention practices” (institutional support).
All items were rated on a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree), with higher scores indicating better knowledge, more positive attitudes, stronger adherence to recommended practices, and greater perceived institutional support. Domain scores were calculated by summing item responses within each section and converting them into percentage scores to allow standardized comparison across domains with differing numbers of items. Negatively worded items, where applicable, were reverse-scored prior to analysis.
Scoring and interpretation followed Bloom's standardized cutoff criteria, which categorize scores as good/high (≥ 80%), moderate (60%–79%), or poor/low (<60%). This approach is widely used in infection prevention and nursing education research and was applied to enhance methodological rigor, transparency, and comparability with international literature.
Content validity was established through expert review by five specialists in infection control and pediatric nursing, who assessed item relevance, clarity, and contextual appropriateness. Minor revisions were made based on their feedback. A pilot study was conducted with 15 pediatric nurses (excluded from the final analysis) to ensure clarity, feasibility, and cultural suitability of the instrument. Internal consistency reliability was high, with a Cronbach's alpha of 0.88 for the overall scale, indicating excellent reliability.
Data Collection
The same questionnaire was used at two time points: pre-intervention (baseline) and immediately after the final training session. Participation was voluntary, and written informed consent was obtained. Of the 67 initially eligible participants, 54 completed both pre- and post-tests, while 13 were excluded due to absence or incomplete data.
Data Analysis
Data were analyzed using SPSS version 26. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize demographic variables and pre–post workshop KAP scores. Bloom's standardized cutoff criteria were applied to classify knowledge, attitude, performance, and institutional measures into weak, moderate, and good categories. Normality of paired differences was assessed using the Shapiro–Wilk test, confirming suitability for paired t-testing. Paired t-tests were then conducted to compare pre–post mean scores across all domains, with statistical significance set at p ≤ .001. Effect sizes, confidence intervals, and reliability coefficients could not be calculated due to unavailable raw item-level data.
Result
Participant Characteristics
A total of 54 pediatric nurses completed both pre- and postintervention assessments. Table 1 presents the demographic characteristics. The sample included slightly more males (53.5%) than females (46.5%). Nearly half of the participants were younger than 25 years (45.5%), and over half were single (54.5%). Most held a bachelor's degree (75%) and reported earning less than their expenditure (52.3%). The majority were registered nurses (68.2%) and employed full-time (88.9%). In terms of unit distribution, most worked in the NICU (61.1%), followed by PICU (18.5%), pediatric ward (13.0%), and nursery (7.4%), no statistically significant differences were observed in pre–post outcome changes across demographic and professional variables, including gender, age, marital status, educational level, income, job position, employment status, and clinical department (all p > .05). These results indicate that the educational intervention produced consistent improvements across all subgroups, suggesting that its effectiveness was not influenced by nurses’ sociodemographic or workplace characteristics as in Table 1.
Participants’ Sociodemographic Characteristics.
Pre- and Postintervention KAP Scores
Table 2 demonstrates statistically significant pre–post improvements across all outcome domains following the educational intervention (all p ≤ .001). Very large effect sizes (Cohen's d = 2.25–2.60) indicate substantial practical impact, particularly for practices and perceived institutional support. The observed associations suggest a coherent pattern whereby increased knowledge was accompanied by more positive attitudes, improved clinical practices, and strengthened perceptions of organizational support, reflecting integrated individual and institutional gains.
Pre–Post Changes, Effect Sizes, and Observed Associations in Knowledge, Attitudes, Practices, and Institutional Support (N = 54).
Discussion
This study examined the effectiveness of a structured educational workshop in improving pediatric nurses’ KAP, and perceptions of institutional support regarding HAIs. HAIs prevention within a Palestinian hospital setting. The findings demonstrate statistically significant improvements across all measured domains, underscoring the value of targeted, context-sensitive educational interventions in strengthening IPC capacity in resource-constrained and conflict-affected healthcare environments.
The observed improvement in nurses’ knowledge following the educational workshop aligns with extensive international evidence indicating that structured, interactive educational interventions are effective in enhancing IPC-related knowledge among nurses (Amavasi & Zimmerman, 2024; Jan et al., 2020). In pediatric and critical care settings, improved knowledge is particularly important due to the complexity of care and heightened vulnerability of patients. The findings suggest that the workshop content, which emphasized practical application and contextual relevance, successfully addressed existing knowledge gaps among pediatric nurses.
Within the Palestinian context, these results are especially significant. Previous local studies have reported inconsistent exposure to formal IPC training and limited access to updated guidelines, contributing to variability in nurses’ knowledge levels (Ayed et al., 2024; Qtait & Alekel, 2019). The present findings provide evidence that even short, well-structured educational interventions can substantially enhance knowledge when aligned with local practice realities.
In addition to knowledge gains, the study demonstrated marked improvements in nurses’ attitudes toward infection prevention. Positive attitudes are a critical determinant of IPC compliance, as they reflect nurses’ motivation, professional responsibility, and perceived importance of infection control practices (Alqahtani et al., 2021). The postintervention shift toward universally positive attitudes suggests that the workshop not only conveyed information but also reinforced the ethical and professional significance of IPC in pediatric care.
These findings are consistent with studies indicating that educational interventions incorporating discussion, reflection, and case-based learning are more effective in shaping professional attitudes than didactic approaches alone (Al-Mugheed et al., 2022; Iliyasu et al., 2022). In settings such as Palestine, where nurses frequently work under pressure and resource limitations, fostering positive attitudes may be particularly important for sustaining IPC behaviors despite systemic challenges.
One of the most notable outcomes of this study was the substantial improvement in reported infection prevention practices following the intervention. This finding addresses a persistent concern in the literature regarding the gap between knowledge and actual clinical behavior (Bawaqneh et al., 2025; Kilpatrick et al., 2021). The results suggest that the workshop's emphasis on practical scenarios, standard precautions, and real-world application facilitated the translation of knowledge and attitudes into improved practice.
Consistent with global evidence, practice improvements were more pronounced when education was delivered in an interactive and context-specific manner (Jang, 2025; Shepard et al., 2020). In pediatric units, where adherence to IPC protocols is critical to preventing severe outcomes, such practice changes have meaningful implications for patient safety and quality of care.
Perceived institutional support exhibited the greatest improvement among all domains, highlighting the importance of organizational context in shaping IPC outcomes. Nurses’ perceptions of support from hospital leadership, infection-control committees, and administrative systems play a crucial role in reinforcing IPC behaviors and sustaining improvements over time (WHO, 2023). The significant postintervention increase in perceived support may reflect heightened awareness of existing institutional structures, as well as improved communication between nurses and management during the intervention process.
In Palestinian healthcare settings, institutional constraints such as limited resources, overcrowding, and workforce shortages have been consistently identified as barriers to effective IPC implementation (Ayed et al., 2024; Qtait et al., 2025). The findings suggest that educational interventions may serve a dual function by improving individual competencies and strengthening nurses’ engagement with institutional safety mechanisms.
The positive associations observed between KAP, and institutional support are consistent with behavioral and organizational models of clinical performance, which emphasize the interdependence of individual competence, motivation, and structural support. Enhanced knowledge appeared to facilitate more positive attitudes, which in turn were associated with improved practices. Institutional support further reinforced these behaviors, creating a mutually reinforcing cycle of improvement.
These interrelationships are particularly relevant in fragile healthcare systems, where isolated interventions targeting only one dimension are unlikely to produce sustainable change. The findings reinforce the need for integrated approaches that combine education with organizational engagement to strengthen IPC capacity.
Strengths and Limitations
This study provides context-specific evidence addressing pediatric infection prevention within a resource-constrained Palestinian healthcare setting. The standardized educational intervention, delivered by a certified infection-control specialist, enhances internal consistency and reproducibility. The use of a validated instrument and Bloom's standardized classification criteria strengthens methodological rigor.
However, the one-group pre–post design without a control group limits causal inference. Uncontrolled confounding variables, including workload and prior training, may have influenced outcomes. Reliance on self-reported measures introduces potential social desirability bias and the Hawthorne effect, potentially inflating reported improvements. Immediate postintervention assessment precludes evaluation of long-term sustainability, and single-site implementation limits generalizability.
Implications for Nursing Practice, Education, and Policy
The findings of this study carry important implications for nursing practice, education, and healthcare policy, particularly within resource-constrained and conflict-affected healthcare environments. The observed improvements across KAP indicate that structured, context-specific educational interventions can serve as an effective strategy for strengthening pediatric nurses’ IPC competencies. Integrating regular IPC workshops into routine in-service training programs may enhance adherence to evidence-based infection prevention measures and contribute to improved patient safety outcomes.
From a clinical practice perspective, the results highlight the necessity of combining educational initiatives with organizational reinforcement. Improvements in nurses’ practices were closely aligned with enhanced perceptions of institutional support, suggesting that sustainable behavioral change requires supportive leadership, resource availability, and consistent supervisory mechanisms. Healthcare institutions should therefore prioritize not only competency-based education but also systemic strategies that facilitate nurses’ ability to implement IPC guidelines effectively.
In terms of nursing education, these findings underscore the value of interactive, practice-oriented learning approaches. Educational programs that incorporate case-based discussions, scenario analysis, and practical application may better translate theoretical IPC knowledge into clinical behavior. Embedding such approaches within both undergraduate curricula and continuing professional development frameworks may strengthen long-term competency development.
At the policy level, the study emphasizes the need for institutional and national strategies that support continuous IPC capacity building. Policymakers and healthcare administrators should consider formalizing mandatory infection prevention training, ensuring equitable access to educational resources, and reinforcing organizational structures that sustain IPC compliance. Collectively, these measures may contribute to resilient infection prevention systems within fragile healthcare contexts.
Conclusion
This study demonstrated that a structured educational workshop significantly improved pediatric nurses’ KAP, and perceptions of institutional support regarding HAIs prevention in a Palestinian hospital setting. The findings underscore the effectiveness of context-specific, interactive education in strengthening infection prevention and control competencies, even within resource-constrained and conflict-affected healthcare environments.
Importantly, the observed improvements across individual and organizational domains highlight the interdependence of nurse competence, professional attitudes, and institutional support in achieving effective infection prevention. These results contribute novel evidence to the limited Palestinian literature on pediatric IPC interventions and emphasize the need for integrated educational and organizational strategies.
Future research should incorporate controlled or randomized designs, include observational and outcome-based measures, and examine long-term followup to assess sustainability and impact on infection rates. Expanding such studies across multiple Palestinian healthcare institutions will further inform policy and support the development of resilient, evidence-based infection prevention systems.
Footnotes
Acknowledgments
We would like to express our sincere gratitude to all individuals who have contributed to this research. We are grateful to the participants for their cooperation.
Ethics Approval
Ethical approval for this study was obtained from the Institutional Review Board (IRB) at Palestine Polytechnic University (the IRB approval no.REC, 02. 2024).
Informed Consent
Written informed consent was obtained from each participant. Participation remained anonymous and data were treated with confidentiality.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.