Revista Ecuatoriana de Ciencia, Tecnología e

Innovación en Salud Pública

Código ISSN 2588-0551

Revista Ecuatoriana de Ciencia, Tecnología e

Innovación en Salud Pública

Scientific magazine INSPILIP - Volume 7 - Special Number - November 2023

https://www.inspilip.gob.ec

Toapanta S., Rueda-García D.,

Armas P., Borja-Cevallos L., Flores

M. Knowledge and practices of

biosecurity measures in the students

of the last year of the Nursing Career

of an Ecuadorian university. Original

Article . INSPILIP. 2023; Vol. 7,

Spec. Num.

Scientific magazine INSPILIP.

Volume 7, Special Number

November 2023

The author declares to be free of any

personal or commercial association

that may involve a conict of interest

in connection with the article, as

well as having respected the ethical

principles of research, such as having

requested authorizations from the

institution where the study was

conducted, permission to use the data,

informed consents and in the case of

observational studies and clinical

trials, authorization from a CEISH,

ARCSA, Environment, among

others, according to the category. In

addition, the license to publish images

of the person or persons appearing in

the manuscript. Therefore, INSPILIP

is not responsible for any aectation

to third parties, neither INSPI as

publishing entity, nor the Editor, the

responsibility of the publication is of

absolute responsibility of the authors.

Patricio Vega Luzuriaga

EDITOR-IN-CHIEF

Toapanta Iza Shirley Anabel

, satoapantail@uce.edu.ec

Rueda-García Dunia Ekatierina

, derueda@uce.edu.ec

Armas Freire Paulina Isabel

a,b

, piarmas@uce.edu.ec

Borja-Cevallos Lusi Tamara

, ltborja@uce.edu.ec

Flores Villacís Myriam Silvia

,* msoresv@uce.edu.ec

a. Central University of Ecuador. Faculty of Medical Sciences, Quito, Ecuador.

b. Indo-America Technological University, Faculty of Health Sciences and Human Welfare, Quito,

Ecuador.

*Correspondence: Myriam Flores Villacís; Email: msoresv@uce.edu.ec

Identication of the responsibility and contribution of the authors: The authors declare to

have contributed in a similar way in the original idea (ST, DR,), design of the study (ST, DR),

data collection (ST, DR, LB,PA) , data analysis (ST,DR, PA, LB), writing the draft and writing the

article (DR, LB,PA, MF).

Date of Entry: 17/8/2023.

Date of Aproval: 31/10/2023.

Date of Publication: 27/11/2023.

Knowledge and practices of biosecurity measures in the students of the last year of the

Nursing Career of an Ecuadorian university

Conocimientos y prácticas de las medidas de bioseguridad en los estudiantes del último año de la

Carrera de Enfermería de una universidad ecuatoriana

Original Article

Open Access

Abstract

Citation

Introduction: Biosafety is currently the pillar where risk prevention converges,

adopted not only by health teams, but also by the general population. Objective:

To determine the level of knowledge and practice of biosafety measures among

students in the last year of the nursing career at a public university in Quito,

Ecuador. Methodology: A cross-sectional descriptive study was carried out,

with a population of 140 students of the rotating internship of the Nursing

career. Data were obtained relating the variables: knowledge of biosafety

standards of rotating interns and the places where they performed their

pre-professional internships, with a condence level of 95%, considering p

< 0.05 as signicant, a previously validated and structured questionnaire was

applied with 16 questions validated with a Cronbach's Alpha of 0.85, which

covered the principles of biosafety. Results: It was evidenced that 100% of the

students knew the hand washing procedure; 86% knew about the knowledge,

norms, and principles of biosafety; with respect to waste management, only 76%

were clear about the procedure; 54% knew how to proceed with the treatment

of contaminated material. Regarding the use of personal protective equipment

(PPE), 91% of the students used the surgical mask as protection in the places

of practice and only 39% used the N95 respirator. The vaccination used before

performing their practices it was evidenced that 100% of the participants had

the COVID- 19 vaccine, followed by the Hepatitis B vaccine with 94%, the

Diphtheria and Tetanus vaccine was used in 91% and 70% the inuenza vaccine.

Conclusions: It could be determined that biosafety knowledge was high in the

evaluated students, on the other hand, biosafety practices, the use of personal

protective equipment (PPE), depend on the complexity and level of care where

the practices were performed, more emphasis should be made regarding waste

management and treatment of contaminated material. In health careers, the

evaluation of adherence to biosafety practices is of vital importance.

Keywords: Knowledge, Practices, Biosafety, Students, Nursing.

DOI: 10.31790/inspilip.v7iESPECIAL.537

Revista Ecuatoriana de Ciencia, Tecnología e

Innovación en Salud Pública

Código ISSN 2588-0551

Scientific magazine INSPILIP - Volume 7 - Special Number - November 2023

https://www.inspilip.gob.ec

Resumen

Introducción: La bioseguridad es actualmente el

pilar donde conuye la prevención de riesgos a la

salud, adoptada no solo por los equipos médicos,

sino también por la población en general. Objetivo:

Determinar el nivel de conocimientos y prácticas

de las medidas de bioseguridad en los estudiantes

del último año de la Carrera de Enfermería

de una universidad pública de Quito Ecuador.

Metodología: Se realizó un estudio descriptivo

transversal, cuya población fue de 140 estudiantes

del internado rotativo de la carrera de Enfermería.

Se obtuvieron datos relacionando las variables:

Conocimiento de las normas de bioseguridad

de los internos rotativos y los lugares donde

realizaron sus prácticas preprofesionales, con

un nivel de conanza del 95%, considerando p <

0.05 como signicativa, se aplicó un cuestionario

previamente validado y estructurado con 16

preguntas validado con un Alfa de Cronbach de

0,85, que abarcaron los principios de bioseguridad.

Resultados: Se evidenció que un 100% de los

estudiantes conocían el procedimiento de lavado

de manos; en cuanto a los conocimientos, normas

y principios de bioseguridad un 86 % conocían

de los mismos, en cuanto al manejo de desechos

solo un 76 % tenían claro el procedimiento,

en relación con el tratamiento del material

contaminado un 54 % sabían cómo proceder con

el mismo. Con respecto al Equipo de Protección

personal (EPP) el 91 % de los estudiantes usaron

la mascarilla quirúrgica como protección en

los lugares de práctica y solo un 39 % utilizó el

respirador N95. La vacunación utilizada antes de

realizar sus prácticas se evidencio que el 100 %

de los participantes contaba con la vacunade la

COVID- 19, seguido de la vacuna de la Hepatitis

B con un 94 %, la vacuna de la Difteria y la del

Tétanos fue utilizada en un 91 % y un 70 % la

vacuna de la inuenza. Conclusiones: Se pudo

determinar que el conocimiento en bioseguridad

fue alto en los estudiantes evaluados, por otro

lado, las prácticas de bioseguridad y el uso del

equipo de protección personal (EPP), dependen

de la complejidad y el nivel de atención donde

se realizaron las practicas, se deberá hacer más

énfasis en lo que respecta al manejo de desechos

y tratamiento de material contaminado. En las

carreras de salud, la evaluación de adherencia a

prácticas de bioseguridad es de vital importancia.

Palabras clave: Conocimiento, Prácticas,

Bioseguridad, Estudiantes, Enfermería.

Introduction

Biosafety is the basic strategy for the protection

of patients, personnel of health institutions, and

the environment, and takes on special relevance

in the prevention of infection risks, which is

directly related to the prevention and protection of

all persons who are exposed and involved in the

health eld. It is worth mentioning that biosafety is

the starting point for the reduction and elimination

of biological risk factors that may aect the

health or life of people, it is for this reason that

such measures should be assumed and applied by

all health professionals in their dierent areas of

work or practice, which have been declared by

the World Health Organization (WHO) as: "A set

of standards and measures to protect the health

of personnel, against biological, chemical and

physical hazards to which they are exposed in the

performance of duties, of all persons involved in

the healthcare environment " (1,2).

Biosafety involves very broad aspects ranging

from the physical design of the facilities, the

proper use of equipment and protective material,

the monitoring of appropriate strategies, such as

immunization of personnel working in the dierent

health areas, as well as the proper disposal of waste

or waste generated, covering a series of standards

that are aimed at protecting health personnel and

achieve behaviors that reduce the risk to which

they may be exposed during their care activities,

which is the basis of this research (3).

The inappropriate application of biosafety in

patient care can have serious consequences, due

to an increase in infections associated with health

care, as well as to health care personnel due to

occupational accidents that can cause and trigger

occupational diseases, aecting the cost of care

to the state and putting the lives of health care

workers and patients at risk (3).

The rst is universality, which urges healthcare

personnel to consider that all patients and their

body uids, regardless of diagnosis, should be

considered as potentially pathogenic, so that

all personnel should routinely comply with

standardized norms to prevent accidents and

exposure to disease.

The second principle is the use of barriers, which

aims to avoid direct exposure to uids such as

blood and others, for which the use of Personal

Protective Equipment (PPE) and the use of

vaccines for health personnel fullls this function

of biological barriers. The third statement is the

adequate waste management, being together

the basis for maintaining a safe practice in the

dierent health services (4).

With respect to the COVID-19 vaccines, it was

implemented within the requirement scheme

for all health personnel and the community in

general, due to the pandemic, it is essential for

each member of the health team to comply with

such requirement as a means of prevention of

DOI: 10.31790/inspilip.v7iESPECIAL.537

Revista Ecuatoriana de Ciencia, Tecnología e

Innovación en Salud Pública

Código ISSN 2588-0551

Revista Ecuatoriana de Ciencia, Tecnología e

Innovación en Salud Pública

Scientific magazine INSPILIP - Volume 7 - Special Number - November 2023

https://www.inspilip.gob.ec

acquiring COVID-19, depending on the brands,

it can be 2 doses or a single dose. The rst dose

confers only partial protection, in such a way

that the second dose is the one that increases the

protection, thus the maximum level of immunity is

reached between the second and third week after

the second dose. (5) Although it is true that the

vaccines against

COVID-19 do not prevent 100% infection with

the virus, but they do reduce the risk of mortality,

being eective in preventing mortality by 80-

86%, thus preventing a person from presenting a

serious disease caused by this virus in 85% (5,6).

(5,6). These vaccines are currently considered

mandatory by the Ecuadorian Ministry of

Health, in addition to the Hepatitis B, Diphtheria,

Tetanus, Inuenza, Varicella, Meningococcus,

Pneumococcus vaccines; to be able to perform the

pre-professional practice within the rst, second

and third level of care centers in Ecuador.

Personal protective equipment (PPE) is the set of

elements used by healthcare personnel to protect

them from risks that threaten their safety and/or

health; however, its eectiveness depends largely

on its correct use, selection, maintenance, and

adequate provisioning. (3).

Among the chemical barriers we nd hand washing,

which consists of the mechanical removal and

elimination of pathogens from the skin to prevent

the transmission of microorganisms from person

to person (3).

Contaminated material disposal measures are

dened as: the set of appropriate procedures and

devices through which the materials used in patient

care are deposited and disposed of without risk,

being important the application of safe practices

from the site of waste generation (7).

This study shows how the nursing sta, who

perform their professional work by providing

direct care to the users of the health system, took

biosafety as a daily and ecient practice, in the

dierent places of practice in health institutions,

by providing ecient care to the dierent groups

of the population served, taking into account all

the principles of biosafety.

Methodology

Type of study: a cross-sectional descriptive

study was conducted, using as primary source a

previously validated survey for the measurement

of the variables: Knowledge of Biosafety Measures

and places of practice in 140 students of the

rotating internship of the nursing career, during the

academic period 2021-2022. Data were obtained

based on inferential statistics with a signicance

level of p<0.05 and a condence level of 95%.

All participants signed the informed consent form

and those who did not wish to participate in the

study were excluded. Knowledge of biosafety

measures and practice sites was established with

a survey consisting of 16 questions, validated

with a Cronbach's Alpha of 0.85, and then the

information was processed.

Statistical analysis: the information obtained

was entered into a database of the Microsoft

Excel program (Microsoft Corp.). After reviewing

and verifying the information with the SPSS

program (IBM Corp.) version 26, the distribution

of frequencies and the analysis of crossed tables

with the study variables were carried out, using

descriptive statistics.

Ethical considerations: The project was approved

by the Ethics and Research Committee of the

Universidad Central del Ecuador.

Variables: The following qualitative variables

were evaluated in this research: knowledge of

biosafety standards of rotating interns, physical

barriers, biological barriers, and practice sites.

Procedure: After surveying the rotating interns

of the Nursing career of the Universidad Central

del Ecuador enrolled in the period 2021-2022 in

the seventh and eighth semester of the career, data

were obtained with the predetermined instrument.

Instrument: Knowledge of biosafety measures

and practice sites was established with a survey

consisting of 16 questions validated with a

Cronbach's Alpha of 0.85, after which the

information was processed.

Ethical considerations: The project was approved

by the Ethics and Research Committee of the

Universidad Central del Ecuador.

Revista Ecuatoriana de Ciencia, Tecnología e

Innovación en Salud Pública

Código ISSN 2588-0551

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Analysis of results: The students had an average

age of 24 years; the minimum age was 20 years, and

the maximum age was 51 years. Of the population,

80.7% (n=113) were female and 19.3% (n=27)

were male.

From the information collected, it was found that

most of the rotating interns of the Nursing Career

were doing their pre-professional internships in the

following services: Obstetric Center with a total of

21% (n=30), followed by Neonatology with 19%

(n=26), Pediatrics with 18% (n=25), followed by

Surgical Center with 18% (n=25) , community

medicine 10% (n=14) , other services 9% (n= 12),

internal medicine 5% (n= 8) with a 95% CI with a

signicance of p<0.05.

Regarding the more general knowledge of biosafety,

100% (n=140) of the students in the last year of

the Nursing Career know the time and procedures

of hand washing, with a 95% CI, followed by the

denition of disinfection of instruments in 89%

(n=124) with a 95% CI, as well as the biosafety

regulations and its principles in 86% (n=120)

with a 95% CI, 76% (n=106) with a 95% CI, and

76% (n=106) with a 95% CI, also know about the

percentage of protection of the N95 mask and its

duration in 71% (n=99) with a 95% CI, nally

54% (n=76) recognize the treatment process to be

followed with contaminated material, with a 95%

CI with a signicance of p< 0.05.0,05.

It is evident that the most used personal protective

equipment was the surgical mask in 91% (n=127)

with a CI of 95%, followed by the cap in 77%

(n=109) with a CI of 95%, gloves were used by

74% (n=104) with 95% CI, followed by gown by

69% (n=97) with 95% CI, boots by 53% (n=74)

with 95% CI, followed by N95 respirator by 39%

(n=55) with 95% CI; with a signicance of p<0.05

in the related data.

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When analyzing the relationship between the

area of practice and the use of the N95 mask, the

following results were obtained: in the Surgical

Center it was used in 9.3% (n=13) with a 95% CI,

followed by the Obstetric Center in 8.6% (n=12)

with a 95% CI, in the Neonatology and Pediatrics

services it was used in 7% (n=10) with a 95% CI.

It is evident that the most used personal protective

equipment was the surgical mask in 91% (n=127)

with 95% CI, followed by the cap in 77% (n=108)

with 95% CI, gloves in 74% (n=104) with 95%

CI, followed by the gown with 69% (n=97) with

95% CI, and nally the use of boots 53% (n=74)

with 95% CI; with a signicance of p<0.05 in the

related data.

When analyzing the qualitative level, it was found

that 5% (n=7) with a 95% CI of students who have

a high level of knowledge, comply with 100% of

the use of PPE, compared to 95% (n=133) with a

95% CI of students who use PPE incompletely.

The most used vaccine, due to the pandemic

situation, was the Coronavirus vaccine,

within these the most used in 55% (n=77) was

AstraZeneca, followed by 39% (n=55) Sinovac

and nally only 6% (n=8) was Pzer, with a 95%

CI. Hepatitis B vaccine was the second most used

vaccine in 94%(n=132) with 95% CI, Diphtheria

and Tetanus vaccine in 91% (n=127) with 95% CI,

followed by Inuenza vaccine in 70% (n=98) with

95% CI, being these the most used by the group of

interns in their pre-professional practices, the data

obtained had a statistically signicant relationship

with a p<0.05.

Discussion

In the present study it was possible to establish

that knowledge and conceptualization of biosafety

principles are high (86%), which indicates that

most of the rotating interns of the C.

Ethical considerations: The project was approved

by the Ethics and Research Committee of the

Universidad Central del Ecuador.

The nursing sta has extensive knowledge of

biosafety measures.

From this perspective, it is valid to consider several

similar studies, among them the one conducted by

Chero in his research ¨ Level of knowledge about

biosafety measures and their use by students in

a Peruvian University¨, where it was determined

that the knowledge about the concept of biosafety

was high in 66.7%, compared to the present study

where 86% was obtained. (8).

In a study conducted in Bucaramanga Colombia

in 2017 by Carrascal ¨ Evaluation of adherence

to biosafety standards in the nursing sta of the

San Camilo Psychiatric Hospital¨ the result of his

research evidenced that 98% of the sta working

there know about biosafety measures and they are

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correctly applied. (9).

In another study conducted in Colombia by

Salcedo in 2014, ¨Knowledge and attitudes in

the application of biosafety of nursing service

personnel¨, indicates that 80% of the nursing sta

know about biosafety measures, therefore, it is

related to the results of the present study (10).

In the work done by Rojas in 2019 ¨ Biosafety in

nursing interns in hospital practice at the National

University of Chimborazo¨, it was found that

100% of respondents say that they have complied

with the vaccination schedule to perform hospital

practices. Ninety-six percent armed that during

their internships in health institutions, they were

administered the inuenza vaccine, which is

similar to the vaccination coverage of the nursing

interns in the present study. (11).

In the study conducted by Espinoza in 2019,

¨Immunization in health personnel¨, he determined

that the most frequently applied vaccines were:

Hepatitis B, Measles, Rubella, Mumps, Inuenza

and Varicella, being related to the present study

(12).

It is important to point out that within the results

obtained about the concepts of biosafety, 100% of

the students of the Rotational Nursing Internship

know the time and procedures of hand washing.

These results are consistent with the study

conducted by Montaño in 2016

¨Level of knowledge and practices in biosafety in

nursing students of a higher education institution

in Tuluá, in the second semester¨, where he

describes that 89.4% of nursing students always

perform hand washing before and after performing

a procedure. (13).

Similar to the study conducted by Rojas ¨ Biosafety

in nursing interns in hospital practice. Universidad

Nacional de Chimborazo, 2019¨, 88% of students

know the technique for proper hand washing

within the institutions where services are provided,

in addition to maximizing hygiene levels. (11).

Regarding the correct management of contaminated

waste disposal, the proper handling of contaminated

waste is considered of great importance. In the

present study, the level of knowledge about this

parameter was considered, and the results showed

a high level of knowledge, represented by 76%, on

the part of the nursing interns.

The study conducted by Montaño in 2016 ¨Level

of knowledge and practices in biosafety in

nursing students of a higher education institution

in Tuluá, in the second semester¨, refers that

89.4% of students eliminate contaminated waste

in appropriate containers, similar to the present

study (13).

Likewise, the study conducted by Rojas ¨

Biosafety in Nursing Interns in Hospital Practice.

Universidad Nacional de Chimborazo, 2019¨,

the interns comply with discarding sharps waste

correctly in a percentage of 100%, that is to say

that all sharps are being disposed of properly,

which coincides with the present study 76 % (11).

Conclusions

The results obtained in the present research

showed that the knowledge about biosafety in

the Nursing Interns was high, in the places where

they did their pre-professional practices, the use

of Personal Protective Equipment (PPE) was

used partially and varies according to the place

where they did their pre-professional practices.

Regarding vaccination coverage for the prevention

of infectious diseases, it could be specied that it

was quite wide, mainly regarding the COVID-19

vaccines, where the coverage was 100%, which

were provided by the Ministry of Health.

The practice areas where biosafety standards

were most adequately met were: Obstetric Center,

Neonatology, Pediatrics and Surgical Center.

It is evident that most of the places are familiar

with the biosafety protocols, depending on the area

and its complexity, and that personal protective

equipment (PPE) is used.

The evaluation of biosafety knowledge and

practices in health career students is essential in

order to follow the protocols established by the

Ministry of Health, which may vary in each of

the medical services where the pre-professional

practices are performed according to the level of

care and complexity of these.

Peer review

The manuscript was peer-reviewed and approved

in a timely manner by the INSPILIP Editorial

Team.

Revista Ecuatoriana de Ciencia, Tecnología e

Innovación en Salud Pública

Código ISSN 2588-0551

Revista Ecuatoriana de Ciencia, Tecnología e

Innovación en Salud Pública

Scientific magazine INSPILIP - Volume 7 - Special Number - November 2023

https://www.inspilip.gob.ec

Availability of data and materials

The data supporting this manuscript are available

upon request to the corresponding author.

Conict of Interest

The authors declare that they have no conicts of

interest.

Authors' contribution

The dierent phases of the research were carried

out by the authors, who contributed equally

throughout the process.

Acknowledgments

The authors appreciate the collaboration of the

dierent hospitals of the state health network of

Quito Ecuador.

Financing

Authors owns.

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