Title: Work experience was associated with the knowledge and practice of catheter-associated
urinary tract infection prevention among nurses at University of Gondar Comprehensive
Specialized Hospital, northwest Ethiopia, 2021
Version: 5 Date: 09 Dec 2022
Reviewer's report:
"PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
No - there are minor issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Yes - current version is technically sound
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: A lot of issues regarding the methods is much more clear now. The
manuscript improved substantially. Yet, some aspects need to be reported in an other way, or
alternatively, need to be nuanced strongly in the discussion section.
REQUESTED REVISIONS:
I still have major problems by defining 'good knowledge' by just achieving a score equal to or
greater than the mean score of the cohort. I understand the reasoning of the authors and from
a pure methodological view it is not incorrect. Such an approach is indeed used for evaluating
subjects in training. But this is another type of participant. These practicing nurses from which
one may assume they know their job. It is not okay defining 'good knowledge' as simply
achieving a mean score. The mean knowledge score in this study was 5.6/10. This cannot be the
threshold to define 'good'. I know it is a cliché by comparing healthcare workers with pilots, but
would you step in an airplane when knowing the pilot has a score of 5.6/10 on how to handle a
civilian airplane...? The authors have 3 options: (i) to define good knowledge at a higher level
that is not depending on the average performance of the cohort (e.g., 7.5/10). (ii) To step of the
idea of defining knowledge as a binary variable with poor or good, and to make more gradations
in the scores: very good, good, poor, very poor, ... (iii) to step of the idea of putting a label on
certain scores and just report the knowledge scores in a detailed way: n nurses (%) had a score
>90%, n nurses (%) had a score between 81 and 90%, n nurses (%) had score between 71 and
80%, and so on. In this way (what I would prefer) it is up to the reader to decide what is a good
or a bad score.
The authors report on demographic and educational characteristics of nurses with knowledge.
However, I would also welcome an additional analysis to assess relationships between attitude
and knowledge. They have the data!
Discussion: for interpreting the data on knowledge, it is a strange observation that ale nurses
perform better. However, this has been reported repeatedly by Sonia Labeau in her studies to
assess knowledge of critical care nurses about evidence based guidelines for infection prevention
(catheter-associated bloodstream infection, ventilator-associated pneumonia, surgical wound
infection).
Mind the correct way of reporting bacterial species: for example, Pseudomonas aeruginosa
(instead of Aeruginosa). Take note that many journals ask to report species names in italic.