What is the perception of biological risk by undergraduate nursing students?

Abstract Objective: to analyze undergraduate nursing students' perception of biological risk and its relationship with their prior practical training. Method: a descriptive cross-sectional study was conducted among undergraduate nursing students enrolled in clinical practice courses in the academic year 2013-2014 at the School of Nursing at the University of Barcelona. Variables: sociodemographic variables, employment, training, clinical experience and other variables related to the assessment of perceived biological risk were collected. Both a newly developed tool and the Dimensional Assessment of Risk Perception at the worker level scale (Escala de Evaluación Dimensional del Riesgo Percibido por el Trabajador, EDRP-T) were used. Statistical analysis: descriptive and univariate analysis were used to identify differences between the perception of biological risk of the EDRP-T scale items and sociodemographic variables. Results: students without prior practical training had weaker perceptions of biological risk compared to students with prior practical training (p=0.05 and p=0.04, respectively). Weaker perceptions of biological risk were found among students with prior work experience. Conclusion: practical training and work experience influence the perception of biological risk among nursing students.


Introduction
One of the main objectives of university education is to prepare students for the professional world and to enable them to develop the skills that define each discipline. In the field of health sciences, training includes interventions aimed at the acquisition of knowledge, skills and attitudes needed to be a competent health professional. In this environment, there must be skills aimed at promoting and ensuring the safety of the student and the patient.
Healthcare professionals are exposed to numerous risks (1) , and biological risk is one of the most important risks due to its severity and increasing frequency (2)(3) .
Biological risk is an important issue in public health, and although hepatitis B, hepatitis C and Human Immunodeficiency Virus (HIV) infections are the most well known, other emerging diseases (e.g., Ebola) can be acquired by other routes of biological exposure, such as air or physical contact.
In this context, undergraduate nursing students work in an unfamiliar and complex clinical environment that exposes them to numerous risks (4) during their formative years. Their inexperience (1) and stress levels (5)(6)(7)(8)(9)(10) are compounded with changing situations and constant uncertainty in this environment.
Several studies on accidents involving nursing students during the course of their clinical practice have shown that rates of biological risk exposure (e.g., punctures, eye splashes and cuts) remain very high (11)(12)(13)(14)(15) . The EPINETAC project (3) found that a considerable portion of percutaneous accidents is caused by inadequate maneuvers that are banned by standard recommendations, such as the recapping of needles.
This finding shows significant deficiencies in security measures and points to low effectiveness of theoretical and practical training to prevent biological risks among college students.
Additionally, nursing professionals perceive low student knowledge of protocols and preventive measures and student attitudes of poor initiative and insecurity (13)(14)16) . These issues should be considered when planning educational activities for students.
A multicenter study (17) on the use of standard precautions against biological agents showed a high degree of conceptual confusion and a lack of awareness of preventive measures, and this study found risk behaviors related to protections used by participants from different healthcare fields. Another study (18) determined that training for standard hygienic and precautionary measures was not universally performed over all studies, and some discrepancies existed between theoretical and practical training. Another important issue related to prevention is an individual's perception of risk. Some authors state that this perception affects one's attitude towards risk and one's behavior at work (19)(20)(21) . In the study by Cordeiro (22) (23) . The first 2 questions of this section (B1 and B2) explore the knowledge among students and among the professional nurses responsible for these students.

Ethical issues
Authorizations from both the Bioethics Committee of the UB and the direction of the EUE were obtained.
Students were provided with verbal and written information about the study to ensure the anonymity and confidentiality of data.

Results
Of 40 students in Group 1 (those without prior practical training) and 49 students in Group 2 (those

Assessment of biological risk perceived by undergraduate nursing students
The relationship between the perception of biological risk and students' prior practical training was analyzed. Statistically significant differences were found for perception of knowledge of biological risk (B1) and the possibility of harm due to a biological agent (B4); students without prior practical training had weaker perceptions of knowledge of risks and damage due to biological risk than students with prior practical training (p=0.05 and p=0.04, respectively).
Statistically significant differences were also found for items B8 (harm to a large number of people) and B10  Table 3.
training among undergraduate nursing students is shown in Table 2.

Discussion
Obviously, risk reduction should be a common goal among professionals who are in contact with nursing students. Many authors agree that accidents including biological risk exposure remain relatively frequent, and knowledge among nursing students is low (11)(12)(13)(14)(15). This matter becomes more complicated when the concept of "risk" is not universally understood, Finally, stronger perceptions of knowledge of the risk was found among men compared to women, which could also be related to their weaker perception of the severity of the consequences.
A potential limitation of the study is that the study population belongs to one university, and the results may not be extrapolated to the entire community of nursing students. However, we believe that this limitation does not substantially affect the results because the sociodemographic characteristics of students are similar to those of students from other universities.
Another potential limitation is that data on knowledge of biological risk were not recorded, which may also influence risk perception.

Conclusion
These results show that undergraduate nursing students' sociodemographic, employment and training variables are related to the perception of biological risk.
Students with prior practical training have a stronger perception of biological risk than untrained students.
Further studies that relate the perception of biological risk to other important aspects of university education, such as students' knowledge regarding the risk, the use of preventive measures during their practical training and the biological accidents suffered, are needed. In this way, specific interventions could be designed to foster a safety culture at the university, which is an added value to university education that goes beyond academic education.