Healthcare-associated infections (HAIs) represent a major challenge in global public health, as their high incidence not only jeopardizes care quality and patient safety but also exacerbates the economic burden on healthcare systems. Infection prevention and control (IPC), which underpins patient safety, requires healthcare institutions to adhere to stringent accreditation standards to safeguard patients (Care, 2019, Huang et al., 2023). Standard precautions (SPs), the core practices of IPC, interrupt pathogen transmission chains by standardizing hand hygiene, personal protective equipment use and medical waste management (Lam, 2014). Although abundant evidence links healthcare workers’ adherence to SPs with reductions in HAI rates, diminished spread of multidrug-resistant organisms and lower occupational exposure risks (Al-Hussami et al., 2011, Ojanperä et al., 2020, Büchler et al., 2021), compliance remains markedly suboptimal worldwide, particularly among nursing students. Studies report that Chinese nursing interns’ mastery of key IPC practices ranges from 49.6 % to 89.3 % and 93.6 % of interns experienced sharps injuries during clinical placements, underscoring a weak connection between theory and practice (Reda et al., 2010, Efstathiou et al., 2011, Kennedy and Burnett, 2011).

It is noteworthy that current assessment methods in Chinese nursing education have several limitations, mainly due to the inadequate cross-cultural adaptation of evaluation tools and the lack of instruments that can capture the determinants (actionable drivers and barriers) of SPs adherence among nursing students within local training and clinical teaching structures. Most existing instruments, developed in Western healthcare contexts, have been validated primarily among registered nurses, limiting their applicability to nursing students. For instance, internationally used SPs compliance scales often focus on individual behavioral determinants while overlooking influences inherent to Chinese nursing education, such as collectivist cultural norms, teacher-student interaction patterns and clinical preceptor practices, that affect behavior change and shape modifiable adherence drivers (Lam et al., 2010, Mitchell et al., 2014, Wang et al., 2015, Bouchoucha et al., 2021, Li et al., 2022). More importantly, many available tools mainly provide an overall “compliance level,” but they do not clearly show which aspects of the teaching and clinical environment are driving poor adherence in Chinese nursing students, such as weak justification, insufficient leadership modelling, or an unsupportive practice culture. Consequently, evaluation results lack interpretive depth, offer limited guidance for designing targeted interventions and have had minimal impact on enhancing compliance (Bouchoucha et al., 2021, Wang et al., 2015). Moreover, factors specific to Chinese nursing students, namely the disconnect between theory and practice, uneven distribution of educational resources and low prioritization of occupational protection, may further compromise the cross-cultural suitability and practical utility of SPs assessment tools. Therefore, there is a pressing need for instruments specifically designed for the nursing student population, with scale adjustments to accommodate their unique context and quantify modifiable barriers and facilitators of SPs adherence in a way that can directly inform educational strategies (Bouchoucha and Moore, 2019).

To address these issues, the present study translated and cross-culturally adapted the FIASP-SV for Chinese nursing students and conducted a psychometric evaluation. FIASP-SV was selected because it does not treat SPs adherence as an individual habit alone and instead, it views adherence as the result of multiple influences, including how students understand the need for SPs (justification), what they observe from teachers and clinical preceptors (leadership), whether the clinical environment provides reminders and practical conditions to support SPs (contextual cues) and whether the ward climate consistently values occupational protection and safe practice (practice culture). This framework is particularly necessary in Chinese nursing education because learning is often strongly shaped by teacher guidance, team norms and clinical preceptorship and students may adjust their behavior to fit the expectations and routines of the ward. In this regard, we first introduced culturally sensitive items and contextualized statements optimized to ensure linguistic and cultural appropriateness. Second, localized clinical practice scenarios were integrated to construct an evaluation framework that both reflects international standards and aligns with the Chinese nursing education ecosystem. Compared with the original instrument, this study achieved two key advances: enhancement of practical relevance through localized scenarios and assurance of reliability and validity via psychometric evaluation. Accordingly, this study addressed three main questions: whether the Chinese FIASP-SV demonstrates satisfactory reliability, whether it shows acceptable validity (content and structural validity) and whether the original four-factor structure (justification, leadership, contextual cues and practice culture) is preserved in Chinese nursing students.