Infection Prevention and Control Compliance among Healthcare Workers in a Rural Ugandan District: A Facility-Based Study
Abstract:
Hospital-acquired
infections remain a significant public health challenge, and adherence to
standard precautions and infection prevention and control (IPC) measures is
essential to minimize transmission. However, compliance in rural health
facilities is often inadequate. This study employed an institution-based
cross-sectional design conducted over two months in 2021, involving all
healthcare workers in 30 lower-level health facilities in Butambala District,
Uganda. Inclusion of the entire workforce minimized selection bias and improved
representativeness. Data were collected using structured questionnaires and
focus group discussions. Chi-square tests, Fisher’s exact tests, and
multivariate logistic regression were used to identify factors associated with
IPC compliance. Only 10.6% of healthcare workers fully complied with IPC
measures. Professional cadre was significantly associated with compliance, with
laboratory technicians showing higher adherence (AOR = 2.17, 95% CI
[1.14–5.74], p = 0.037). COVID-19 vaccination status was also a significant
factor; those who had received the second dose were more likely to comply (AOR
= 3.94, 95% CI [1.04–5.74], p = 0.043). Conversely, an inadequate supply of
personal protective equipment (PPE) was strongly linked to non-compliance (AOR
= 0.012, 95% CI [0.03–0.45], p = 0.002). In conclusion, IPC compliance among
healthcare workers in Butambala District was alarmingly low. Professional
cadre, vaccination status, and PPE availability were key influencing factors.
Strengthening IPC requires targeted interventions to improve PPE supply,
enhance training, and promote adherence to national protocols to protect both
healthcare workers and patients.
References:
[1].
Chipfuwa,
T., Manwere, A., & Shayamano, G., 2014, The role of infection prevention
and control (IPC) in clinical governance: A comparison of infection control
strategies in a selected teaching hospital in Zimbabwe. Annals of Medical
and Health Sciences Research, 4(5), 664-670.
[2].
Ndejjo,
R., Musinguzi, G., Yu, X., Buregyeya, E., Musoke, D., Wang, J. S., ... &
Makumbi, F. E., 2015, Occupational health hazards among healthcare workers in
Kampala, Uganda. Journal of Environmental and Public Health, 2015.
[3].
Monegro,
J. I., Muppidi, V., & Regunath, K., 2020, Hospital-Acquired Infections.
Stat Pearls. Stat Pearls Publishing.
[4].
Sydnor,
E., & Perl, T. M., 2011. Hospital epidemiology and infection control in
acute-care settings. Clinical Microbiology Reviews, 24(1), 141-173.
[5].
WHO,
2015. Report on the Burden of Endemic Health Care-Associated Infection
Worldwide: Clean Care is Safer Care.
[6].
Tariku,
G. H., Eshetu, H. E., and Abdella, A. A., 2017, Compliance with Standard
Precautions and Associated Factors among Healthcare Workers in Gondar
University Comprehensive Specialized Hospital, Northwest Ethiopia. Journal
of Environmental and Public Health, 2017;8. https://doi.org/10.1155/2017/2050635
[7].
Kaye, K.
S., 2014, Infection control in healthcare facilities: A confluence of three
emerging challenges. Infection Control & Hospital Epidemiology,
35(4), 367-370
[8].
Nejad, B.
S., Allegranzi, B., Syed, S. B., Ellisc, B., and Pittetd, D., 2011,
Health-care-associated infection in Africa: a systematic review. Bulletin of
the World Health Organization, 89(10), 757–765
[9].
Reda, A. A.,
Fisseha, S., Mengistie, B., and Vandeweerd, J.M., 2010. Standard precautions:
occupational exposure and behaviour of health care workers in Ethiopia. 5(12).
[10].
Valim, M.
D. L. A., 2016, The influence of occupational risks on hand hygiene practices
among healthcare professionals. International Journal of Infection Control,
12(3).
[11].
Ilesanmi,
O., & Afolabi, A., 2020, COVID-19: Knowledge, Attitude, Risk Perception,
and Communication Practices of Healthcare Workers in a Tertiary Health
Institution in Southwestern Nigeria. Journal of Multidisciplinary Healthcare,
13, 1407-1414.
[12].
Wang, D., Hu, B., HU, C., Zhu, F., Liu, X., Zhang,
J., Wang, B., et al., 2020, Clinical
Characterstics of 138 Hospitalized Pateints with 2019 Novel
CoronoVirus-infected Pneumonia. JAMA, 323(11): 1061-1069.
[13].
Ong, M. S.,
et al., 2013, Communication interventions to improve adherence to
infection control precautions: a randomized crossover trial. BMC
Infectious Diseases 72, 1–9.
[14].
Ilesanmi,
O. S., Afolabi, A. A., Akande, A., Raji, T., & Mohammed, A., 2021,
Infection prevention and control during COVID-19 pandemic: realities from
health care workers in a north central state in Nigeria. Epidemiology
and infection, 149, e15. https://doi.org/10.1017/S0950268821000017
[15].
Chughtai,
A. A., Seale, H., Islam, M. S., Owais, M., Macintyre, C. R., 2020, Policies on
the use of respiratory protection for hospital health workers to protect from
coronavirus disease (COVID-19). Int J Nurs Stud 105():103567.
[16].
Li, L.,
Xv, Q., and Yang, J., 2020, COVID-19: the need for continuous medical education
and training. The Lancet Respiratory Medicine 8, e23. https://doi:10.1016/S2213-2600 (20):30125-9
[17].
Fernandes,
A. H., Murphy, M., Creedon, S., Bhuachalla, C., O’Brien, D., Gould, D., 2019,
Patient involvement in the implementation of infection prevention and control
guidelines and associated interventions: a scoping review. BMJ Open,
9(3), Doi: 10.1136/bmjopen-2018-025824
[18].
World
Health Organization, 2016, Guidelines on Core Components of Infection
Prevention and Control Programmes at the National and Acute Health Care
Facility Level. [Online] Available from: https://www.who.int/gpsc/core-components.pdf [Accessed on 13/06/2021]
[19].
World
Health Organization. 2017, Infection prevention and control in health care. WHO
Guidelines.
[20].
Bartman,
I., Boulet, J. R., Qin, S., and Bowmer, M.I., 2020, Canadians studying medicine
abroad and their journey to secure postgraduate training in Canada or the
United States. Canadian Medical Education Journal, 11(3),
p.e13.
[21].
Nofal,
M., Subih, M., & Al-Kalaldeh, M., 2017, Factors influencing compliance to
the infection control precautions among nurses and physicians in Jordan: A
cross-sectional study. Journal of infection prevention, 18(4),
182–188. https://doi.org/10.1177/1757177417693676
[22].
Komuhangi,
G., 2019, Compliance with Standard Precautions of Infection Control in the
Management of Labour by Health Care Workers at Mulago Hospital, Uganda. International
Journal of Medical Science and Health Research. 3(2); 2581-3366
[23].
Opollo,
M. S., Otim, T. C., Kizito, W., Thekkur, P., Kumar, A. M. V., Kitutu, F. E.,
Kisame, R., Zolfo, M., 2021, Infection Prevention and Control at Lira
University Hospital, Uganda: More Needs to Be Done. Trop. Med. Infect.
Dis. 6, 69. https://doi.org/10.3390/tropicalmed6020069
[24].
Wasswa,
P., Nalwadda, C. K., Buregyeya, E., et al., 2015,.Implementation of
infection control in health facilities in Arua district, Uganda: a
cross-sectional study. BMC Infect Dis 15, 268 https://doi.org/10.1186/s12879-015-0999-4
[25].
Chitimwango,
P. C., 2017, Attitudes and Practices of Nurses in Infection Prevention and
Control Within a Tertiary Hospital in Zambia.
[26].
Azene, Z.
N., Merid, M. W., Muluneh, A. G., Geberu, D. M., Kassa, G. M, Yenit, M. K, et
al., 2020, Adherence towards COVID-19 mitigation measures and its associated
factors among Gondar City residents: A community-based cross-sectional study. PLoS
ONE, 15(12): https://doi.org/10.1371/journal.pone.0244265
[27].
Zhou, Q.,
Lai, X., Zhang, X., and Tan, L., 2020, Compliance measurement and observed
influencing factors of hand hygiene based on COVID-19 guidelines in China. American
Journal of Infection Control, https://doi.org/10.1016/j.ajic.2020.06.003
[28].
Cochrane,
2021. Factors that influence whether healthcare workers follow infection
prevention and control guidelines for respiratory infectious diseases. Accessed
on 11th June 2021 at https://www.cochrane.org/news/factors-influence-whether-healthcare-workers-follow-infection-prevention-and-control-guidelines
[29]. Haile, T.
G., Engeda, E. H., & Abdo, A. A., 2017, Compliance with Standard
Precautions and Associated Factors among Healthcare Workers in Gondar
University Comprehensive Specialized Hospital, Northwest Ethiopia. Journal
of Environmental and Public Health, 9(7) https://doi.org/10.1155/2017/2050635
[30]. Ireye,
F., Ejiyere, H., Aigbiremolen, A. O., Famiyesin, O. E., Rowland-Udoh,
E. A., Ogeyemhe, C. O., Okudo, I., and Onimisi, A. B., 2019, Knowledge,
Attitude and Infection Prevention and Control Practices Regarding Lassa Fever
among Healthcare Workers in Edo State, Nigeria. 8(1): 21-27 https://doi:10.5923/j.ijpt.20190801.03
[31]. Eljedi,
A., and Dalo, S., 2014, Compliance with the National Palestinian Infection
Prevention and Control Protocol at Governmental Paediatric Hospitals in Gaza
Governorates. 14 (3)
[32]. Russell,
D., Dowding, D. W., McDonald, M. V., Adams, V., Rosati, R. J., Larson, E. L.,
et al., 2018, Factors for compliance with infection control practices in home
healthcare: findings from a survey of nurses' knowledge and attitudes toward
infection control. Am J Infect Control. 46(11):1211–1217. https://doi:10.1016/j.ajic.2018.05.005
[33].
Desta, M., Ayenew, T., Sitotaw, N., Tegegne, N.,
Dires, M., Getie, M., 2018, Knowledge,
practice and associated factors of infection prevention among healthcare
workers in Debre Markos referral hospital. Northwest Ethiopia BMC
Health Serv Res. 18(1):1–10. https://doi:10.1186/s12913-017-2770-6
[34].
AlJohani, A., Karuppiah, K., Al Mutairi, A., 2021, Narrative review of infection control knowledge and
attitude among healthcare workers. J Epidemiol Glob Health.11(1):20
[35].
Albano, L., Matuozzo, A., Marinelli, P., Di Giuseppe,
G., 2014, Knowledge, attitudes and
behaviour of hospital health-care workers regarding influenza A/H1N1: a cross-sectional
survey. BMC Infect Dis. 14(1):1–7. https://doi:10.1186/1471-2334-14-208
[36].
Romanelli,
F., Bird, E., & Ryan, M., 2009. Learning
styles: a review of theory, application, and best practices. American
journal of pharmaceutical education, 73(1), 9. https://doi.org/10.5688/aj730109
[37].
Schmitz,
A., Maiolino, P., Maggiali, M., Natale, L., Cannata, G., and Metta, G., 2011.
Methods and technologies for the implementation of large-scale robot tactile
sensors. IEEE Transactions on Robotics, 27(3),
pp.389-400.
[38]. Bedoya, G., Dolinger, A., Rogo, K., Mwaura, N., Wafula, F., Coarasa, J., Das, J., et al., 2017, Observations of Infection Prevention and Control Practices in Primary Health Care, Kenya. Bulletin of the World Health Organization, 95, 503-516. https://doi.org/10.2471/BLT.16.179499
