Factors Affecting Compliance to Infection Prevention Control among Frontline Health Workers at the Kailahun Government Hospital, Sierra Leone: A cross-sectional study
Keywords:
Knowledge, Attitude, Practice, Infection Prevention Control, healthcare worker, Sierra LeoneAbstract
Introduction
Healthcare workers are at increased risk of exposure to infectious agents. 3 million of the 35 million healthcare workers (HCWs) in the world are exposed percutaneously to blood borne pathogens (BBPs) annually. This study aims to determine factors affecting compliance with infection prevention and control (IPC) standards among frontline health workers (FHWs) at the Kailahun Government Hospital in Sierra Leone.
Methods
A cross-sectional study using a mixed-methods approach was employed. The study targeted FHWs at the Kailahun Government Hospital, which included doctors, nurses, community health officers/assistants, lab personnel, pharmacists, etc. Using the relief application, a sample size of 69 was estimated using parameters such as 83 (total population of the health facility), 95% confidential level, margin error (5), and population proportion of 50%. Participants were selected using a Stratified Random Sampling technique, and the data was analyzed using SPSS software version 26.0.
Results
The results revealed that the majority (78.2%) of the participants were female, and 21.8% were male. 65.5% of the study participants were nurses, followed by 23.6% who were allied health professionals and 3.6% who reported being doctors. The study identified several positive factors influencing IPC compliance, such as adequate training (34.5%), availability of resources (49.1%), clear guidelines and protocols (56.4%), positive reinforcement (83.6%), peer support (65.5%), and management support (61.8%). The study's identification of barriers, such as fear or discomfort with PPE, cultural or personal beliefs, and lack of understanding or misinformation were also identified by the participants. The regression analysis revealed significant relationships between knowledge of IPC protocols and factors like age (p<0.000), gender (p<0.005), Years of experience in healthcare (p<0.005), and department (p<0.013), suggesting that demographic and professional characteristics play a role in IPC adherence. The study's findings on attitudes toward IPC compliance, particularly the importance of PPE and cleaning and disinfection products, are corroborated by research emphasizing the role of these resources in promoting adherence to IPC measures. The study explores barriers to accessing IPC resources, such as inadequate storage or distribution systems and high costs.
Conclusion
The findings underscore the need for targeted interventions to address identified barriers and improve compliance with IPC measures. Future research could build on these findings by examining the long-term effectiveness of such interventions and exploring additional factors that may influence IPC compliance.
References
1. Wicker, S., Stirn, A. V., Rabenau, H. F., Von Gierke, L., Wutzler, S., & Stephan, C. (2014). Needlestick injuries: causes, preventability and psychological impact. Infection, 42, 549-552.
2. Bahat, H., Hasidov-Gafni, A., Youngster, I., Goldman, M., & Levtzion-Korach, O. (2021). The prevalence and underreporting of needlestick injuries among hospital workers: a cross-sectional study. International Journal for Quality in Health Care, 33(1), mzab009.
3. De Guzman, K., Stone, G., Yang, A. R., Schaffer, K. E., Lo, S., Kojok, R., ... & Kayser, G. L. (2023). Drinking water and the implications for gender equity and empowerment: A systematic review of qualitative and quantitative evidence. International Journal of Hygiene and Environmental Health, 247, 114044.
4. Sehulster, L., Chinn, R. Y., Arduino, M. J., Carpenter, J., Donlan, R., Ashford, D., ... & Cleveland, J. (2003). Guidelines for environmental infection control in health-care facilities. Morbidity and mortality weekly report recommendations and reports RR, 52(10).
5. Scott, R. D. (2009). The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention.
6. Maina, M., Tosas-Auguet, O., English, M., Schultsz, C., & McKnight, J. (2020). Infection prevention and control during the COVID-19 pandemic: challenges and opportunities for Kenyan public hospitals. Wellcome open research, 5.
7. Umpleby, H., & Houghton, R. (2021). Infection prevention and surgery in the pandemic era. Surgery (Oxford), 39(11), 722-729.
8. Auta, A., Adewuyi, E. O., Tor-Anyiin, A., Aziz, D., Ogbole, E., Ogbonna, B. O., & Adeloye, D. (2017). Health-care workers’ occupational exposures to body fluids in 21 countries in Africa: systematic review and meta-analysis. Bulletin of the World Health Organization, 95(12), 831.
9. Haque, M., Sartelli, M., McKimm, J., & Bakar, M. A. (2018). Health care-associated infections–an overview. Infection and drug resistance, 2321-2333.
10. Kamara, I. F., Tengbe, S. M., Fofanah, B. D., Bunn, J. E., Njuguna, C. K., Kallon, C., & Kumar, A. M. (2022). Infection prevention and control in three Tertiary healthcare Facilities in Freetown, Sierra Leone during the COVID-19 pandemic: more needs to Be done!. International Journal of Environmental Research and Public Health, 19(9), 5275.
11. Squire, J. S., Conteh, I., Abrahamya, A., Maruta, A., Grigoryan, R., Tweya, H., ... & Vandi, M. A. (2021). Gaps in infection prevention and control in public health facilities of Sierra Leone after the 2014–2015 Ebola outbreak. Tropical medicine and infectious disease, 6(2), 89.
12. Squire, J. S., Dadzie, D., Nyarko, K. M., Danso-Appiah, A., Kaburi, B. B., Noora, C. L., ... & Sackey, S. O. (2022). Risk Factors for COVID-19 infection among Hospital Healthcare Workers, Sierra Leone, 2020. Journal of Interventional Epidemiology and Public Health, 5(4).
13. Hawkins, K., Price, N., & Mussá, F. (2009). Milking the cow: Young women's construction of identity and risk in age-disparate transactional sexual relationships in Maputo, Mozambique. Global Public Health, 4(2), 169-182.
14. Kangbai, D. M., Bandoh, D. A., Manu, A., Kangbai, J. Y., Kenu, E., & Addo-Lartey, A. (2022). Socio-economic determinants of maternal health care utilization in Kailahun District, Sierra Leone, 2020. BMC pregnancy and childbirth, 22(1), 276.
15. Pieterse, P., & Saracini, F. (2023). Unsalaried health workers in Sierra Leone: a scoping review of the literature to establish their impact on healthcare delivery. International Journal for Equity in Health, 22(1), 255.
16. Cham K., (2020). State-of-the-art baby-friendly hospital unit unveiled in Kailahun.
17. World Health Organization. (2021). Infection prevention and control in primary care: a toolkit of resources.
18. Hinson, C., Kilpatrick, C., Rasa, K., Ren, J., Nthumba, P., Sawyer, R., & Ameh, E. (2024). Global surgery is stronger when infection prevention and control is incorporated: a commentary and review of the surgical infection landscape. BMC surgery, 24(1), 397.
19. Leong, M., Picton, R., Wratten, M., Mahe, A., & Zimmerman, P. A. (2024). Baseline evaluation of the World Health Organization (WHO) infection prevention and control (IPC) core components in Pacific Island Countries and Territories (PICTs). Antimicrobial Resistance & Infection Control, 13(1), 108.
20. Moreal, C., Chiappinotto, S., Blackman, I., Grassetti, L., Scarsini, S., Narduzzi, B., ... & Palese, A. (2025). Missed infection prevention and control activities and their predictors: insights from a pre-and post-pandemic study. Journal of Hospital Infection, 155, 95-105.
21. Kigozi, E., Kamoga, L., Ssewante, N., Banadda, P., Atai, F., Kabiri, L., & Mbalinda, S. N. (2024). Infection Prevention and Control: Knowledge, Practices and Associated Factors Among Cleaners at a National Referral Hospital in Uganda. Infection Prevention in Practice, 100376.
22. Pointon-Haas, J., Waqar, L., Upsher, R., Foster, J., Byrom, N., & Oates, J. (2024). A systematic review of peer support interventions for student mental health and well-being in higher education. BJPsych open, 10(1), e12.
23. Cochrane Effective Practice and Organisation of Care Group, Houghton, C., Meskell, P., Delaney, H., Smalle, M., Glenton, C., ... & Biesty, L. M. (1996). Barriers and facilitators to healthcare workers’ adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: a rapid qualitative evidence synthesis. Cochrane database of systematic reviews, 2020(8).
24. Edward, M., John, W., Mahulu, E., Lyabangi, J. F., Nkumba, O., Basaya, D., ... & Daniel, I. (2024). Challenges of Compliance with Infection Prevention and Control (IPC) Standard Procedures among Healthcare Workers: A Hospital-Based Cross-Sectional Study. International Journal of Health Policy Planning, 3(1), 1-7.
25. Aldhamy, H., Maniatopoulos, G., McCune, V. L., Mansi, I., Althaqafy, M., & Pearce, M. S. (2023). Knowledge, attitude and practice of infection prevention and control precautions among laboratory staff: a mixed-methods systematic review. Antimicrobial Resistance & Infection Control, 12(1), 57.
26. Cox, J., Clark, C., & Sanders, T. (Eds.). (2023). Rural healthcare. CRC Press.
27. Muflih, S., Al-Azzam, S., Lafferty, L., Karasneh, R., Soudah, O., & Khader, Y. (2021). Pharmacists self-perceived role competence in prevention and containment of COVID-19: A cross-sectional study. Annals of Medicine and Surgery, 64, 102243.
28. Al-Azzam S, et al. (2012). "Knowledge, attitudes, and practices of healthcare workers in intensive care units regarding infection control." American Journal of Infection Control, 40(5), 439-444.
29. Li, Z., Chen, X., Vong, J. S., Zhao, L., Huang, J., Yan, L. Y., ... & Ko, H. (2021). Systemic GLP-1R agonist treatment reverses mouse glial and neurovascular cell transcriptomic aging signatures in a genome-wide manner. Communications biology, 4(1), 656.
30. Gamble, C., Ekwaru, P. J., Garner, P., & Ter Kuile, F. O. (2007). Insecticide-treated nets for the prevention of malaria in pregnancy: a systematic review of randomised controlled trials. PLoS medicine, 4(3), e107.
