Project – Assessment of Nurses’ Compliance with Infection Prevention and Control Practices: A Case Study of Selected Public Hospitals in Lagos State.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Infection prevention and control (IPC) is a fundamental component of safe and effective healthcare delivery. It refers to the policies, procedures, and practical measures used to prevent the transmission of infectious agents among patients, healthcare workers, and visitors within healthcare facilities. Healthcare-associated infections (HAIs) are infections that develop during the provision of healthcare and were not present or incubating when care began. These infections can result in prolonged hospital stays, increased treatment costs, disability, and death. The World Health Organization (WHO, 2022) identifies effective infection prevention and control programmes as essential to improving the quality and safety of healthcare services. Similarly, the Centers for Disease Control and Prevention (CDC, 2024) emphasises that adherence to standard precautions, including hand hygiene, appropriate use of personal protective equipment, safe injection practices, and environmental cleaning, reduces the risk of infection transmission. Nurses are central to these efforts because they provide continuous bedside care and frequently perform procedures that bring them into direct contact with patients, body fluids, medical equipment, and contaminated surfaces.

The importance of nurses’ compliance with IPC practices is particularly evident in hospitals, where patients with different illnesses receive care in shared clinical environments. Nurses may be exposed to infectious organisms while administering medication, dressing wounds, inserting or managing intravenous lines, assisting with personal hygiene, handling clinical specimens, and disposing of medical waste. When preventive procedures are not followed correctly, pathogens may spread between patients, healthcare workers, and the surrounding environment. The WHO (2022) recommends a combination of standard precautions and additional transmission-based precautions where necessary to reduce the spread of infectious diseases. Standard precautions apply to all patients, irrespective of their diagnosis or presumed infection status, and include hand hygiene, risk-based use of personal protective equipment, respiratory hygiene, sharps safety, and appropriate handling of equipment and linen. Therefore, nurses’ compliance is not simply a matter of following hospital rules; it is a practical requirement for protecting patients, staff, and the wider healthcare environment.

Hand hygiene is one of the most important elements of infection prevention because hands can transfer microorganisms between patients, healthcare workers, equipment, and environmental surfaces. The WHO (2009) identifies key moments for hand hygiene, including before touching a patient, before clean or aseptic procedures, after exposure to body fluids, after touching a patient, and after touching the patient’s surroundings. However, compliance may be influenced by workload, staffing levels, availability of water and alcohol-based hand rub, accessibility of handwashing facilities, staff knowledge, and workplace culture. The WHO (2022) explains that effective IPC requires more than written policies; facilities also need adequate infrastructure, staff education, monitoring, feedback, and leadership support. For nurses in public hospitals, consistently performing hand hygiene can become challenging when patient numbers are high, emergencies occur, supplies are insufficient, or several clinical duties must be completed within a limited period. Assessing compliance therefore requires examining both nurses’ actual practices and the working conditions that may support or hinder them.

Another important component of IPC is the appropriate use of personal protective equipment (PPE), including gloves, gowns, medical masks, respirators, and eye protection, depending on the anticipated exposure and mode of transmission. PPE serves as a barrier against infectious materials, but it is effective only when the correct equipment is selected, used appropriately, removed safely, and disposed of or reprocessed according to established procedures. Gloves, for example, do not replace hand hygiene, and inappropriate reuse or removal can contribute to contamination. The CDC (2024) recommends standard precautions for patient care and the selection of protective measures according to the risks associated with the task being performed. Nurses must also follow safe injection practices, use sharps containers correctly, handle contaminated instruments carefully, and ensure that clinical waste is segregated and disposed of properly. These practices are especially important in busy hospital wards, emergency units, operating theatres, maternity units, and other departments where exposure to blood and body fluids may occur. Consequently, a meaningful assessment of nurses’ compliance should consider several IPC practices rather than focusing on hand hygiene alone.

The burden of healthcare-associated infections is a major concern in countries with limited healthcare resources, where infection prevention systems may face challenges involving infrastructure, staffing, supplies, training, and surveillance. The WHO (2022) notes that the implementation of effective IPC programmes is essential to reducing avoidable infections and improving patient safety across healthcare settings. The WHO (2023) also highlights the need to strengthen IPC systems, including education, monitoring, and the provision of appropriate resources. In resource-constrained settings, healthcare workers may understand the importance of infection prevention but still experience difficulties complying with all recommended procedures when essential supplies are unavailable or facilities are overcrowded. It is therefore important to distinguish between lack of knowledge, unwillingness to comply, and practical barriers arising from the working environment. Understanding these factors can help hospital managers develop realistic interventions that combine staff training with improved access to equipment, adequate staffing, supportive supervision, and reliable monitoring systems.

In Nigeria, infection prevention and control is particularly important because public hospitals provide services to large and diverse patient populations while managing a range of infectious and non-infectious conditions. The Federal Ministry of Health’s National Guidelines for Infection Prevention and Control in Healthcare Facilities (Federal Ministry of Health, 2017) provides a national framework for strengthening safe practices in healthcare institutions. Nevertheless, the existence of guidelines does not automatically guarantee consistent implementation at the bedside. Nurses’ compliance may vary according to their professional experience, IPC training, knowledge of standard precautions, availability of supplies, workload, and the degree of institutional support. In addition, hospital departments may have different exposure risks and operational demands, which can influence the consistency with which preventive practices are performed. An assessment of compliance in Nigerian public hospitals should therefore consider the recommended procedures alongside the practical conditions under which nurses deliver care. Such an assessment can provide evidence to guide targeted improvements in clinical practice and hospital infection-control programmes.

Lagos State provides an important setting for examining nurses’ compliance with IPC practices because its public hospitals serve substantial and varied healthcare needs across urban and densely populated communities. In these facilities, nurses work in departments where the frequency of patient contact, the complexity of care, and the risk of exposure to infectious materials may differ. Although national and international guidelines establish the practices expected of healthcare workers, the level of compliance in a particular hospital must be established through local assessment rather than assumed. A study of selected public hospitals in Lagos State can examine nurses’ adherence to hand hygiene, PPE use, safe injection and sharps practices, waste segregation, and other relevant standard precautions. It can also identify potential barriers, including inadequate supplies, workload, training needs, and supervision. The findings may assist hospital administrators and infection-control teams in identifying gaps, strengthening staff education, improving the availability of preventive materials, and developing more effective monitoring systems. Against this background, the present study assesses nurses’ compliance with infection prevention and control practices in selected public hospitals in Lagos State, Nigeria.

1.2 Statement of the Problem

Healthcare-associated infections remain a serious patient-safety concern because they can lead to preventable illness, prolonged hospitalisation, increased healthcare expenditure, and avoidable deaths. Although many of these infections can be reduced through appropriate infection prevention and control practices, the effectiveness of such measures depends on their consistent implementation by healthcare workers. The WHO (2022) reported substantial gaps in IPC implementation across healthcare systems and emphasised that effective programmes can reduce the burden of infections acquired during healthcare. Its subsequent global report also reaffirmed that healthcare-associated infections remain a daily threat and that a considerable proportion can be prevented through effective IPC and basic water, sanitation, and hygiene services (WHO, 2024). Nurses have a particularly important role because their routine responsibilities involve frequent patient contact, medication administration, wound care, and the handling of potentially infectious materials. Therefore, inconsistent compliance with recommended precautions may expose both patients and healthcare workers to avoidable risks.

A further problem concerns the difference between knowing the recommended IPC procedures and applying them consistently during clinical practice. Nurses may understand the importance of hand hygiene, PPE, safe injection practices, sharps disposal, and environmental cleanliness, yet adherence may be affected by heavy workloads, emergencies, limited time, inadequate supplies, and the accessibility of handwashing facilities. The WHO (2009) explains that microorganisms can be transferred through healthcare workers’ hands when hand hygiene is omitted or performed inadequately, creating opportunities for transmission between patients and contaminated surfaces. Similarly, the WHO (2022) identifies staff education, appropriate infrastructure, monitoring, and institutional support as important components of effective IPC programmes. Consequently, the presence of infection-control guidelines in a hospital does not necessarily establish that nurses comply with them in routine practice. Direct assessment is required to identify the extent of adherence and the specific practices where improvement may be needed.

In Nigeria, the availability of national IPC guidance provides a framework for improving safety in healthcare facilities, but effective implementation requires consistent action at the facility and point-of-care levels. The Nigeria Centre for Disease Control and Prevention and the Federal Ministry of Health published The Nigerian Manual of Infection Prevention and Control in 2021 to support infection prevention and control in the country’s healthcare system (Federal Ministry of Health & Nigeria Centre for Disease Control, 2021). However, policy guidance must be translated into daily practice through training, supervision, adequate resources, and routine assessment. In public hospitals, the demands of patient care and differences in departmental activities may make compliance difficult to maintain uniformly. Without systematic information on actual nursing practices, hospital managers may find it difficult to determine whether observed infection-control challenges arise mainly from knowledge gaps, resource constraints, workload, or weaknesses in supervision. This creates a need for a structured assessment of nurses’ compliance with the principal IPC practices recommended for healthcare settings.

In selected public hospitals in Lagos State, the level of nurses’ compliance with infection prevention and control practices should be established using evidence from the hospitals under study rather than assumptions about their performance. Without locally collected data, it may be difficult to identify which practices are followed consistently, which are neglected, and what factors nurses themselves report as barriers to compliance. This information is necessary for developing interventions that address the actual needs of the participating hospitals. The present study therefore seeks to assess nurses’ compliance with IPC practices in selected public hospitals in Lagos State, with attention to hand hygiene, the use of personal protective equipment, safe injection and sharps practices, and appropriate waste handling. It will also examine selected factors that may influence compliance. The findings are expected to provide evidence that can inform staff training, supervision, resource allocation, and hospital-level infection prevention strategies.

1.3 Aim and Objectives of the Study

The main aim of this study is to assess nurses’ compliance with infection prevention and control practices in selected public hospitals in Lagos State.

The specific objectives are to:

1. Determine the level of nurses’ compliance with infection prevention and control practices in selected public hospitals in Lagos State.

2. Assess nurses’ compliance with specific IPC practices, including hand hygiene, appropriate use of personal protective equipment, safe injection and sharps handling, and healthcare waste disposal.

3. Identify factors that influence nurses’ compliance with infection prevention and control practices in the selected hospitals.

4. Examine the relationship between selected professional and workplace factors, such as IPC training, years of experience, workload, availability of supplies, and nurses’ compliance with IPC practices.

1.4 Research Questions

The study will be guided by the following research questions:

1. What is the level of nurses’ compliance with infection prevention and control practices in selected public hospitals in Lagos State?

2. To what extent do nurses comply with hand hygiene, appropriate PPE use, safe injection and sharps handling, and healthcare waste disposal?

3. What factors influence nurses’ compliance with infection prevention and control practices in the selected hospitals?

4. What relationship exists between selected professional and workplace factors and nurses’ compliance with infection prevention and control practices?

1.5 Research Hypothesis

The following null hypothesis will be tested at the 0.05 level of significance:

H₀: There is no statistically significant relationship between selected professional and workplace factors and nurses’ compliance with infection prevention and control practices in selected public hospitals in Lagos State.

1.6 Significance of the Study

The findings of this study are expected to be useful to nurses, hospital administrators, infection prevention and control committees, healthcare policymakers, patients, and future researchers.

Nurses: The study may help nurses understand the importance of consistent compliance with infection prevention and control procedures. By identifying areas of strong performance and practices requiring improvement, the findings may encourage nurses to strengthen their adherence to hand hygiene, PPE use, safe injection procedures, and appropriate waste disposal.

Hospital management: The findings may provide hospital administrators with evidence for evaluating existing infection-control policies and identifying gaps in their implementation. Information about barriers such as workload, limited supplies, and inadequate training may help management make informed decisions about resource allocation, staffing, and supportive supervision.

Infection prevention and control committees: The study may assist IPC committees in developing targeted training programmes, improving monitoring procedures, and identifying clinical practices that require closer supervision. The findings may also contribute to the development of practical strategies for strengthening compliance across hospital departments.

Healthcare policymakers: The results may provide useful local evidence for policymakers and public health authorities seeking to strengthen infection prevention and control in public healthcare facilities. The findings may support efforts to translate national IPC guidance into practical activities at the facility level.

Patients and the general public: Improved compliance with IPC practices can help reduce opportunities for infection transmission within healthcare facilities. Patients may benefit from safer care, while healthcare workers may experience reduced occupational exposure to infectious materials.

Researchers and students: The study may serve as a reference for future research on nurses’ compliance, patient safety, healthcare-associated infections, and the implementation of IPC policies in Nigeria. It may also identify questions that future studies can investigate using larger samples or different research designs.

1.7 Scope of the Study

The study focuses on nurses’ compliance with infection prevention and control practices in selected public hospitals in Lagos State, Nigeria. Its geographical scope is limited to the public hospitals selected for the research. The specific hospitals will be identified in the research methodology according to the study’s sampling plan and the necessary institutional permissions.

The content scope covers nurses’ adherence to key IPC practices, including hand hygiene, the appropriate use of personal protective equipment, safe injection and sharps handling, and healthcare waste disposal. The study will also examine selected factors that may influence compliance, such as IPC training, years of professional experience, workload, availability of preventive materials, and workplace supervision.

The study concerns nurses and their infection prevention and control practices. It is not primarily designed to measure the prevalence of healthcare-associated infections among patients or to determine the microbiological causes of infections. Any conclusions will therefore be limited to the nurses, hospitals, practices, and factors included in the study.

1.8 Limitations of the Study

The study may encounter certain limitations. First, the use of selected public hospitals means that the findings may not represent every public hospital in Lagos State or healthcare facilities in other states. Second, if questionnaires are used, some respondents may provide answers they consider professionally acceptable rather than reporting their usual practices. This may lead to social desirability bias.

Third, direct observation of nursing practices may be affected by the presence of the researcher, as nurses may temporarily improve their behaviour when they know they are being observed. Fourth, differences in hospital departments, patient numbers, and availability of IPC materials may affect comparisons between participants. Finally, limited time and financial resources may restrict the number of hospitals or nurses that can be included.

These limitations can be reduced by using clear data-collection instruments, protecting participants’ confidentiality, applying consistent assessment procedures, and combining appropriate data-collection methods where feasible. The limitations will be considered when interpreting and presenting the results.

1.9 Operational Definition of Terms

Assessment: The systematic process of collecting and analysing information to determine the level of nurses’ compliance with infection prevention and control practices in the selected hospitals.

Compliance: The extent to which nurses follow established infection prevention and control guidelines and procedures while providing patient care. In this study, compliance will be determined using the indicators and scoring criteria specified in the research instrument.

Nurses: Registered or otherwise appropriately recognised nursing personnel working in the selected public hospitals and meeting the study’s eligibility criteria.

Infection prevention and control (IPC): The policies, procedures, and practical measures used to prevent or reduce the transmission of infectious agents within healthcare settings.

Healthcare-associated infection (HAI): An infection acquired in the course of receiving healthcare that was not present or incubating at the time care began, subject to the applicable clinical definition.

Hand hygiene: Cleaning the hands through handwashing with soap and water or using an appropriate alcohol-based hand rub at recommended times during patient care.

Personal protective equipment (PPE): Protective items such as gloves, gowns, masks, respirators, and eye protection used according to the exposure risk associated with a clinical task.

Safe injection and sharps handling: Procedures designed to prevent injury and infection during injections and the use, handling, and disposal of needles and other sharp medical instruments.

Healthcare waste disposal: The segregation, handling, storage, and disposal of waste generated during healthcare activities according to applicable infection-control procedures.

Public hospitals: Government-owned healthcare facilities included in the study in Lagos State.

Selected public hospitals: The specific government-owned hospitals chosen for participation in the research according to the sampling procedure described in the methodology.

Project – Assessment of Nurses’ Compliance with Infection Prevention and Control Practices: A Case Study of Selected Public Hospitals in Lagos State.