Aim
This study sought to close the data gap in the Fako Division by assessing the compliance of HCWs with infection prevention and control measures (standard precautions) and identifying the factors associated with HCWs’ compliance level with these measures.
Study design and setting
A hospital-based cross-sectional study was conducted over 5 months (1st January to 31st May 2024) among HCWs from four health facilities (two public and two private) in Fako Division. The four hospitals include Hospital #1 and Hospital #2 which are government-funded and are the region’s two main referral and teaching hospitals, whereas Hospital #3 and Hospital #4 are private district-level facilities. They were conveniently selected based on the nature of funding, high capacity, and patient turnout.
Hospital #1 is a secondary health facility and a main referral hospital in the Southwest Region. The hospital is made up of four major departments, which include: Pediatrics, Internal Medicine, Surgery, Obstetrics, and Gynecology (OBGYN). The hospital also has specialized centres such as the Dialysis Centre, Intensive Care Unit (ICU), Ophthalmology Unit, Dentistry, Medical Imaging, Neonatology, and kangaroo Mother Care (KMC). The healthcare workers are made up of doctors (30, nurses and midwives (180), laboratory technicians (lab. technician)(30), and pharmacy attendants(06). The hospital has a sanitation department but no statutory meetings.
Hospital #2 serves as a secondary health facility and a main referral hospital located in the central town of Limbe. The hospital has a Pediatric department, OBGYN department, Internal Medicine department, Surgical department, Dentistry, Ophthalmology, Physiotherapy, and Intensive Care Units. It has an Imaging Centre, two Theatres, and an equipped Laboratory. The healthcare workers are made up of doctors (39), nurses and midwives (181), lab. technicians (36), and pharmacy attendants (06). The hospital has an IPC committee with neither a specified meeting period nor regular follow-up.
Hospital #3 is situated in Buea at the foot of Mount Cameroon. The total catchment area is about 50,000. It has Internal Medicine, Pediatric, Maternity, Laboratory, and Outpatient units. The HCWs are made up of doctors (05), nurses (26), midwives (13), lab. technicians (09), and pharmacy attendants (02). Hospital 3 has an IPC committee with regular monthly meetings with staff.
Hospital #4 is located in the Buea, it is a private clinic. The clinic is made up of Medical, Surgical, Maternity, Pediatric, and Laboratory units. The HCWs are made up of doctors (9), nurses (27), midwives (09), lab. technician (08), pharmacy (05). In the clinic, the IPC committee is an ad hoc committee where they convene when needed.
Study population
All healthcare workers working within the four aforementioned health facilities for at least six months and who gave informed consent were included in the study. These HCWs included medical doctors, nurses, midwives, and laboratory scientists. A total number of 276 participants were included in the study using Yamane’s formula as shown below
$$\:\varvec{n}=\frac{\varvec{N}}{\varvec{1}+\varvec{Ne}^{\varvec{\wedge}}2}$$
n = Minimum sample size
N = Total number of functional HCWs in all four hospitals = 607
e = precision at 0.05 at a 95% confidence interval.
Minimum calculated sample = 242 HCWs. We considered 267 as our minimum sample size to account for a 10% non-response rate.
The participants were recruited using sampling proportionate to size from each of the four facilities as shown: \(\:\frac{\varvec{n}\times\:\varvec{N}\varvec{f}}{\varvec{N}}\)
n: minimum sample size of the study population
Nf: total number of healthcare workers in the health facility
N: the total number of healthcare workers in all the hospitals
Hospital #1 minimum sample population: \(\:\frac{267\times\:240}{607}=105.56\sim106\)
Hospital #2 minimum sample population: \(\:\frac{267\times\:256}{607}=\;112.60\;\sim\;113\)
Hospital #3 minimum sample population: \(\:\frac{267\times\:53}{607}=23.31\sim24\)
Hospital #4 minimum sample population: \(\:\frac{267\times\:58}{607}\;=25.51\sim26\)
Data collection
The data collection tool comprised a structured questionnaire and an observation sheet. The structured questionnaire was adapted from existing literature and similar studies. It contained information on sociodemographic characteristics, knowledge of IPC (made up of a set of 10 structured questions that delved into IPC-related topics), and IPC-related characteristics [11,12,13]. The observation sheet was adapted from the WHO hand hygiene observation form [14] (see Additional file 1). The data collection form was pre-tested in a different facility and modified accordingly.
The HCWs were met on duty, with informed written consent obtained 24 h before administering the data collection form to reduce the Hawthorn effect. Each participant was observed only once for at least 20 min when caring for a patient or carrying out a diagnostic procedure. Three opportunities for IPC compliance measures to be implemented were recorded per participant. The observer noted opportunities for the need for precautionary measures, the indication, and whether action was taken or not, with emphasis on the WHO five-period for hand hygiene. This was done only in the observer’s field of view (patient care area to be observed and includes visible areas where HCW can clean the hands e.g. sinks and standby alcohol dispensers which varied based on the structure of the facility) defined before the start of the observation. If the HCW left the field of view without taking any action, it was considered that the HCW never did. This observation was done per HCW per department, covering workers on day and night shifts.
After this observation, a structured questionnaire with two parts: Part 1, with a score from 0 to 10, was immediately self-administered to collect socio-demographic and IPC-related characteristics and to assess their knowledge of infection prevention and control practices (10-item question) [15] (see Additional file 2).
Data analysis
Data was verified, entered into the data collection form designed on Kobo Collect, and exported to Excel 2016 for cleaning. All participants’ information was coded to ensure confidentiality.
Data cleaned in Excel was exported into StataMP 18.0 for analysis. The data was explored to identify hidden patterns and important variables. Categorical variables were presented as frequencies and percentages, quantitative variables as means with standard deviation (SD), or median with interquartile range after checking for normality of distribution. A cut-off for good compliance was set at an overall score of ≥ 80% according to the compliance standard precautions scale (CSPS) (Lam SC: Compliance with standard precautions scale: fact sheet, unpublished). A good knowledge level was defined as a knowledge score ≥ 7/10 since the mean score was 7.0. The overall compliance proportion was calculated as the total HCWs with ≥ 80% compliance level. This was also calculated and reported by cadre, facility, and department. The Chi-square test was used to compare proportions. Multivariable logistic regression analysis with backward elimination was used to identify factors independently associated with good compliance. Multicollinearity was checked with the mean-variance inflation factor (VIF) = 1.19 and the model fitness with Pearson’s goodness of fit (p = 0.30). The likelihood ratio p-values were reported with their adjusted odd ratios and 95% confidence intervals. The level of significance was set at p-value < 0.05.
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