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Effect of Neonatal Infection Prevention Education on Infection Prevention Practices among Healthcare Workers in Nigerian Hospitals

Abstract

Neonatal infections remain an important public health concern and a significant threat to newborn survival, particularly among preterm, low-birth-weight, and critically ill newborns who may be more vulnerable to infection. Healthcare workers in neonatal units and maternity settings play a critical role in preventing the transmission of infectious organisms because their practices directly influence the safety of newborns, especially during routine newborn care, invasive procedures, feeding, medication administration, and contact with equipment and caregivers. Neonatal infection prevention education provides healthcare workers with knowledge and practical skills relating to hand hygiene, aseptic techniques, standard precautions, safe cord care, appropriate use of personal protective equipment, environmental cleaning, equipment disinfection, safe handling of breast milk and feeding equipment, prevention of device-associated infections, appropriate waste disposal, and early recognition and reporting of suspected neonatal infections. Neonatal infection prevention practices refer to actions undertaken by healthcare workers to reduce the risk of infection among newborns, including appropriate hand hygiene, aseptic procedures, safe handling of newborns and equipment, environmental cleaning, appropriate use of personal protective equipment, safe cord and skin care, appropriate waste management, and adherence to neonatal infection prevention and control protocols. In Nigeria, inadequate infection prevention training, high workloads, staff shortages, overcrowded neonatal units, limited availability of hand hygiene facilities and personal protective equipment, inadequate environmental cleaning resources, and inconsistent compliance monitoring may affect neonatal infection prevention practices. Effective neonatal infection prevention education may improve healthcare workers' knowledge, practical skills, confidence, and adherence to recommended infection prevention measures. Against this background, this study investigates the effect of neonatal infection prevention education on infection prevention practices among healthcare workers in Nigerian hospitals. The study is anchored on Social Cognitive Theory, the Knowledge-Attitude-Practice framework, and the Theory of Planned Behaviour. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, behavioural capabilities, social influences, and environmental conditions in shaping healthcare workers' infection prevention behaviour. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge and attitudes resulting from neonatal infection prevention education may influence healthcare workers' practices. The Theory of Planned Behaviour explains how attitudes, subjective norms, perceived behavioural control, and behavioural intentions may influence healthcare workers' adherence to recommended infection prevention procedures. Collectively, these theoretical perspectives provide a suitable framework for explaining how neonatal infection prevention education may influence infection prevention practices among healthcare workers in Nigerian hospitals. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from healthcare workers providing neonatal and maternity care in selected public and private hospitals in Nigeria using a structured self-administered questionnaire, neonatal infection prevention knowledge assessment, and an observational infection prevention practices checklist. A multistage sampling technique will be employed to select states, local government areas, hospitals, neonatal units or maternity departments, and eligible healthcare workers. Where feasible, selected hospitals or healthcare worker groups will be assigned to intervention and comparison groups. Healthcare workers in the intervention group will receive structured neonatal infection prevention education covering neonatal infection risks, hand hygiene, aseptic techniques, standard precautions, appropriate use of personal protective equipment, safe cord and skin care, environmental cleaning, equipment disinfection, safe handling of breast milk and feeding equipment, prevention of device-associated infections, safe healthcare waste disposal, and early recognition and reporting of suspected neonatal infections. Infection prevention practices will be assessed using indicators such as hand hygiene compliance, appropriate aseptic technique, correct use of personal protective equipment, environmental and equipment cleaning, safe cord and skin care, safe handling of feeding equipment, appropriate waste disposal, and adherence to neonatal infection prevention and control protocols. Direct observation will be prioritized where feasible to reduce reliance on self-reported behaviour. Descriptive statistics will be used to summarize healthcare workers' sociodemographic and professional characteristics, neonatal infection prevention knowledge, exposure to education, and infection prevention practice scores. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the effect of neonatal infection prevention education on infection prevention practices. Where appropriate, pre-intervention and post-intervention practice scores will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that neonatal infection prevention education has a significant positive effect on infection prevention practices among healthcare workers in Nigerian hospitals. Healthcare workers exposed to structured neonatal infection prevention education are expected to demonstrate improved knowledge and greater adherence to recommended infection prevention procedures. Education may improve hand hygiene, aseptic techniques, use of personal protective equipment, environmental cleaning, equipment disinfection, safe cord and skin care, feeding equipment hygiene, healthcare waste disposal, and early identification and reporting of suspected neonatal infections. It may also strengthen healthcare workers' awareness of the vulnerability of newborns to infection and the importance of maintaining consistent infection prevention practices during all aspects of neonatal care. However, education alone may not guarantee sustained compliance because healthcare workers may continue to face barriers such as overcrowded neonatal units, inadequate staffing, insufficient hand hygiene facilities, shortages of personal protective equipment and disinfectants, inadequate equipment, heavy workloads, and weak institutional monitoring. Consequently, neonatal infection prevention education is expected to be most effective when supported by adequate staffing, functional infection prevention infrastructure, reliable supplies, regular supervision, compliance monitoring, refresher training, and strong hospital infection prevention and control programmes. The study is expected to contribute to the literature on neonatal infection prevention, infection prevention and control, neonatal health, healthcare-associated infections, healthcare worker education, newborn survival, maternal and child health, patient safety, and public health in Nigeria by providing empirical evidence on the effect of neonatal infection prevention education on infection prevention practices among healthcare workers. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, Nigeria Centre for Disease Control and Prevention, state ministries of health, hospital management authorities, neonatal units, infection prevention and control committees, nursing and midwifery professional bodies, paediatric and neonatal health programmes, public health practitioners, development partners, and policymakers regarding strategies for reducing neonatal infections in healthcare facilities. The study will also provide evidence-based recommendations for strengthening neonatal infection prevention education, improving hand hygiene and infection prevention infrastructure, ensuring continuous availability of essential supplies, strengthening compliance monitoring and supportive supervision, conducting regular refresher training, and promoting effective infection prevention practices among healthcare workers caring for newborns in Nigerian hospitals.

Keywords: Neonatal infection prevention education, infection prevention practices, healthcare workers, Nigerian hospitals, neonatal infections, infection prevention and control, newborn health, neonatal care, hand hygiene, aseptic technique, maternal and child health, healthcare worker education, patient safety, public health, Nigeria.