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Effect of Healthcare-Associated Infection Education on Infection Prevention Practices among Hospital Staff in Nigeria

Abstract

Healthcare-associated infections (HAIs) are an important public health and patient-safety concern because infections acquired during healthcare delivery can increase morbidity, mortality, length of hospital stay, healthcare costs, and the burden on already constrained health systems. Hospital staff, including clinical and non-clinical personnel, may contribute to the transmission of infectious agents through inadequate hand hygiene, inappropriate use of personal protective equipment, unsafe injection practices, improper handling of contaminated materials, inadequate environmental cleaning, poor waste management, and other lapses in infection prevention and control. Healthcare-associated infection education provides hospital staff with knowledge and practical skills relating to the sources and modes of transmission of healthcare-associated infections, standard precautions, hand hygiene, personal protective equipment, injection and sharps safety, respiratory hygiene, environmental cleaning, waste management, isolation precautions, and appropriate procedures for preventing and reporting infection risks. Infection prevention practices refer to the behaviours and procedures adopted by hospital staff to prevent the transmission of infectious agents within healthcare facilities, including appropriate hand hygiene, correct use of personal protective equipment, safe injection practices, proper waste disposal, environmental hygiene, respiratory hygiene, appropriate isolation practices, and compliance with established infection prevention and control procedures. In Nigeria, inadequate infection prevention knowledge, limited access to essential supplies, overcrowding, high workloads, insufficient staffing, weak supervision, and inconsistent implementation of infection prevention and control programmes may affect infection prevention practices among hospital staff. Effective healthcare-associated infection education may improve staff knowledge, practical skills, risk perception, and compliance with recommended infection prevention practices. Against this background, this study investigates the effect of healthcare-associated infection education on infection prevention practices among hospital staff in Nigeria. The study is anchored on Social Cognitive Theory, the Health Belief Model, and the Knowledge-Attitude-Practice framework. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, behavioural capabilities, social influences, and environmental conditions in shaping infection prevention behaviour. The Health Belief Model explains preventive health behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding hospital staff's adoption of infection prevention practices. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge and attitudes resulting from healthcare-associated infection education may influence infection prevention practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how healthcare-associated infection education may influence infection prevention practices among hospital staff in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from hospital staff in selected public and private hospitals in Nigeria using a structured self-administered questionnaire, healthcare-associated infection knowledge assessment, and an observational infection prevention practices checklist. A multistage sampling technique will be employed to select states, local government areas, hospitals, departments or units, and eligible hospital staff. Where feasible, selected hospitals or staff groups will be assigned to intervention and comparison groups. Staff in the intervention group will receive structured healthcare-associated infection education covering modes of infection transmission, standard precautions, hand hygiene, appropriate use of personal protective equipment, injection and sharps safety, respiratory hygiene, environmental cleaning, healthcare waste management, isolation precautions, occupational exposure prevention, and infection reporting procedures. Infection prevention practices will be assessed using indicators such as compliance with hand hygiene, appropriate use of personal protective equipment, safe injection and sharps practices, proper waste segregation and disposal, environmental hygiene, respiratory hygiene, appropriate isolation practices, and adherence to established infection prevention and control procedures. Where feasible, direct observational assessment will complement self-reported information to improve measurement accuracy. Descriptive statistics will be used to summarize hospital staff's sociodemographic and professional characteristics, healthcare-associated infection knowledge, exposure to education, and infection prevention practices. 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 healthcare-associated infection education on infection prevention practices. Where appropriate, pre-intervention and post-intervention infection prevention 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 healthcare-associated infection education has a significant positive effect on infection prevention practices among hospital staff in Nigeria. Staff exposed to structured infection education are expected to demonstrate improved knowledge of healthcare-associated infection risks and greater compliance with recommended infection prevention procedures. Education may improve hand hygiene, appropriate use of personal protective equipment, injection and sharps safety, waste segregation and disposal, environmental hygiene, respiratory hygiene, isolation practices, and adherence to standard precautions. It may also improve staff members' ability to recognize infection risks and respond appropriately to potential exposures. However, education alone may not guarantee sustained infection prevention practices because hospital staff may continue to face barriers such as inadequate water supply, shortages of personal protective equipment and other supplies, overcrowding, heavy workloads, staff shortages, inadequate waste-management infrastructure, and weak institutional supervision. Consequently, healthcare-associated infection education is expected to be most effective when supported by adequate infection prevention supplies, functional healthcare infrastructure, routine compliance monitoring, supportive supervision, regular refresher training, and strong institutional infection prevention and control programmes. The study is expected to contribute to the literature on healthcare-associated infections, infection prevention and control, hospital safety, healthcare worker behaviour, health education, occupational health, patient safety, and public health in Nigeria by providing empirical evidence on the effect of healthcare-associated infection education on infection prevention practices among hospital staff. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Nigeria Centre for Disease Control and Prevention, National Primary Health Care Development Agency, state ministries of health, hospital management boards, healthcare facility managers, infection prevention and control committees, professional healthcare associations, occupational health professionals, public health practitioners, development partners, and policymakers regarding strategies for reducing healthcare-associated infections. The study will also provide evidence-based recommendations for strengthening healthcare-associated infection education, ensuring continuous availability of infection prevention supplies, improving hospital infrastructure, strengthening infection prevention and control monitoring, conducting regular refresher training, improving supportive supervision, and promoting a sustained culture of infection prevention and patient safety across hospitals in Nigeria.

Keywords: Healthcare-associated infection education, infection prevention practices, hospital staff, healthcare-associated infections, infection prevention and control, hand hygiene, personal protective equipment, patient safety, occupational health, health education, hospital safety, public health, Nigeria.