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Influence of Hospital Cleanliness on Patient Satisfaction in Nigerian Public Hospitals

Abstract

Hospital cleanliness is an important component of healthcare quality because the physical condition of healthcare facilities can influence patients' perceptions of safety, comfort, dignity, hygiene, and overall quality of care. Hospital cleanliness refers to the level of cleanliness and hygiene maintained within healthcare facilities, including wards, consultation rooms, waiting areas, toilets, corridors, treatment rooms, and other patient-accessible areas. Patient satisfaction refers to the extent to which patients' expectations and perceptions regarding healthcare services and their overall hospital experience are met. In Nigerian public hospitals, challenges such as inadequate cleaning personnel, insufficient cleaning materials, overcrowding, poor waste management, inadequate sanitation facilities, and inconsistent cleaning practices may negatively affect the hospital environment and patients' perceptions of service quality. Poor cleanliness may also contribute to concerns about healthcare-associated infections and patient safety, while a clean and well-maintained hospital environment may promote comfort, confidence, trust, and a positive perception of healthcare services. Against this background, this study investigates the influence of hospital cleanliness on patient satisfaction in Nigerian public hospitals. The study is anchored on Donabedian's Structure-Process-Outcome Model, the Servicescape Theory, and Expectancy-Disconfirmation Theory. Donabedian's Model identifies hospital infrastructure, sanitation facilities, and environmental maintenance as important structural components that can influence healthcare processes and outcomes. Servicescape Theory explains how the physical service environment influences users' perceptions, emotions, behaviour, and evaluation of service quality. Expectancy-Disconfirmation Theory explains patient satisfaction as the result of comparing patients' expectations concerning hospital services and environmental conditions with their actual experiences. Collectively, these theoretical perspectives provide a suitable framework for explaining how hospital cleanliness may influence patient satisfaction in Nigerian public hospitals. The study will adopt a quantitative cross-sectional research design. Primary data will be collected from selected Nigerian public hospitals using structured patient questionnaires, healthcare worker questionnaires, hospital cleanliness assessment checklists, environmental inspection records, and relevant facility-management documents. A multistage sampling technique will be employed to select states, public hospitals, departments or service units, healthcare workers, patients, and relevant hospital facilities. Hospital cleanliness will be assessed using indicators such as cleanliness of wards, consultation rooms, waiting areas, toilets, corridors, treatment rooms, floors, walls, windows, beds and other patient-contact surfaces, availability of cleaning materials, frequency of cleaning, waste disposal practices, odour control, sanitation facilities, and general environmental hygiene. Where feasible, direct observation and standardized environmental assessment checklists will be used to provide objective measures of cleanliness rather than relying solely on patient perceptions. Patient satisfaction will be assessed using indicators such as satisfaction with environmental cleanliness, hygiene, comfort, perceived safety, service quality, staff responsiveness, willingness to return, willingness to recommend the hospital, and overall satisfaction. Additional information will be collected on patients' age, sex, educational level, type of service received, duration of hospital stay, frequency of hospital visits, and department attended. Descriptive statistics will be used to summarize hospital cleanliness conditions, patient characteristics, and satisfaction levels. Inferential statistical techniques, including chi-square tests, correlation analysis, and multiple regression analysis, will be used to determine the influence of hospital cleanliness on patient satisfaction. Diagnostic tests will also be conducted to assess the reliability of research instruments, model assumptions, goodness of fit, multicollinearity, and robustness of the findings. The study is expected to find that higher levels of hospital cleanliness have a significant positive influence on patient satisfaction in Nigerian public hospitals. Patients attending hospitals with clean wards, consultation areas, toilets, waiting spaces, corridors, and treatment rooms are expected to report higher satisfaction than patients attending facilities with poor environmental hygiene. Regular cleaning, effective waste disposal, adequate sanitation facilities, and good odour control are expected to improve patients' perceptions of safety, comfort, dignity, and healthcare quality. A clean hospital environment may also strengthen patient confidence in infection prevention and demonstrate the hospital's commitment to quality care. Conversely, dirty floors and surfaces, overflowing waste bins, unpleasant odours, poorly maintained toilets, and visibly inadequate cleaning may contribute to dissatisfaction and negative perceptions of healthcare services. However, hospital cleanliness alone may not fully determine patient satisfaction because patients' experiences are also influenced by waiting time, healthcare provider communication, availability of medicines and equipment, healthcare costs, clinical outcomes, and facility accessibility. Therefore, environmental cleanliness should form part of a broader patient-centred healthcare quality strategy. The study is expected to contribute to the literature on hospital cleanliness, patient satisfaction, healthcare quality, hospital hygiene, environmental health, patient experience, infection prevention, hospital administration, and public health in Nigeria by providing empirical evidence on the relationship between the physical cleanliness of hospitals and patients' perceptions of healthcare services. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, state ministries of health, hospital management boards, public hospital administrators, environmental health officers, infection prevention and control teams, healthcare quality-improvement units, healthcare professionals, development partners, and policymakers regarding strategies for improving hospital environmental hygiene. The study will also provide evidence-based recommendations for strengthening hospital cleaning systems, improving the availability of cleaning materials, increasing cleaning frequency, strengthening waste-management practices, improving sanitation facilities, monitoring environmental hygiene standards, training cleaning personnel, and establishing routine cleanliness audits to improve patient experience and healthcare quality in Nigerian public hospitals.

Keywords: Hospital cleanliness, patient satisfaction, Nigerian public hospitals, hospital hygiene, healthcare quality, patient experience, environmental health, sanitation, infection prevention, hospital management, environmental cleanliness, public health.