The authors have declared that no competing interests exist.
Most hospitals have infection prevention and control committees but some of them are struggling to maintain and to apply infection prevention and control protocols due to lack of enough resources. Healthcare workers’ (HCWs) knowledge, attitude and practices (KAP) of infection prevention and control procedures are crucial for effective infection prevention and control (IPC). The study aimed to assess HCW’s KAP towards IPC in Rwanda. A cross-sectional hospital based study was directed in three hospitals in Karongi district from February to March 2022. Data were collected from 215 healthcare workers using a pre-tested self-administered questionnaire using a stratified sampling technique. Data were collected, checked, coded, and entered into the Kobo Collect Toolbox before being transferred to SPSS version 21 for analysis. Bivariate and multiple logistic regression analyses were performed. The KAP Score was also calculated. P-values of less than 0.05 were considered statistically significant. We found that 50.7% of HCWs were males, 63.3% were between the ages of 18 and 58.2% had a secondary education. The overall 78.6% of HCWs demonstrated high level of knowledge, 79.5% with a positive attitude, and 63.3% with good IPC practice. The results revealed that being over 45 years old(AOR=3.1;95%,CI=(2.16-5.25; p=0.024) having university level(AOR=3.3); 95%CI=(1.56-7.56;p=0.035), working experience between 5-10years(AOR=1.7; 95%CI=(1.37-5.45); (p=0.003), having high level of knowledge (AOR=2.7;95%CI: (1.68–7.95; p=0.045)and positive attitude(AOR=2.3; 95%CI:(1.36-7.72); p=0.017) towards IPC were associated with IPC good practice. Improving institutional supplies such as hand hygiene supplies, PPE, water supply and other facilities can improve safe infection prevention and control.
The nosocomial infections and the related ones are known as infections emerging successively in the practice of care in a healthcare facility that was not existing/incubating at the time the client was admitted, complained after discharge or developed to facility personnels
Annually due to occupational exposure, infection cases emerge continuous on the following scale to medical providers. More importantly, the fore mentioned infections can be prevented and controlled through effective IPC measures and significantly minimize the risks among health professionals
The report from health international bodies present that nearly 100,000 of two million patients die every year suffer from hospital-acquired infections. IPC non compliance the staff who mal-practice infection prevention measures had Hepatitis B,C and HIV infections. Thus, healthcare professionals are major front liners for protecting clients and themselves from infection
Annually worldwide more than three million exposures are reported by World Health Organization, in Africa data indicate that needle stick injuries occur on average of range of two and four annually in South Africa Nigeria and Tanzania, while on medical staff the average injuries are 2.1
High-income countries follow IPC Standard Precautions to protect healthcare Workers from occupational exposure to blood and the risk of infection with blood borne pathogens. In low-income countries, where standard accommodation is sometimes used, the situation is different
Epidemiologically, the burden of health the nosocomial infection is also significant high among low income earner’s countries
Concession/compliance by medical personnel who make attention in service been proved as core role players to prevent and set mitigations in fighting nosocomial infections. The mentioned remedial outputs guarantee the safety of health facility workers and clients, the most among precautions highlighted are proper hand hygiene hand hygiene and use of PPES
Even if the previous practices and interventions to curb down these infections at health facilities, still high prevalence remain persisting in our health facilities to our clients even the health personnel
The health system of Rwanda achieved tangible efforts with positive progress in the area of disease burden reduction, country wide. That makes the strong need for personnel trainings on the subject matter at all health facilities levels
This study was a descriptive cross-sectional study design. This research was a quantitative study in nature. This study aims to assess the HCWs’KAP towards IPC among in Rwanda. The sample size for this study equals to 215 healthcare workers. A stratified sampling or cluster sampling was considered to identify the sample unit. Strata were constituted of hospitals targeted by this study. A self-completed questionnaire was used for data collection. Data entry and statistical analysis were performed using SPSS version 21. This study was conducted at Kibuye, Mugonero and KirindaHospitals located in Karongi district, Rwanda.
Karongi is a district in Western Province of Rwanda and it is divided into 13 sectors: Bwishyura,Gishyita, Gashari, Gitesi,Mubuga, Murambi, Murundi, Mutuntu,Rubengera, Rugabano, Ruganda, Rwankuba and Twumba. The 4th Rwanda Population and Housing Census (PHC4) counted 331,808 people in Karongi District, accounting for 13.4 percent of the Western Province's total population
According to hospital administration, Kibuye Hospital accounts for 187HCWs, Kirinda Hospital has 132HCWs and Mugonero Hospital accounts for 147HCWs. This study was targeting a population of 466 healthcare workers working in those three hospitals (Karongi Integrated Personnel and Payroll System, 2021).
Yamane's formula was used to estimate the sample size. When the researcher has a finite population and the population size is known, this formula is used
the following formula was used: n = N/(1+N(e)]2
Where:
n =corrected sample size,
N =population size, and,
e =margin oferror equals to 5% or 0.05 at 95% confidence interval.
Hereafter, n = 466/[1+466(0.05)2] = 215.2 ∼ 215
With a 95 percent confidence interval of 5 percent marginal error, the sample size for this research is 215 HCWs to be examined. The 215 HCWs were distributed proportionally within Kibuye, Kirinda and Mugonero Hospitals.
Every healthcare worker who was working in the selected department (Doctors, Health officers, Midwives, Nurses, X-ray Technician, and Pharmacy laboratory staff) and who have worked at least 3 months in these hospitals was involved. Healthcare workers absent during data collection for annual leave or other reasons were excluded.
For data collection, a self-administered questionnaire (SAQ) was distributed at the HCWs work unit. The tool was created using a modified CDC Infection Prevention and Control tool for acute care hospitals
SPSS v.21 was used for data entry and statistical analysis. Socio-demographic characteristics were calculated using descriptive statistics such as frequencies and percentages and continuous variables expressed as means and standard deviations. The cut-off values were scores less than 60%, which were seen as low knowledge, negative attitudes, or bad practices, while those higher than 60% were seen as high knowledge, positive attitudes, and good practices. The KAP score was calculated by adding the total scores for each respondent. To assess the relationship between dependent and independent variables, bivariate and multivariate logistic regressions were used. Variables with a p-value less than0.05 (p<0.05) in the bivariate analysis were then entered into a multivariable logistic regression to control for the effect of confounders. The statistical significance was confirmed at the p < 0.05 with 95% of Confidence interval (CI).
The researcher considered ethical issues concerning research ethics. Mount Kenya University's Institute of Postgraduate Studies and Research has provided ethical clearance and an introduction letter. These documents were presented to the Karongi district administration in order to obtain permission to conduct the research. Prior to completing the pre-tested self-administered questionnaire, the sampled respondents signed an informed consent form. By coding questionnaires, storing data in a password-protected database, and only using data for academic purposes, confidentiality was always maintained.
According to
Variables | Frequency (n) | Percent (%) | |
Hospital | Kibuye Hospital | 86 | 40.0 |
Kirinda Hospital | 61 | 28.4 | |
Mugonero Hospital | 68 | 31.6 | |
Gender | Male | 109 | 50.7 |
Female | 106 | 49.3 | |
Age category | 18-35 years | 136 | 63.3 |
36-45 years | 44 | 20.5 | |
More than 45 years | 35 | 16.2 | |
Marital status | Single | 73 | 34.0 |
Married | 142 | 66.0 | |
Level of education | Primarylevel | 8 | 3.7 |
Secondary level | 125 | 58.2 | |
University | 82 | 38.1 | |
Occupational status | Physicians | 18 | 8.4 |
Nurses | 108 | 50.2 | |
Midwifes | 27 | 12.6 | |
Lab technicians | 23 | 10.7 | |
Administrative officers | 11 | 5.1 | |
Cleaners | 28 | 13.0 | |
Work experience | <5 years | 113 | 52.6 |
5-10 years | 58 | 27.0 | |
>10 years | 44 | 20.4 |
Source: Primary data (2022)
According to
Variables | Frequency (n) | Percent (%) |
Disinfection prevents health care acquired infections. | ||
Corrects answers | 206 | 95.8 |
Incorrect answers | 9 | 4.2 |
Antiseptic prevents health care acquired infections. | ||
Corrects answers | 195 | 90.7 |
Incorrect answers | 20 | 9.3 |
All equipment is sterilized using a chemical process. | ||
Corrects answers | 93 | 43.3 |
Incorrect answers | 122 | 56.7 |
For all equipment, physical sterilization (heat/radiation technique) is used. | ||
Corrects answers | 78 | 36.3 |
Incorrect answers | 137 | 63.7 |
Autoclaving destroys all microorganisms, including spores. | ||
Corrects answers | 132 | 61.4 |
Incorrect answers | 83 | 38.6 |
Each equipment needs decontamination beforesterilization. | ||
Corrects answers | 175 | 81.4 |
Incorrect answers | 40 | 18.6 |
Personal protective equipment minimizes health care acquired infection. | ||
Corrects answers | 199 | 92.6 |
Incorrect answers | 16 | 7.4 |
Wearinggloves replace the need for handwashing. | ||
Corrects answers | 62 | 28.8 |
Incorrect answers | 153 | 71.2 |
There is PPE for HIV after exposure. | ||
Corrects answers | 209 | 97.2 |
Incorrect answers | 9 | 2.8 |
Source: Primary data (2022)
The SPSS score assessment was used to assess nine (9) questions related to IPC knowledge, and the score was two (2) marks for a right answer and zero (0) for a false answer. By adding the scores for each respondent across all nine (9) questions, an overall knowledge score was calculated. According to
Frequency (n) | Percent (%) | |
Level of knowledge about IPC | ||
Low (Score <60%) | 46 | 21.4 |
High (Score ≥ 60%) | 169 | 78.6 |
Minimum score: 10.0 | Mean score:11.7 ; Stand. Dev.:1.4 | |
Maximum score: 16.0 | ||
Attitudes towards IPC | ||
Negative (Score < 60%) | 44 | 20.5 |
Positive (Score ≥ 60%) | 171 | 79.5 |
Minimum score: 6.0 | Mean score:22.2; Stand. Dev.:6.3 | |
Maximum score: 30.0 | ||
Practice towards IPC | ||
Poor (Score < 60%) | 79 | 36.7 |
Good (Score ≥ 60%) | 136 | 63.3 |
Minimum score: 10.0 | Mean score:11.8; Stand. Dev.:2.1 | |
Maximum score: 20.0 |
Source: Primary data (2022)
According to the findings in
Variables | n (%) | ||||
Strongly disagree | Disagree | Neutral | Agree | Strongly agree | |
When caring for a patient, you must be concerned about exposing your family and friends to HCAIs. | 21(9.8) | 23(10.7) | 17(7.9) | 97(45.1) | 57(26.5) |
HCWs at my facility are concerned about contracting HCAIs while caring for patients. | 15(7.0) | 20(9.3) | 12(5.6) | 125(58.1) | 43(20.0) |
Washing hands before and after contact with patients reduces the risks of getting HCAIs. | 19(8.8) | 15(7.0) | 4(1.9) | 95(44.2) | 82(38.1) |
I believe PPE protect HCWs from infection. | 2(0.9) | 22(10.2) | 13(6.0) | 151(70.2) | 27(12.6) |
In the absence of standard precaution, Infection and nosocomial diseases can occur in health care facilities. | 14(6.5) | 10(4.7) | 21(9.8) | 91(42.3) | 79(36.7) |
In your workplace, there is a high risk of occupational infection among health workers. | 19(8.8) | 73(34.0) | 33(15.3) | 71(33.0) | 19(8.8) |
Source: Primary data (2022)
Each respondent's overall score for the setting was calculated by combining the scores of the six (6th) attitude-related questions. The answers were graded on a scale of 0 to 5. The responses were graded on a Likert scale. According to the results in
The findings in
Variables | Frequency (n) | Percent (%) | |
Wash hands using soap before patient care | Yes | 209 | 97.2 |
No | 6 | 2.8 | |
Wash hands using soap after patient care/contact with fluid | Yes | 204 | 94.9 |
No | 11 | 5.1 | |
Wash hands without using soap before and after patient care | Yes | 74 | 34.4 |
No | 141 | 65.6 | |
Are using personal protective equipment (PPE) when taking care of patients? | Yes | 190 | 88.4 |
No | 25 | 11.6 | |
What kind of PPE are you using in patient care? (n=190) | Gloves | 186 | 98.1 |
Goggles | 112 | 59.1 | |
Face masks | 173 | 91.2 | |
Gown | 133 | 70.2 | |
Other PPE | 25 | 13.0 | |
There are written infection control policies and procedures available. | Yes | 207 | 96.3 |
No | 8 | 3.7 | |
Recapping needles before disposing | Yes | 120 | 55.8 |
No | 95 | 44.2 | |
Ever had contact with blood, liquids or puncture wounds | Yes | 144 | 67.0 |
No | 71 | 33.0 | |
What are the IPC measures adopted after being exposed to blood/stick injury?(n=144) | Taking PEP | 56 | 39.0 |
Cleaning by alcohol | 42 | 29.2 | |
Washing with water | 74 | 51.3 | |
Giving health education to the patients about HCAIs | Yes | 197 | 91.6 |
No | 18 | 8.4 | |
The hospital has a competency-based hand hygiene training program. | Yes | 206 | 95.8 |
No | 9 | 4.2 | |
Supplies necessary for adherence to hand hygiene are readily accessible in patient care areas. | Yes | 209 | 97.2 |
No | 6 | 2.8 |
Source: Primary data (2022)
The 'practice' section included ten (10) IPC-related questions that were graded individually for each respondent. If a respondent gave the correct answer, they received two points. If he/she gave a false response, he/she received a zero. Each respondent received an overall practices score by adding the scores from the ten practice-related questions. According to the research findings presented in
Age, educational level, work experience, level of knowledge, and attitude toward IPC practices were factors that were significantly associated with IPC practice in the bivariate analysis. However, in the multivariate analysis, all variables were found to be meaningfully associated with IPC practice (
According to multiple regression analysis, the odds of having good practice towards IPC were 2.7 times higher (AOR=2.7; 95 percent CI: (1.68-7.95); p=0.045) among HCWs with a high level of knowledge towards IPC compared to those with a low level of knowledge, and the odds of having good practice towards IPC were 2.3 times higher (AOR=2.3; 95 percent CI: (1.36-7.72); p=0.017) among those with.
Variables | Items | Crude OR (95%CI) | P-value | Adjusted OR (95%CI) | P-value |
Age category | 18-35 years | Ref. | Ref. | ||
36-45 years | 2.1(1.78-5. 93) | 0.412 | 0.14(0.03-3.22) | 0.342 | |
> 45 years | 2.7(1.9-5.07) | 0.017 | 3.1(2.16-5.25) | 0.024 | |
Level of education | Primary | Ref. | Ref. | ||
Secondary | 2.9(1.46-7.98) | 0.079 | 2.5(1.25-7.89) | 0.061 | |
University | 2.4(1.19-6.89) | <0.001 | 3.3(1.56-7.56) | 0.035 | |
Work experience | <5 years | Ref. | Ref. | ||
5-10 years | 3.1(1.92-4.89) | <0.001 | 2.9(1.37-5.45) | 0.003 | |
>10 years | 2.1 (1.37-3.27) | 0.001 | 1.2 (0.69-1.97) | 0.561 | |
Level of knowledge | Low | Ref. | Ref. | ||
High | 2.6(1.48-6.98) | 0.031 | 2.7(1.68–7.95) | 0.045 | |
Attitude | Negative | Ref. | Ref. | ||
Positive | 2.5(1.70-7.44) | 0.014 | 2.3(1.36-7.72) | 0.017 |
Source: Primary data (2022)
According to this study, 78.6 percent of healthcare workers are knowledgeable about infection prevention and control. This result indicates that a high proportion of medical staff in the three hospitals studied have infection prevention and control skills, consistent with similar and related studies in Zambia (74.4 percent)
According to the findings of this study, approximately three-quarters (79.5 percent) of the respondents had positive attitudes toward IPC. This could be because the study was conducted during a novel coronavirus pandemic (COVID-19), during which people were more sensitive to IPC measures. Though, a similar study found a higher percentage (93.4 percent) of HCWs with a positive attitude toward IPC
According to a study directed in an Egyptian hospital, 63.3 percent of healthcare workers practice good infection prevention and control activities (67.1 percent)
In this study, age is one of the significant factors in infection prevention and control practice. It showed that health workers older than 45 years were about 3.1 times more likely to practice infection prevention and control activities than those who were 1835 years old. This is comparable with other studies conducted in Northwest Ethiopia
In terms of educational attainment, higher levels of education were positively associated with better infection prevention intervention implementation than lower levels of education. This finding contradicts a study conducted in the Amhara region
Furthermore, this study found that work experience is a important factor in the practice of infection prevention and control activities. According to a study conducted in Bahirdar, healthcare workers with 5 to 10 years of experience were 1.7 times more likely to engage in infection prevention and control activities
In addition, up-to-date knowledge and skills in infection prevention and control can increase healthcare professionals' confidence in adhering to suggested procedures and available services. In this study, healthcare workers with a high level of knowledge about IPC were 2.7 times more likely to practice IPC than those with a low level of knowledge. This is consistent with the findings of studies conducted in Northwest Ethiopia
The specific objectives of my study were to determine and assess the knowledge, attitudes and practices of health care professionals regarding infection prevention and control in three hospitals of Karongi district and to identify factors associated with infection prevention and control practices in three hospitals of Karongi district are connected. This study revealed that most of respondentswere aware of IPC and its advantage to their health. Unfortunately, some respondents revealed low level of knowledge (21.4%), negative attitude (20.5%) and poor practice (36.7%) towards IPC activities.Among factors associated with IPC were: level of education, work experience, level of knowledge towards IPC and attitude towards IPC. The Ministry of Health and Hospitals, along with other stakeholders, have to reinforce awareness on IPC activities in hospitals facilities; to continue to support health facilities to organize regular trainings for HCWs on IPC.