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Health care workers' compliance with infection prevention guidelines and

associated factors in the hospitals of Hadiya zone, Southern Ethiopia:
Hospital based cross- sectional stud...

Article in International Journal of Epidemiology · January 2019

DOI: 10.23880/eij-1600011

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 Epidemiology International Journal
ISSN: 2639-2038

Health-Care Workers’ Compliance with Infection Prevention

Guidelines and Associated Factors in Hadiya Zone, Southern
Ethiopia: Hospital Based Cross Sectional Study

Yohannes T1*, Kassa G2, Laelago T3 and Guracha E4 Research Article

1College of medicine and health sciences, Hawassa University, Ethiopia Volume 3 Issue 1

2Department Received Date: January 18, 2019

of health information technology, Hossana College of Health
Published Date: February 13, 2019
Science, Ethiopia
DOI: 10.23880/eij-16000117
3School of public health, Wolaita sodo University, Ethiopia
4Department of Medical Laboratory Technology, Hossana College of Health Sciences, Ethiopia

*Corresponding author: Tadele Yohannes, College of medicine and health sciences, Hawassa University, Hawassa,
Ethiopia, Tel: +251916463961 Email: [email protected]

Abstract
Background: Infections in health care facilities have become a major health problem, especially in the health
institutions located in developing countries. The objective of this study was assessing health-care workers’
compliance with Infection prevention guidelines and factors that influence compliance in Hospitals of Hadiya Zone,
Southern Ethiopia, 2017.
Methods: A hospital based cross-sectional study was conducted from May to June 2017. To draw a total sample of
size 279 simple random sampling technique was used. Data were entered using Epi-Data version 3.1 and exported to
SPSS version 20 for analysis. Binary logistic regression analysis was used to see significance of association between
the outcome and independent variables. Odds ratios at 95% CI were computed to measure the strength of the
association between the outcome and the explanatory variables. P-value ˂0.05 was considered as a statistically
significant.
Results: The findings of this study showed that the overall compliance of health care workers with infection
prevention guidelines was 15.0% (95%CI: 11.0%, 19.0%). Being female (AOR: 2.962, 95%CI: (1.342, 6.535)), positive
attitude towards IP guidelines (AOR: 3.130, 95%CI: (1.192, 8.224)), access to IP guidelines (AOR: 2.820, 95%CI:
(1.076, 7.389)), training on IP guidelines (AOR: 2.262, 95%CI: (1.008, 5.078)) were significantly associated with
compliance with IP guidelines.
Conclusion: In this study the overall compliance level of the health care workers to infection prevention guide lines
was very low. Being female, attitude towards infection prevention guidelines, accessibility of personal protective
equipment’s and training were factors significantly associated with compliance with infection prevention guidelines.

Health-Care Workers’ Compliance with Infection Prevention Guidelines and Associated Epidemol Int J
Factors in Hadiya Zone, Southern Ethiopia: Hospital Based Cross Sectional Study
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Epidemiology international journal
Continuous training on infection prevention guidelines should be given to health care workers, especially for males.
Accessibility of infection prevention materials and equipments in the hospitals should get due attention.

Keywords: Compliance; Health care workers; Infection Prevention; Ethiopia

Abbreviations: CI: Confidence Interval; HAI: the region showed that its magnitude would be much
Hospital Acquired Infection; HCWs: HealthCare higher than in the developed nations [8].
workers; HBV: Hepatitis B Virus; HCV: Hepatitis C Virus; Percutaneous exposures to blood and body fluids
HIV: Human immune deficiency virus; IP: Infection through contaminated needle pricks and other sharps
Prevention; PPE: Personal Protective Equipment; SPSS: are an important occupational hazard for morbidity and
Statistical Package for Social Sciences. mortality from infections with blood-borne pathogens
among health care workers. It is estimated that 2.5% of
Background Human Immuno deficiency Virus (HIV) cases and 40%
of Hepatitis B virus (HBV) and Hepatitis B virus (HCV)
Health care acquired infection (HAI) is an infection cases among HCWs worldwide are the result of this
occurring in a patient in a hospital or other health care form of exposure [9].
facility in whom the infection was not present or
incubating at the time of admission. This includes Sex of health care workers, infection risk perception,
infections acquired in the health care facilities but training on standard precautions, accessibility of
appearing after discharge, and also occupational personal protective equipment and management are
infections among staff of the facilities [1]. considered as major factors influencing compliance to
infection prevention guidelines [2].
The most common pathogens that cause Nosocomial
infections are staphylococcus aureus, Pseudomonas Nosocomial infection rates range from as low as 1%
aeruginosa, and E. coli which are transmitted through in a few countries in Europe and the Americas to more
different modes like contaminated hands of health care than 40% in parts of Asia, Latin America and sub-
workers and contaminated instruments [2]. Saharan [10].

HAIs remain as the most frequent adverse event in In many developing countries, however, the risk of
any health care delivery system and affect millions of needle stick injuries and accidental exposure to blood
people each year, leading to significant morbidity and or body fluids is even higher [11].
mortality [3].
Study conducted in Ethiopia revealed that significant
Nosocomial (hospital-acquired) infections are a numbers of healthcare workers (65.9%) were exposed
significant problem throughout the world and are to blood and body fluids, of which 29% were because of
increasing at alarming rate [4]. needle-stick injury [9]. Preventing and controlling
infection in health care facilities involves two levels of
The Institute of Medicine reported that adverse approach, standard precautions and transmission-
events affect approximately 2 million patients each year based precautions. Standard precautions are taken to
in the United States, resulting in 90,000 deaths and an reduce the risk of transmitting blood-borne
estimated $4.5–5.7 billion per year in additional costs microorganisms and other pathogens from both
for patient care [5]. recognized and unrecognized sources. These
precautions are used as a minimum, in the care of all
Between 2002 and 2009 HAI prevalence increased by patients in health care facilities and settings, regardless
11.7 % in a network of major Canadian hospitals [6]. of their diagnoses or presumed infection status [12].
Data from American hospitals demonstrated that HAIs
alone account for an estimated 1.7million infections Infection prevention guidelines guide health care
within a year. The same data also revealed 98,987 HAIs workers (HCWs) to practice regular hand hygiene , use
associated deaths; of these, 36.3% were for pneumonia, personal protective equipment (PPE) like gloves, masks,
31% for blood stream infections, 13.2% for urinary eye protection, face shield and gowns when contact
tract infections, 8.3% for surgical site infections, and with mucus membranes , blood and body fluids of
11.2% for infections of other sites [7]. Although a well- patients is anticipated. The guidelines also recommend
established data were not available regarding the correct disposal of sharps and other clinical waste [2].
burden of HAIs in Africa, a systematic review done in In Ethiopia, the protection of patients and healthcare

Yohannes T, et al. Health-Care Workers’ Compliance with Infection Prevention Copyright© Yohannes T.
Guidelines and Associated Factors in Hadiya Zone, Southern Ethiopia: Hospital Based
Cross Sectional Study. Epidemol Int J 2019, 3(1): 000117.
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Epidemiology international journal
workers form infections inside the health care facilities population of Hadiya zone is 1,594,950. Hadiya zone has
has been given particular attention by the Federal 10 woredas. In the zone there are 01public general
Ministry of Health. Indeed, the Ministry is scaling-up its hospital, 02 primary hospitals, 61public and 02 private
activities related to infection prevention and using all health centers and 305 health posts. The functional
opportunities to strengthen ongoing activities. As in hospitals in zone are NEMM general hospital, Homacho
many of its program, the Ministry has been utilizing primary hospital and shone primary hospital. In the
available evidence to establish optimal infection three hospitals there are around 482 clinical health care
prevention practices in health facilities [3]. Despite a workers, according to Hadiya zone Health Department
significant improvement in facility of health institutions annual report of 2016.
and in the number and kind of health task forces in
Ethiopia particularly in the last two decades, local Study Design and Period
reports showed that there is still high burden of HAIs
Institutional based cross-sectional study was
[13]. On the other hand very limited evidences are
conducted from May to June 2017
available with regard to the level of compliance of
Study participants: The source population of the study
healthcare workers with infection prevention
was all health care workers in public Hospitals of
guidelines and its associated factors in the country in
Hadiya zone. The study population was all health care
general and in the study area in particular. There is also
workers assigned in clinical services in public Hospitals
no study conducted before in the study area regarding
of Hadiya zone. All health care workers who were
compliance of health care workers with infection
assigned to clinical services during the study period and
prevention guidelines.
have regular program for direct patient care were
included in the study and those health care workers
Therefore, this study was aimed at assessing health
who were assigned to clinical services but absent during
care workers’ compliance with infection prevention
study period and those with less than six months
guidelines and associated factors in Hospitals of Hadiya
working experience were excluded from the study.
zone, Southern Ethiopia.
Sample size determination and Sampling technique:
Methods Sample size was determined using Epi info version 7 for
single population proportion by considering 12% of
Study Area health care workers’ compliance with IP guidelines,
Hadiya zone is a zone in the Ethiopian southern obtained from similar previous study in Gondar [14].
nations, nationalities and people s’ region. It is located Confidence level of 95 % and 0.04 margin of error were
230 km from Addis Ababa and 164 from Hawassa. taken in the calculation. Considering 10 % none
Hadiya zone is bordered on the south by Kambata response rate, the determined sample size was 279.
Tambaro zone, on the south west by the Dawro zone, on
the west by the Omo River which separate it from The required number of sample was allocated
Oromia region and the Yem especial woreda, on the proportionally among the three hospitals found in
north by Gurage, on the north east by Silte and on the Hadiya Zone. The sample was allocated depending on
east by Halaba especial woreda. The woredas of Mirab the number of health care workers in 2009 E.C. The
Badawacho and Misraq Badawacho form an exclave sample assigned to each hospital was proportionally
separated from the rest of the zone by Kambata allocated to each category of health care workers. The
Tembaro zone. The administrative centre of the zone is sampling units, the health care workers, were selected
hosanna. The zone covers 3542.66 square km. Total by using simple random sampling technique.

Yohannes T, et al. Health-Care Workers’ Compliance with Infection Prevention Copyright© Yohannes T.
Guidelines and Associated Factors in Hadiya Zone, Southern Ethiopia: Hospital Based
Cross Sectional Study. Epidemol Int J 2019, 3(1): 000117.
4
Epidemiology international journal

hospitals in hadiya
zone

NEMM general Shone district Homacho district

Hospital Hospital Hospital
280 clinical staffs 102 clinical staffs 100 clinical staffs

sample sample sample

162 59 58

Intern General GP (7%)

doctors(3.5%) practitioners(10.3%)
4
5 6

General
Practitioners(19%) Nurses (45.3%)
Nurses(47%)
30 27
27

nurses (51%) Midwifes(16%)

82 9 Midwifes(16%)
10
midwifes(10.8%)
18 Lab.tech.(10.4%)
6
Lab. tech.(14%)
lab. tech.(9%) 8
15 anesthetists(2.8%)
2
anesthetists(2.4%) Ansthetists(2%)
4 HO(12.4%) 1
7
X-ray(2.8%)
5 EMS(2%)
EMS(2.8%) 1
HO(1.7%)
2
3

HO(12%)
7

279

Figure 1: Schematic presentation of sampling procedure.

Yohannes T, et al. Health-Care Workers’ Compliance with Infection Prevention Copyright© Yohannes T.
Guidelines and Associated Factors in Hadiya Zone, Southern Ethiopia: Hospital Based
Cross Sectional Study. Epidemol Int J 2019, 3(1): 000117.
5
Epidemiology international journal
Data Collection and Measurement period of data collection. Completeness of the
information on all variables and legibility of each filled
Self- administered questionnaire and observation
in the questionnaire/check list was audited at the end of
check list was used to collect data from each study
each day to ensure accuracy.
subject. The questionnaire is developed based on the
Ethiopian national infection prevention and patient
safety guideline [15]. The questionnaires consist of four
Data Analysis
parts. Part I consist of socio-demographic Data were entered and cleaned using Epi-Data
characteristics. Part II contains questionnaire that version 3.1 and exported to SPSS version 20 for
would assess health care workers compliance with IP analysis. Descriptive statistics (Frequency, mean,
guidelines. Part III contains about individual factors standard deviation, and proportion) was calculated to
including knowledge and Attitude and part IV contains summarize the findings. Results were presented by
institutional factors. tables and graphs. For knowledge and attitude scale, the
items were summed up to produce composite measure
Four diploma nurses were recruited as data and mean score was calculated for each score. For
collectors and two public health masters as supervisor, HCWs compliance to IP guidelines, those who reported
all were working in other health facilities. that they were always compliant were taken as
compliant. Those who reported that they were
Observation of the infection prevention practices was sometimes and seldom compliant were taken as
done using a check list to supplement the findings. noncompliant. Next, summation of the 22 compliance
Compliance with IP guidelines was measured using 22 items was made. Then, the variable was re-coded and
items on a 3-point Likert scale (1 = seldom, 2 = dichotomized as compliant/noncompliant. Binary
sometimes, and 3 = always). Each respondent was logistic regression was used to predict variables which
dichotomized as compliant/noncompliant. Those who have independent association with outcome variable.
reported that they were always compliant were taken Variables which have a significant association at p-value
as compliant and those who reported that they were <0.05 in the bivariate analysis were taken to
sometimes and seldom compliant were taken as multivariate analysis to include all potential variables.
noncompliant. Odds ratio at 95% CI was used to check for the
existence and strength of association between
Knowledge was measured using 13 items prepared to independent and outcome variables. P-value of less than
assess it. Right answer was given a value of 1 and for 0.05 was considered as statistical significant in the
those incorrect answers a value of 0 was given. After multivariate analysis.
computing the mean of all respondents, the mean score
of each respondent was dichotomized as knowledgeable Results
or not knowledgeable.
Knowledgeable >= mean A total of 274 health care workers returned
Not knowledgeable < mean completely filled questionnaire which had a response
rate of 98.2% out of 279 health care workers. Based on
Attitude was measured using 5 items on five points the finding minimum, mean and maximum ages in years
Likert (1 = strongly disagree, 2 = Disagree, 3= Neutral, of the respondents were 19, 26.68 and 57 respectively
4= Disagree and 5 = strongly agree). After computing with SD of 4.18. The median work experience of the
the mean of all respondents’ responses, the mean score HCWs was 3 years with minimum work experience of
of each respondent was dichotomized as have positive 0.5 year and maximum work experience of 40 years.
attitude or negative attitude Out of the total respondents 147(53.6%) were males.
Positive attitude >= mean Concerning Respondent's marital status, majority
Negative attitude < mean 170(62.0%) was single. Professionally, most frequent
135(49.3%) were nurses. Around one third 76(27.7%)
Quality Assurance were working in outpatient department (Table 1).
Training of data collectors and supervisors was made
Total (N and %), N
for 2 days to enable them acquire basic skills necessary Variables
=274
for data collection and supervision, respectively. Pre-
testing of data collection tool was made in hospital Marital status(n=274)
other than the study area on 10% of sampled HCWs. Married 104(38%)
Based on the results of pre-testing, data collectors was Single 170(62%)
reoriented and the questionnaire was modified as Age category(n=274)
necessary. The principal investigators and supervisors < 25years 127(46.4%)
made a day to day on site supervision during the whole 26-30 years 121 (44.2%)

Yohannes T, et al. Health-Care Workers’ Compliance with Infection Prevention Copyright© Yohannes T.
Guidelines and Associated Factors in Hadiya Zone, Southern Ethiopia: Hospital Based
Cross Sectional Study. Epidemol Int J 2019, 3(1): 000117.
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>31 years 26 (9.5%) Pediatrics ward 18(6.6%)
Sex(n=274) Operation room 20(7.3%)
Male 147(53.6%) Radiology room 3(1.1%)
Female 127(46.4%) Intensive care unit 17(6.2%)
Educational Status(n=274) TB and ART clinic 6(2.9%)
Diploma 132 (48.2%) Ophthalmology clinic 4(1.6%)
Degree 136(49.6%)
Table 1: Socio-demographic characteristics of the
Masters 4 (1.5%) respondents in Hospitals of Hadiya zone, Southern
Others 2 (0.70%) Ethiopia, July, 2017 (N=274).
Work experience (n=274)
< 5 years 197(71.9%) *Specialists, emergency medical surgeons and x-ray
5-10 years 69(25.2%) professionals
>10years 8(2.9%) Compliance level with infection prevention guidelines
Profession (n= 274)
From health care workers enrolled in this study,
General practitioners 40(14.6%) 35.0%, 52.2%, 74.8% and 42.3% always wash hands
Nurses 135(49.3%) before touching a patient, before clean or aseptic
Midwives 37(13.5%) procedures, after body fluid exposure and after
Laboratory touching a patient, respectively. Only 38.0% were
35(12.8%) complaint to wear eye goggles whenever there is a
technologists/tech.
Anesthetists 11(4%) possibility of body fluid splashing and around half
(52.8%) always provide care considering all patients as
Health officers 8(2.9%)
potentially infectious. Concerning waste segregation,
Others* 8(2.8%) 75.2% always segregate infectious medical wastes in
Currently assigned yellow coloured coded dust bin. The compliance level of
places(wards) health care workers for never recapping needles was
Outpatient department 76(27.7%) 69.3% (Table 2).
Laboratory Room 19(6.9%)
Inpatient and Emergency 31(11.4%) In this study the overall compliance level of the
Medical ward 24(8.8%) health care workers to infection prevention guide line
was 15.0% (95%CI: 11.0%, 19.0%) which was obtained
Surgical ward 17(6.2%)
by considering the components of infection prevention
Gynecology and obstetric described below in Table 2.
39(14.3%)
ward
Compliance level (N and %), N =274
Variables seldom Sometimes Always
Wash hands before touching a patient 68(24.8%) 110(40.1%) 96(35.0%)
Wash hands before clean or aseptic procedures 37(13.5%) 94(34.3%) 143(52.2%)
Wash hands after body fluid exposure 15(5.5%) 54(19.7%) 205(74.8%)
Wash hands after touching a patient 40(14.6%) 118(43.1%) 116(42.3%)
Wash hands immediately after removal of gloves 60(21.9%) 115(42.0%) 99(36.1%)
Wash hands between patient contact 67(24.5%) 122(44.5%) 85(31.0%)
Wash hands after touching patient surroundings 54(19.7%) 117(42.7%) 103(37.6%)
I provide care considering all patients as potentially infectious 27(9.9%) 105(38.3%) 142(51.8%)
I protect myself against body fluids of all patients regardless of their
12(4.4%) 86(31.4%) 176(64.2%)
diagnosis
I wear clean gloves whenever there is a possibility of exposure to any
10(3.6%) 72(26.3%) 192(70.1%)
body fluids
I change gloves between contacts with different patients 18(6.6%) 61(22.3%) 195(71.2%)
I avoid wearing my gown out of hospital compounds 19(6.9%) 35(12.8%) 220(80.3%)
I wear a waterproof apron whenever there is a possibility of body
96(35.0%) 70(25.5%) 108(39.4%)
fluid
I wear eye goggles whenever there is a possibility of body fluid
111(40.5%) 59(21.5%) 104(38.0%)
splashing

Yohannes T, et al. Health-Care Workers’ Compliance with Infection Prevention Copyright© Yohannes T.
Guidelines and Associated Factors in Hadiya Zone, Southern Ethiopia: Hospital Based
Cross Sectional Study. Epidemol Int J 2019, 3(1): 000117.
7
Epidemiology international journal
I sterilize all reusable equipment before being used on another
46(16.8%) 43(15.7%) 185(67.5%)
patient
I clean and disinfect equipment and environmental surfaces 36(13.1%) 39(14.2%) 199(72.6%)
I segregate noninfectious wastes in black colour coded dust bin 22(8.0%) 38(13.9%) 214(78.1%)
I segregate infectious medical wastes in yellow coloured coded dust
15(5.5%) 53(19.3%) 206(75.2%)
bin
I never bend needles with my hands 23(8.4%) 46(16.8%) 205(74.8%)
I avoid removing used needles from disposable syringes 22(8.0%) 38(13.9%) 214(78.1%)
I place used sharps in puncture-resistant container at point of use 13(4.7%) 44(16.1%) 217(79.2%)
I never recap needles 30(10.9%) 54(19.7%) 190(69.3%)
Table 2: Compliance level with infection prevention guidelines among health care workers in Hospitals of Hadiya
zone, Southern Ethiopia, July, 2017 (N=274).

Observed Compliance with IP Guidelines hands before putting on gloves and after removing
gloves. 92.2% observed participants wash hands after
Hand hygiene: Out of the 51 observed participants for
handling contaminated objects. Less than half (39.2%)
IP practices, more than half (58.8%) did hand hygiene
perform hand hygiene before preparing medication
by washing with water and soap or using alcohol based
(Figure 2).
hand rub before and after performing any procedure
and only one third of the participants (66.7%) wash

100.00%
92.20%
90.00%

80.00%

70.00%

60.00%

50.00%
41.20% 39.20%
40.00%
33.30%
30.00%

20.00%

10.00%

0.00%
Before and after Before putting on After handling Before preparing
performing any gloves and after contaminated medication
procedure removing gloves objects i.e., used
instruments
Hand hygine
Figure 2: Observed Compliance level with hand hygiene among health care workers in Hospitals of Hadiya zone,
Southern Ethiopia, July, 2017 (N=51).

Use of PPE: From the observed participants almost all procedures which are likely to generate splashes or
(98%) worn gowns during procedures when contact sprays of blood or other body fluids but only about half
with blood or body fluids is anticipated and during (54.9%) used Mouth, nose and eye protection (figure 3).

Yohannes T, et al. Health-Care Workers’ Compliance with Infection Prevention Copyright© Yohannes T.
Guidelines and Associated Factors in Hadiya Zone, Southern Ethiopia: Hospital Based
Cross Sectional Study. Epidemol Int J 2019, 3(1): 000117.
8
Epidemiology international journal

120.0%

98.00%
100.0% 94.10%

80.0%

60.0% 54.90%

40.0%

20.0%

0.0%
Gloves are worn when Gowns are worn Mouth, nose and eye
contact with blood or during procedures protection is used
body fluids when contact with when a procedure is
blood or body fluids likely to generate
splashes

Use of PPE
Figure 3: Observed Compliance level with use of PPE among health care workers in Hospitals of Hadiya zone,
Southern Ethiopia, July, 2017 (N=51).

Instrument Processing Waste Management

From the observed 51 health care workers, 90.2% of the observed participants did not recap or
45(88.2%) decontaminated Used instruments bend needles after use and both needle and syringe are
immediately after use by soaking in 0.5% chlorine for immediately disposed of into a puncture resistant
10 minutes and then washed in soapy water, then container and 76.5% segregated Solid waste at point of
rinsed in clean water and dried before sending them for use according to category (Table 3).
high level disinfection or sterilization.

Variable Number %
Waste management
Needles are not recapped or bent after use and both needle and syringe 46 90.2
Puncture resistant containers for sharps are disposed of when ¾ full 47 92.2
Solid waste is segregated at point of use according to category 39 76.5
Contaminated waste is disposed of into a container with a plastic liner 46 90.2
Waste containers are disposed of when ¾ full 46 90.2
Table 3: Observed Compliance level with waste management among health care workers in Hospitals of
Hadiya zone, Southern Ethiopia, July, 2017 (N=51).

Individual Factors
From the participants included in this study, 91.6% 89.1% 90.5% and 90.1% knew airborne, contact with
and 90.1% of the respondents heard about infection blood and body fluid, contaminated instruments and
prevention guide lines and Health facilities acquired contaminated hands as mode of transmission for HAI,
infections, respectively from different sources. With respectively. As prevention means of HAI, 96.4% knew
respect to knowledge on infection prevention Instrument processing and 88.3% knew isolation. From
guidelines, 93.8% of the respondents were the HCWs included in this study, more than half (51.5%)
knowledgeable. From the respondents, 86.9%, 90.1%, ever had no training on infection prevention (Table 4).

Yohannes T, et al. Health-Care Workers’ Compliance with Infection Prevention Copyright© Yohannes T.
Guidelines and Associated Factors in Hadiya Zone, Southern Ethiopia: Hospital Based
Cross Sectional Study. Epidemol Int J 2019, 3(1): 000117.
9
Epidemiology international journal

Out of 274 respondents, 180(65.7%) had positive

attitude and 94(34.3%) had negative attitude towards
infection prevention guide lines.

Variable Number %
Ever heard about infection prevention guide lines 251 91.6
Ever heard about Health facilities acquired infections 247 90.1
Ever had training on infection prevention 133 48.5
Which mode of transmission of HAI do you know
Air borne 238 86.9
Contact with blood and body fluid 244 89.1
Needle sticks 244 89.1
Contaminated instruments 248 90.5
Contaminated hands 247 90.1
Prevention means of HAI HCWs know
Hand hygiene 258 94.2
Use of personal Protective equipment 261 95.3
Proper disposal of medical waste 263 96.0
processing of instruments 264 96.4
Isolation 242 88.3
Table 4: Individual factors among health care workers in Hospitals of Hadiya zone, Southern Ethiopia, July, 2017
(N=274).

Institutional Factors Factors Associated with Compliance with IP

Out of the health care workers, 56.9% replied that Guidelines
there was availability of PPE in their health facility and Result of bivariate analysis showed that sex
56.0% had access to these PPE. More than half (56.6%) (p<0.005), marital status (p=0.001), work experience
did not get management support for safety. Majority (p=0.010) attitude of the respondents towards IP
(63.1%) replied that management provides feedback for guidelines (p<0.010), availability of PPE (p<0.05),
safety practices less frequently. Concerning accessibility accessibility of PPE (P<0.005), management support for
of IP guidelines, for 51.8% IP guidelines were not safety (p<0.010) and presence of training on IP
readily accessible (Table 5). guidelines (P=0.001) were identified as candidates for
multivariate analysis at p-value <0.05 (Table 6).
Variables Number %
PPE availability 156 56.9 In multivariate logistic regression analysis, attitude
PPE accessibility 148 56.0 towards IP guidelines, access to PPE and presence of
training were significantly associated with compliance
Management support for safety 119 43.5 with infection prevention guide lines (Table 6).
Management provide Feedback
101 36.9 Female health care workers were about 3 times more
for safety practice
Presence of training on IP compliant to infection prevention guidelines as
98 35.8 compared to males (AOR: 2.962, 95%CI: (1.342,6.535)).
Guidelines
Accessibility of IP Guidelines 132 48.2
Respondents who had positive attitude towards IP
Table 5: Institutional factors among health care workers guidelines were 3 times more likely to had compliance
in Hospitals of Hadiya zone, Southern Ethiopia, July, with IP guidelines as those who had negative attitude
2017 (N=274). (AOR: 3.130, 95%CI: (1.192,8.224)).

Yohannes T, et al. Health-Care Workers’ Compliance with Infection Prevention Copyright© Yohannes T.
Guidelines and Associated Factors in Hadiya Zone, Southern Ethiopia: Hospital Based
Cross Sectional Study. Epidemol Int J 2019, 3(1): 000117.
10
Epidemiology international journal
The odds of having compliance to IP guide lines was Health care workers who had training on IP
2.5 times higher on those health care workers who had guidelines were 2.3 times more likely to comply with IP
access to IP guidelines as those who had no access to IP guidelines as compared to those who had no training
guidelines (AOR: 2.820, 95%CI: (1.076,7.389)). (AOR: 2.262, 95%CI: (1.008,5.078).

Compliance level (N and %), N =274

Variables seldom Sometimes Always
Wash hands before touching a patient 68(24.8%) 110(40.1%) 96(35.0%)
Wash hands before clean or aseptic procedures 37(13.5%) 94(34.3%) 143(52.2%)
Wash hands after body fluid exposure 15(5.5%) 54(19.7%) 205(74.8%)
Wash hands after touching a patient 40(14.6%) 118(43.1%) 116(42.3%)
Wash hands immediately after removal of gloves 60(21.9%) 115(42.0%) 99(36.1%)
Wash hands between patient contact 67(24.5%) 122(44.5%) 85(31.0%)
Wash hands after touching patient surroundings 54(19.7%) 117(42.7%) 103(37.6%)
I provide care considering all patients as potentially infectious 27(9.9%) 105(38.3%) 142(51.8%)
I protect myself against body fluids of all patients regardless of their
12(4.4%) 86(31.4%) 176(64.2%)
diagnosis
I wear clean gloves whenever there is a possibility of exposure to any
10(3.6%) 72(26.3%) 192(70.1%)
body fluids
I change gloves between contacts with different patients 18(6.6%) 61(22.3%) 195(71.2%)
I avoid wearing my gown out of hospital compounds 19(6.9%) 35(12.8%) 220(80.3%)
I wear a waterproof apron whenever there is a possibility of body
96(35.0%) 70(25.5%) 108(39.4%)
fluid
I wear eye goggles whenever there is a possibility of body fluid
111(40.5%) 59(21.5%) 104(38.0%)
splashing
I sterilize all reusable equipment before being used on another
46(16.8%) 43(15.7%) 185(67.5%)
patient
I clean and disinfect equipment and environmental surfaces 36(13.1%) 39(14.2%) 199(72.6%)
I segregate noninfectious wastes in black colour coded dust bin 22(8.0%) 38(13.9%) 214(78.1%)
I segregate infectious medical wastes in yellow coloured coded dust
15(5.5%) 53(19.3%) 206(75.2%)
bin
I never bend needles with my hands 23(8.4%) 46(16.8%) 205(74.8%)
I avoid removing used needles from disposable syringes 22(8.0%) 38(13.9%) 214(78.1%)
I place used sharps in puncture-resistant container at point of use 13(4.7%) 44(16.1%) 217(79.2%)
I never recap needles 30(10.9%) 54(19.7%) 190(69.3%)

Table 6: Factors associated with compliance with IP guidelines in Hospitals of Hadiya zone, Southern Ethiopia, July,
2017.
Significant at p<0.001*; p<0.01**; p<0.05***
PPE= Personal protective Equipments, CI= Confidence Interval, IP= Infection Prevention

Yohannes T, et al. Health-Care Workers’ Compliance with Infection Prevention Copyright© Yohannes T.
Guidelines and Associated Factors in Hadiya Zone, Southern Ethiopia: Hospital Based
Cross Sectional Study. Epidemol Int J 2019, 3(1): 000117.
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Epidemiology international journal

Discussion In this study, respondents who had positive attitude

towards IP guidelines were 3 times more likely to had
This study was conducted on 274 health-care compliance with IP guidelines as those who had
workers to assess compliance level with Infection negative attitude. This result similar with the findings of
Prevention Guidelines and associated factors in study done in Gondar University Comprehensive
Hospitals of Hadiya Zone, Southern Ethiopia. Specialized Hospital, Northwest Ethiopia which showed
that that HCWs who had higher perception of infection
The findings of the study showed that the overall risk were about 3.5 times more likely to always comply
compliance of HCWs with infection prevention with standard precautions than those who had lower
guidelines was 15.0% (95%CI: 11.0%, 19.0%). This perception of risk. The finding is also similar to study
finding is in line with the findings of study Gondar conducted in Mbagathi district hospital, Nairobi, Kenya
University Comprehensive Specialized Hospital, [14,16]. But it is in contrary to study conducted at
Northwest Ethiopia which showed overall compliance Ronald Ross General Hospital Mufulira District, Zambia
of 12% [14]. Even though the overall compliance of which showed low level of compliance was not due to
HCWs with infection prevention guidelines is very low, negative attitude [17]. This difference might be due to
when specific components of the IP guidelines was the cultural differences in the two countries and the
analyzed better compliance was recorded in some of the difference in up-to- date knowledge and skill regarding
items. A relatively higher proportion of HCWs were infection prevention guidelines among Health care
found to be always compliant with Wash hands after workers.
body fluid exposure (74.8%), wear clean gloves
whenever there is a possibility of exposure to any body This study showed that the odds of having
fluids (70.1%), changing gloves between contacts with compliance to IP guide lines was about 3 times higher
different patients (71.2%), clean and disinfect on those health care workers who had access to IP
equipment and environmental surfaces (72.6%) and guidelines as those who had no access to IP guidelines.
placing used sharps in puncture-resistant container at This result is in consistency with the findings of study
point of use (79.2%). done in Gondar University Comprehensive Specialized
Hospital, Northwest Ethiopia, in which HCWs who had
In contrary, relatively low compliance was recorded access to PPE were 3 times more complaint as those
in Wash hands before touching a patient (35.0%), Wash who had no access [14]. The finding is also similar to
hands between patient contact (31.0%), Wash hands study conducted in Ronald Ross General Hospital
immediately after removal of gloves (36.1%) and Wash Mufulira District, Zambia [17].
hands after touching patient surroundings (37.6%)
These findings were nearly similar to findings of study Health care workers who had training on IP
done in Gondar University Comprehensive Specialized guidelines were 2.3 times more likely to comply with IP
Hospital, Northwest Ethiopia [14]. However, there is guidelines as compared to those who had no training.
improvement in hand washing practice in this study as This finding is in line with the findings of study done in
compared to study conducted in Mbagathi district Gondar University Comprehensive Specialized Hospital,
hospital, Nairobi, Kenya in which only 5.6% Wash hands Northwest Ethiopia and study conducted in Ronald Ross
between patient contact and 3.3% of the participants General Hospital Mufulira District, Zambia [14,17].
wash hands before putting and after removing gloves
[16]. This difference might be due to presence of regular Limitation of the study
training, accessibility of PPE and better management
support on safety for the participants of current study. This study has the following limitations:
The current study revealed that female health care As being cross-sectional in the design, this study lacks
workers were about 3 times more compliant to to show temporal relationship between cause and
infection prevention guidelines as compared to males. effect. Moreover, out of the 274 participated health care
This result is in line with the findings of study done in workers, only 51 were observed on their infection
Gondar University Comprehensive Specialized Hospital, prevention practices. This could have biased the results
Northwest Ethiopia, in which females were 2.2 folds since some of the participants who were not observed
more complaint as compared to males [14]. The could have had some unusual IP practices.
compliance difference in sex might be due to the
females’ natural ability to obey rules and regulations. In Conclusion
Ethiopia, females have more responsibility to care for
family in that they might be more careful not to bring In this study the overall compliance level of the
health problems to their family. health care workers to infection prevention guide lines
was very low. Being female, attitude towards infection
prevention guidelines, accessibility of personal

Yohannes T, et al. Health-Care Workers’ Compliance with Infection Prevention Copyright© Yohannes T.
Guidelines and Associated Factors in Hadiya Zone, Southern Ethiopia: Hospital Based
Cross Sectional Study. Epidemol Int J 2019, 3(1): 000117.
12
Epidemiology international journal
protective equipments and training on infection Ellen Mohammed Memorial General hospital, Shone and
guidelines were factors significantly associated with Homecho district hospitals for providing relevant
compliance with infection prevention guidelines. information for this research activity. Lastly, our
Continuous training on infection prevention guidelines gratitude goes to all individuals who participated in
should be given to health care workers, especially for giving us all the relevant information for this research
males. Accessibility of infection prevention materials process.
and equipments in the hospitals should get due
attention. Authors’ Contributions
Declarations TY conceived the research idea, conducted the data
collection, data analysis and data interpretation, and
Ethics Approval and Consent to Participate wrote and reviewed the paper. GK conducted the data
collection, data analysis and data interpretation, and
Ethical clearance was obtained from ethics review
reviewed the paper. TL and EG approved the proposal,
committee of Hossana College of health sciences.
participated in data analysis and revised subsequent
Permission letter was obtained from hospitals of Hadiya
draft of the paper. All authors read and approved the
Zone. Other concerned bodies of the health facilities
final paper.
were also informed about the study. All the information
retrieved was kept in the way that could not interfere in
personal confidentiality. Informed consent was References
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Cross Sectional Study. Epidemol Int J 2019, 3(1): 000117.
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Epidemiology international journal
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Yohannes T, et al. Health-Care Workers’ Compliance with Infection Prevention Copyright© Yohannes T.
Guidelines and Associated Factors in Hadiya Zone, Southern Ethiopia: Hospital Based
Cross Sectional Study. Epidemol Int J 2019, 3(1): 000117.

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