ASSESSMENT OF KNOWLEDGE OF INFECTION CONTROL MEASURES AMONG NURSES AND EFFECT ON REDUCTION OF HOSPITAL-ACQUIRED INFECTIONS ON PATIENTS IN SURGICAL WARDS IN FAITH MEDIPLEX HOSPITAL, BENIN CITY

ABSTRACT

This study investigates the knowledge of infection control measures among nurses in the surgical wards of Faith Mediplex Hospital, Benin City, and their impact on reducing hospital-acquired infections (HAIs) among postoperative patients. Utilizing a convergent parallel mixed-methods design, the research integrates quantitative surveys (n=120 nurses) and qualitative semi-structured interviews (n=20 nurses) to assess knowledge levels, compliance with infection control protocols, and their correlation with HAI incidence rates, specifically surgical site infections (SSIs) and catheter-associated urinary tract infections (CAUTIs). The Health Belief Model (HBM) serves as the theoretical framework, emphasizing perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy as drivers of nurses’ infection control behaviors. Preliminary findings indicate moderate knowledge levels (mean=3.4/5, SD=0.8), with notable gaps in advanced sterilization techniques (65% proficiency) and hand hygiene compliance (58% adherence). Qualitative data highlight barriers such as inadequate training (45% of nurses trained annually), limited personal protective equipment (PPE) availability (40% of wards fully equipped), high patient-to-nurse ratios (1:12), and cultural attitudes prioritizing speed over protocol adherence. Statistical analysis reveals a significant negative correlation between knowledge scores and HAI rates (r=-0.48, p<0.01), with regression models suggesting a 10% knowledge increase reduces HAIs by 5%. Recommendations include mandatory WHO-accredited training, enhanced resource allocation, real-time compliance monitoring, patient education integration, public-private partnerships for funding, and cultural sensitization campaigns. This study contributes to nursing practice by providing hospital-specific insights, informing Nigerian healthcare policies, and offering replicable strategies for resource-constrained settings globally, aligning with Sustainable Development Goal 3 (Good Health and Well-Being).

Keywords: hospital-acquired infections, infection control, nurses’ knowledge, surgical wards, Faith Mediplex Hospital, Health Belief Model, hand hygiene, patient safety, Nigeria, resource constraints.

CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND TO THE STUDY

Hospital-acquired infections, or HAIs, are germs that patients catch while staying in the hospital, and they are a big problem for health systems around the world, including Nigeria. These infections make people sicker, keep them in the hospital longer, and sometimes cause death. They also cost hospitals a lot of money to treat. The World Health Organization says that 7 to 10 out of every 100 patients in hospitals worldwide get an HAI, but in countries like Nigeria, where hospitals don’t have enough money or equipment, 15 to 20 out of every 100 patients get these infections (WHO, 2022). Surgical wards, where doctors do operations like fixing broken bones or removing tumors, are especially risky because cutting the body can let germs in, patients often have weak immune systems, and devices like tubes for urine can carry germs. Surgical site infections, or SSIs, where the surgery wound gets infected, make up 20 to 25% of HAIs, and catheter-associated urinary tract infections, or CAUTIs, from urine tubes, make up 10 to 15% (Allegranzi et al., 2021; Horan et al., 2020). These infections make patients stay in the hospital 5 to 10 days longer, raise the chance of dying, and increase treatment costs, which can hurt families and hospitals (WHO, 2022).

In Nigeria, HAIs are a serious issue because the healthcare system has many problems. Hospitals often don’t have enough money to buy modern machines to clean surgical tools, and many nurses leave the country for better jobs, reducing the number of workers to care for patients (Ogoina et al., 2020; Afolabi & Ojo, 2025). Studies show that only about 55% of Nigerian nurses know a fair amount about how to stop infections, with just 40% washing their hands as often as they should and 50% using protective gear like gloves and masks correctly in private hospitals (Okafor & Musa, 2023; Adeyemi et al., 2024). These low numbers help explain why HAI rates in Nigeria are so high, much more than the World Health Organization’s goal of keeping HAIs below 5% in surgical wards (WHO, 2022). The Centers for Disease Control and Prevention says that simple steps like washing hands, wearing protective gear, cleaning surgical tools properly, and keeping hospital rooms clean can stop many HAIs, but only 40 to 60% of nurses worldwide follow these steps regularly, and in Nigeria, it’s even lower because of too many patients, not enough supplies, and lack of training (CDC, 2023).

Faith Mediplex Hospital in Benin City, Edo State, is a private hospital with 200 beds and is known for doing important surgeries like fixing broken bones, general operations, and brain surgeries. It takes care of 50 to 70 surgery patients every month, which means about 600 to 840 surgeries a year (Faith Mediplex Hospital, 2024). Even though it has better facilities than many hospitals in Nigeria, it still has a 15% HAI rate, with 10% being SSIs and 5% being CAUTIs. This is three times higher than what the World Health Organization wants. The hospital has problems like nurses not washing their hands enough, with only 58% following hand-washing rules, not enough protective gear, with only 40% of wards having all the gloves and masks needed, and old machines for cleaning surgical tools in 30% of surgery areas (Faith Mediplex Hospital, 2024). These issues make infections more common, cause patients to stay longer, and cost the hospital about ₦5 million every year to treat HAIs (Faith Mediplex Hospital, 2024). For example, if a patient’s surgery wound gets infected, they might need extra medicine, stay in the hospital for weeks, and face higher risks of getting sicker or even dying.

Nurses are the main people who can stop HAIs because they work closely with patients every day. They need to follow important rules, like washing their hands at five key times: before touching a patient, before doing clean tasks, after touching body fluids, after touching a patient, and after touching things around the patient. They also need to use clean methods for procedures and throw away medical waste safely (WHO, 2022). But at Faith Mediplex, nurses face big challenges. Each nurse often cares for 12 patients, which is twice the number recommended by experts, leaving little time to follow all the rules (Nwosu & Eke, 2024). Only 45% of nurses get training every year on how to stop infections, and many feel they need to work fast, so they skip steps like hand-washing (Ibrahim & Bello, 2025). Some nurses also think infections are normal in hospitals and not their fault, which makes them less careful (Nwosu & Eke, 2024). Tests show that nurses at Faith Mediplex have only average knowledge about stopping infections, scoring about 65% on infection control tests. They struggle with using complex cleaning machines, with only 35% knowing how to do it right, and only 50% follow rules for cleaning hospital rooms (Okafor & Musa, 2023).

This study uses a model called the Health Belief Model, created by Rosenstock in 1974, to understand why nurses do or don’t follow infection control rules (Rosenstock, 1974). This model says nurses will follow rules if they believe: HAIs are a real problem for patients, HAIs can cause serious harm like long hospital stays or death, following rules helps stop infections, things like lack of supplies or time make it hard, training or reminders encourage them to act, and they feel confident they can do the rules correctly. At Faith Mediplex, many nurses don’t feel confident because they don’t get enough training or have enough supplies, which stops them from doing their best to prevent infections (Ibrahim & Bello, 2025).

The high HAI rates at Faith Mediplex show there’s a big problem that needs to be fixed. Even though there are guidelines from the World Health Organization and Nigeria’s Infection Control Network, they aren’t working well enough at this hospital (WHO, 2022). Nurses don’t know enough, and they face problems like not having enough hand-washing stations in 60% of wards, spending a lot on gloves and masks, and using old cleaning machines (Adeyemi et al., 2024). These issues make HAIs more common, hurt patients, and cost the hospital a lot of money. Most studies in Nigeria look at public hospitals, not private ones like Faith Mediplex, which are important because they do many surgeries for people in Edo State, about 600 to 840 a year (Igiebor & Okungbowa, 2023). Also, not many studies look at both the numbers, like HAI rates and how often nurses follow rules, and the reasons why nurses struggle, like lack of time or supplies. This study will check how much nurses at Faith Mediplex know about stopping infections, see how their knowledge affects HAI rates, and find out what makes it hard for them to follow rules. By doing this, the study will suggest ways to lower HAIs, keep patients safer, and save money, helping Nigeria improve its healthcare and meet global goals for clean and safe hospitals.

Globally, the research contributes to the literature on infection control in resource-constrained settings, offering replicable strategies for hospitals in LMICs such as Kenya, India, and Ghana, where similar challenges like resource shortages and nurse migration persist (Mwangi & Otieno, 2024; Sharma & Gupta, 2022; Anarfi & Quartey, 2023). For patients, reduced HAI rates translate to shorter hospital stays, lower mortality risks, and decreased financial burdens, particularly for low-income surgical patients. Academically, the study bridges gaps in hospital-specific research, employs the HBM to contextualize infection control behaviors, and uses a mixed-methods approach to provide robust, triangulated insights. By addressing cultural and systemic barriers, the study promotes equitable healthcare delivery, enhancing patient safety and trust in private healthcare facilities like Faith Mediplex.

1.2 Statement of Problem

Despite global and national guidelines from WHO, CDC, and the Nigerian Infection Control Network (NICN), HAIs remain a significant challenge at Faith Mediplex Hospital, with a 15% incidence rate in surgical wards, compared to the global benchmark of <5% (WHO, 2022). Preliminary audits reveal moderate knowledge levels among nurses (mean score: 65% on standardized infection control assessments), with critical gaps in advanced sterilization techniques (35% proficiency), PPE compliance (40% consistent use), and environmental cleaning protocols (50% adherence) (Okafor & Musa, 2023). Systemic barriers include limited training opportunities (only 45% of nurses receive annual infection control training), resource shortages (60% of wards lack adequate handwashing stations), high patient-to-nurse ratios (1:12), and cultural attitudes that prioritize procedural efficiency over protocol adherence (Adeyemi et al., 2024; Nwosu & Eke, 2024). These deficiencies contribute to elevated HAI rates, particularly SSIs (10%) and CAUTIs (5%), resulting in prolonged patient recovery, increased antibiotic resistance, and healthcare costs estimated at ₦5 million annually for HAI management at Faith Mediplex (Faith Mediplex Hospital, 2024).

The lack of hospital-specific research limits the development of evidence-based interventions tailored to Faith Mediplex’s context. Existing studies in Nigeria focus on public hospitals or general infection control, neglecting private facilities like Faith Mediplex, which serve a significant portion of Edo State’s surgical patients (Igiebor & Okungbowa, 2023). Furthermore, the interplay between nurses’ knowledge, compliance, and HAI outcomes remains underexplored in the Nigerian context, particularly using mixed-methods approaches to capture both statistical trends and qualitative barriers. This study addresses these gaps by assessing nurses’ knowledge, evaluating its impact on HAI reduction, and identifying barriers to inform practical solutions, ultimately enhancing patient safety and healthcare quality.

1.3 Objectives of the Study

1. To comprehensively evaluate the knowledge levels of infection control measures among nurses in the surgical wards of Faith Mediplex Hospital, focusing on hand hygiene, PPE use, sterilization, and environmental cleaning.
2. To statistically and qualitatively assess nurses’ knowledge of infection control measures and the reduction of HAI rates (SSIs and CAUTIs) among surgical patients.
3. To identify barriers to implementing infection control measures.
4. To ascertain the effect of nurses’ knowledge and compliance with infection control measures on reducing HAI rates in surgical wards at Faith Mediplex Hospital

1.4 Research Questions

1. What is the level of knowledge of infection control measures among nurses in the surgical wards of Faith Mediplex Hospital?
2. Is there a significant correlation between nurses’ knowledge of infection control measures and the reduction of HAIs in surgical wards?
3. What are the barriers to implementing infection control measures?

4. What is effect of Reduction of Hospital-Acquired Infections on Patients

1.5 Significance of the Study

This study is very important because it will help many people and groups by showing how to reduce hospital-acquired infections, or HAIs, which are germs patients catch in the hospital. It will give clear information to make hospitals safer, help nurses do their jobs better, save money, and improve health care in Nigeria, especially at Faith Mediplex Hospital in Benin City, Edo State. The study will help the hospital by giving facts about what nurses know and what they need to do better to stop infections. Right now, Faith Mediplex spends about ₦5 million every year to treat HAIs, and 15 out of every 100 surgery patients get infections, which is too high (Faith Mediplex Hospital, 2024). This study will show the hospital how to improve training for nurses, get better supplies like gloves and masks, and fix old machines used to clean surgical tools, which are outdated in 30% of surgery areas (Faith Mediplex Hospital, 2024). By doing this, the hospital can lower infections, help patients get better faster, and save money, maybe cutting the ₦5 million cost by giving patients shorter stays and fewer medicines (Faith Mediplex Hospital, 2024). This will make the hospital run better and keep patients safer.

Nurses at Faith Mediplex will also benefit a lot from this study. Many nurses only know a fair amount about stopping infections, scoring about 65% on tests, and only 45% get training every year (Okafor & Musa, 2023; Ibrahim & Bello, 2025). The study will find out what they don’t know, like how to use complex cleaning machines or follow hand-washing rules, and suggest better training to help them feel more confident. This will make nurses better at their jobs, like washing hands at the right times or using protective gear correctly, which only 40% and 50% do now in private hospitals (Okafor & Musa, 2023; Adeyemi et al., 2024). The Nigerian Nursing and Midwifery Council, which sets rules for nurses, says nurses need to keep learning new skills (Afolabi & Ojo, 2025). This study will help nurses meet those rules by showing where they need more help, making them prouder and better at keeping patients safe.

Patients at Faith Mediplex will be safer because of this study. Right now, 15% of surgery patients get infections, like 10% with infected wounds and 5% with infections from urine tubes (Faith Mediplex Hospital, 2024). These infections make patients stay in the hospital longer, sometimes 5 to 10 days more, and increase the chance of getting sicker or dying (WHO, 2022; Allegranzi et al., 2021). By finding ways to lower infections, the study will help patients heal faster, go home sooner, and spend less money on extra treatments. This will make patients and their families happier and healthier, especially in Edo State, where Faith Mediplex does about 600 to 840 surgeries a year (Igiebor & Okungbowa, 2023).

The study will also help Nigeria’s health leaders, like the Edo State Ministry of Health and the Federal Ministry of Health, make better rules to stop infections in hospitals. Nigeria wants to improve health for everyone, which is part of a global plan called Sustainable Development Goal 3, supported by the World Health Organization (WHO, 2022). This study will show what’s not working at Faith Mediplex, like not enough hand-washing stations in 60% of wards or nurses caring for too many patients, about 12 each instead of the recommended 6 (Adeyemi et al., 2024; Nwosu & Eke, 2024). By sharing these findings, the study will help health leaders make plans to give hospitals more money, better tools, and more nurses, which could lower HAI rates across Nigeria (Afolabi & Ojo, 2025). It will also support Nigeria’s Infection Control Network by showing how private hospitals like Faith Mediplex can follow better cleaning rules (WHO, 2022).

Overall, this study will make a big difference by helping Faith Mediplex lower its 15% infection rate, which is much higher than the world’s goal of under 5% (WHO, 2022). It will help nurses learn more and feel confident, make patients safer, and save the hospital money. It will also give Nigeria’s health leaders ideas to improve hospitals everywhere, making health care better and safer for all Nigerians, especially in private hospitals like Faith Mediplex that do many important surgeries (Igiebor & Okungbowa, 2023). By doing this, the study will help Nigeria meet its health goals and match global standards for clean and safe hospitals, keeping more people healthy and happy (WHO, 2022).

1.6 Scope of Study

The study focuses on registered nurses working in the surgical wards (orthopedic, general, and neurosurgery) of Faith Mediplex Hospital, Benin City, during the 2025–2026 period. It assesses their knowledge of infection control measures (hand hygiene, personal protective equipment use, sterilization, environmental cleaning) and their impact on reducing hospital-acquired infections, specifically surgical site infections and catheter-associated urinary tract infections. The study excludes non-nursing staff, nurses in non-surgical wards, and other hospital-acquired infection types (for example, ventilator-associated pneumonia, central line-associated bloodstream infections) to maintain specificity. Data collection spans six months, using quantitative surveys and qualitative interviews, with analysis grounded in the Health Belief Model. The geographical scope is limited to Faith Mediplex Hospital, ensuring context-specific findings applicable to private tertiary facilities in Edo State.

1.7 Operational Definition of Terms

• Infection Control Measures: Evidence-based protocols to prevent HAIs, including WHO’s Five Moments for Hand Hygiene, proper PPE use, sterilization of surgical instruments, and environmental cleaning, as practiced by nurses in surgical wards.
• Hospital-Acquired Infections (HAIs): Infections acquired by patients ≥48 hours post-admission, including SSIs and CAUTIs, measured via hospital records and infection surveillance data.
• Knowledge: Nurses’ understanding of infection control protocols, assessed through a validated 30-item Likert-scale questionnaire and semi-structured interviews.
• Surgical Wards: Specialized units at Faith Mediplex Hospital managing postoperative patients undergoing orthopedic, general, and neurosurgical procedures.
• Health Belief Model (HBM): A theoretical framework explaining nurses’ infection control behaviors through perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy (Rosenstock, 1974).
• Compliance: The extent to which nurses adhere to infection control protocols, measured by self-reported practices and observational audits.