Abstract
Background: Knowledge of healthcare workers (HCWs) is essential for the effective implementation of Infection Prevention and Control (IPC) measures. Inadequate understanding of IPC guidelines, negative attitudes, and poor IPC practices are major barriers to compliance, contributing to healthcare-associated infections (HCAIs). HCAIs are a leading cause of increased morbidity, extended hospital stays, poor patient outcomes, and rising healthcare costs, particularly in the public health sector. HCWs are entrusted with delivering safe, high-quality, and cost-effective care, and failure to adhere to IPC protocols, often due to limited knowledge, low awareness, or non-compliance, can result in avoidable harm. This study aimed to assess the knowledge, attitudes, and practices (KAP) of HCWs regarding IPC and to identify potential barriers to IPC compliance in two public hospitals located in Bethlehem, Free State Province.
Methods: A cross-sectional survey using a structured, self-administered paper-based questionnaire was conducted among 204 HCWs. Descriptive, bivariate, ANOVA, and logistic regression analyses were performed using SPSS software.
Results: The study participants demonstrated good knowledge of IPC, with a mean score of 83.1% according to Bloom’s taxonomy. However, attitudes toward IPC were moderate, and actual implementation of IPC practices was relatively poor, with a mean score of 57.2%. Analysis of variance (ANOVA) indicated statistically significant differences in knowledge scores across professional groups (F = 11.390; p < 0.001; 95% CI: 3.16–3.56), suggesting that professional role influences IPC knowledge. A moderate negative correlation was observed between level of education and prior IPC training (r = –0.328), suggesting that more educated participants were less likely to have received IPC training. Bivariate analysis showed a weak positive, non-significant correlation between education level and work experience (r = 0.083; p = 0.237). Logistic regression analysis revealed that education level was a significant predictor of prior IPC training exposure (COR = 0.721; p < 0.001; 95% CI: 0.671–0.842), whereas work experience was not a reliable predictor of IPC compliance. The regression model accurately predicted IPC training exposure in 143 participants (accuracy = 97.3%), with an overall prediction level of 73.0%. Further analysis of practice-related questions showed that only 79.4% of participants were trained on the "Five Moments for Hand Hygiene," despite 99.0% acknowledging that handwashing is part of their professional role. Additionally, 61.6% correctly identified that patients are not the only source of infection, indicating persistent misconceptions about transmission sources. These findings highlight critical gaps in IPC practice and emphasise the need for targeted educational reinforcement. A weak positive
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correlation was also found between previous IPC training and availability of IPC resources (r = 0.118). This suggests that while resource availability may slightly support training outcomes, it is not a dominant enabler.
Conclusion: This study found that while HCWs in Bethlehem have good IPC knowledge, their attitudes were moderate and practices poor, highlighting a critical gap between knowledge and implementation. Education level predicted IPC training exposure but not compliance, emphasising the need for continuous, role-specific training and improved workplace support. Addressing systemic barriers through targeted interventions is important to strengthen IPC adherence and reduce HCAIs.