Sociodemographic characteristics of the study participants

The respondents’ median (IQR) age was 29.5 (27.0–34.0) years. Two hundred twenty-six (53.6%) of them were male and 228 (44%) were married. First-degree education was attended by 327 (77.5%) of the study participants, while 74 (17.5%) had attended master’s level education and above (Table 1).

Table 1 Socio-demographics characteristics of the study participants Addis Ababa, Ethiopia (n = 422)Employment-related information among HCWs working in public hospitals

The majority of the study participants 304 (72%) were nurses/midwives, while physicians accounted for 81 (19.2%) of the total. Among healthcare workers, 113 (26.8%) worked in emergency units, and 82 (19.4%) worked in surgical wards. Furthermore, a significant portion of the participants, 349 (82.7%) were immunized against hepatitis B virus and 334 (79%) against COVID-19 (Fig. 1).

Table 2 Knowledge of infection prevention and control standard precautions of HCWs in public hospitals in Addis Ababa, Ethiopia 2023 (n = 422)Healthcare workers’ knowledge of infection prevention and control standard precautions

The majority of study participants in the study, comprising 379 (89.8%) viewed every client and patient as potentially infectious or vulnerable to infection. Moreover, 254 (60%) believed that standard precautions should be applied for all individuals seeking healthcare services. Notably, only 306 (72.5%) of the study participants were aware that SPs should be applied for blood, body fluids, secretions, excretions (excluding sweat), mucous membranes, and non-intact skin.

About 376 (89%) of the study participants, knew that hand hygiene is the single most important intervention for preventing the spread of infections, and 348 (82.5%) were aware of the five moments of hand hygiene. Furthermore, 318 (75.4%) of the participants are aware that it is advisable to perform hand hygiene after handling the same patient for a while.

Regarding PPE, 343 (81.3%) are aware that an HCW must assess the circumstances before using it, and 384 (91.0%) are aware that an HCW should wear gloves if there is a chance that he/she will come in contact with non-intact skin, mucous membranes, or bodily fluids. To prevent needle-stick injuries, only 171 (40.5%) people are aware that needles should not be recapped after usage.

Most participants 380 (90.0%) knew that patient care equipment should be cleaned between each patient use to prevent cross-contamination. However, only 326 (77.3%)of participants knew the steps for reprocessing medical and surgical devices using sterilization or high-level disinfection, and 371 (87.9%) see the need to clean environmental surfaces around the patient in the patient care area to prevent infection.

Most participants 315 (74.6%) knew the importance of segregating infectious waste at the place where waste was generated, and 393 (93.1%) knew that adherence to standard precautions can prevent healthcare-associated infections. In addition, 381 (90.3%) of the study participants agreed that adherence to standard precautions could prevent the spread of antimicrobial resistance (Table 2).

Table 3 HCWs compliance with infection prevention and control standard precautions in public hospitals in Addis Ababa, Ethiopia 2023 (n = 422)Knowledge of various components of the standard precautions among different professional categories

Majority of physicians 63 (77.8%), nurses 227 (74.7%), and laboratory professionals 32 (86.5%) had a good level of knowledge of hand hygiene. Similarly, majority of professionals demonstrated a solid understanding of personal protective equipment (physician: 71 (87.7%), nurses: 265 (87.2%), laboratory professionals: 33 (87.2%). Furthermore, regarding safe injection practices (physicians: 73 (90.1%), nurses: 268 (87.2%), laboratory professionals: 33 (89.2%) have good knowledge.

Instrument reprocessing was the category with the lowest reported knowledge across all professional categories, with physicians reporting the lowest knowledge at 50 (61.7%). Cleaning and disinfection were well understood across all categories, with laboratory professionals 33 (89.2%) demonstrating the most knowledge, followed by nurses 269 (88.5%) and physicians 69 (85.2%).

Medical and surgical instrument reprocessing was generally well understood across all categories; 50 (72.8%) of physicians, 233 (74.3%) nurses, and 23 (81.1%) of laboratory professionals knew about reprocessing and similar proportions of all categories reported healthcare waste management (physicians: 59 (72.8%), nurses 226 (74.3%), laboratory professionals: 30 (81.1%) (Fig. 2).

Fig. 1

Employment-related information of the health care workers in public hospitals in Addis Ababa, Ethiopia 2023 (n = 422)

Fig. 2

Knowledge of various components of the standard precaution among different professional categories in public hospitals Addis Ababa, Ethiopia 2023(N = 422)

Healthcare workers’ compliance with infection prevention and control standard precautions

Table 3 demonstrates the HCWs’ level of compliance with different components of infection prevention and control standard precautions. One hundred eighty-nine (44.8%) and 139 (32.9%) of the HCWs reported that they wash/sanitize their hands before touching the patient “sometimes” and “always” respectively.

Table 4 Bivariate and multivariable ordinal logistic regression on factors associated with hcws compliance in public hospitals Addis Ababa, Ethiopia 2023 (n = 422)

Only 192 (45.5%) of the study participants “always” wash/sanitize their hands before performing clean or aseptic procedures. Most participants 309 (73.2%) “always” wash/sanitize their hands after exposure to body fluids.

Concerning was the fact that only 171(40.5%) of HCWs washed/sanitized hands ‘’sometimes’’ after touching the patients, and 196 (46.4%) indicated that they “always” sanitized/washed their hands when opportunities were there. About 172 (40.8%) of the HCWs washed/sanitized their hands “always” immediately after removing used gloves.

Regarding the washing/sanitizing of hands between patient contacts, 134 (31.8%) of the study participants are “always” compliant, and 173 (41.0%) washed/sanitized their hands “sometimes” after touching patients’ surroundings.

Two hundred seven (49%) of the HCWs “always” considered all patients potentially infectious/susceptible to infection during care. However, 259 (61.4%) of respondents reported, “always” protecting themselves using protective barriers regardless of the patient’s diagnosis. Two hundred and seventy-two (64.5%) of HCWs of all different professional categories indicated that they “always” changed gloves between different patients. Of these, 104 (24%) of them “sometimes” changed gloves between patients. Hundred fifty-two (36.0%) of the participants “always” wear plastic/rubber aprons whenever there is the possibility of body fluids splashing, and 143 (33.9%) of HCWs “sometimes” wear plastic/rubber aprons when indicated.

On reused, medical and surgical equipment cleaning and disinfection, and sterilization, 244 (57.8%) of respondents were “always” adhering to these practices. Two hundred seventy-four (64.8%) of the study participants were “always” compliant with cleaning and disinfecting frequently touched surfaces.

Compliance with healthcare waste management at the point of generation was relatively good with 254 (60.2%) and 266 (63.0%) respondents reporting compliance with waste segregation based on the contamination level and disposal into designated waste bins. Two hundred and seventy-two (64.5%) respondents indicated that they never bend needles by hand, avoiding contact with sharp boxes 244(57.8%), and 287(68.0%) of the participants were compliant with disposing of used needles and sharps into puncture-resistant boxes. However, only 197 (46.7%) of HCWs indicated that they never recap needles after each use (Table 3).

Factors associated with Healthcare workers’ compliance with infection prevention and control standard precautions

In bivariable ordinal logistic regression sex, marital status, education status, work experience, department, profession, training in IPC, presence of mechanism to enforce/support IPC practices, PPE availability, presence of resources for waste disposal and segregation, water services, work environment flow pattern and activity, adequacy, and sustainability of cleaning and disinfection agents were identified as candidate variables for the multivariable analysis. However, after controlling the effects of confounding only, working experience, department, profession, IPC training, a mechanism to enforce IPC practices, and adequacy and sustainability of cleaning and disinfection were significantly associated with compliance with IPC standard precautions in multivariable ordinal logistic regression.

Healthcare workers who had accumulated 5–8 years of professional experience exhibited a higher likelihood of adhering to standard precautions, in comparison to HCWs with 3–5 years of experience. This increased adherence was significantly associated with optimal compliance, as indicated by the adjusted odds ratio (AOR = 2.43, 95% Cl = 1.12–5.27, p = 0.025. Likewise, HCWs in the gynecology and obstetrics department had four times the odds of compliance compared to those in the medical ward (AOR = 3.87, 95% CI = 1.53–9.75, p = 0.004). Nurses/midwives had higher odds than physicians of having optimal compliance (AOR = 2.29, 95% CI = 1.31–4.04, p = 0.004). HCWs who received IPC training were more likely to have sub-optimal and optimal compliance than those who did not (AOR = 1.813, 95% CI = 1.065–3.086, p = 0.028).

HCWs with optimal knowledge of standard precautions are more likely to comply with SPs than those with sub-optimal knowledge (AOR 3.46, 95% Cl = 1.83–6.54, p < 0.001). HCWs who work in hospitals with mechanisms to support/enforce IPC practice are more likely to comply with standard precautions than those who work in hospitals without such mechanisms (AOR = 1.71, 95% Cl = 1.01–2.89, p = 0.046).

Finally, when cleaning and disinfection agents were consistently provided, healthcare workers (HCWs) were more likely to comply with infection prevention and control standards (AOR = 2.18, 95% Cl = 1.15–4.13, p = 0.017) compared with when these chemicals were not (Table 4).