Infection Control Knowledge, Attitudes, and Practices among Health Care Workers at Mulago Hospital, Kampala, Uganda

Background: Mulago Hospital is a 1500-bed, national referral hospital in Kampala, Uganda.  An infection control team exists, but lack of resources limit its effectiveness.

Objective: To determine the knowledge, attitudes, and practices (KAP) of infection control principles among health care workers (HCWs) in the national referral hospital of Kampala, Uganda.

Methods: Between June and November 2009, we carried out a 66-item, KAP survey of all health care workers including nurses, residents, and attending physicians.  Domains included hand hygiene, barrier protection, isolation and contact precautions, and prevention of mosquito-borne transmission of disease.  Four-point Likert scales were used to assess knowledge and attitudes (strongly agree, agree, disagree, strongly disagree) and practices (all of the time, most of the time, some of the time, never).  Responses were compared across groups using Pearson's chi-square and Fisher's exact tests.

Results: Of the 161 HCWs approached, 146 (91%) completed the survey including 94 (63%) nurses and midwives, 33 (23%) physicians, 14 (10%) nursing or clinical assistants, and 5 (3%) other  HCWs.  While almost all HCWs (99%) knew to wash their hands between patients, 75% of HCWs disagreed with the fact that their hands, when unclean, were a common way in which infections are spread.  The latter varied significantly by occupation (87% for physicians, 77% for nurses, 57% for assistants, 40% for other HCWs; p=0.038). While 98% reported washing their hands to protect themselves from infections, less (81%) did so to protect their patients from infections. Less than half (48%) of HCWs reported having easy access to clean water in between patients.

Almost all HCWs (97%) believed that crowded conditions spread infections (97%) but only 60% believed that separating patients with respiratory infections was feasible in their hospital and 61% reported that their ward separated patients with an active respiratory infection from those without.

When required, gloves were the most commonly used barrier protection used (95%), followed by masks (61%), gowns (47%), eye protection (34%), and bed nets (26%).  Only 60% knew to whom to ask questions regarding infection control and 16% believed their hospital had adequate resources to prevent the spread of infections.

Conclusions: Overall, HCWs had adequate knowledge of infection control principles, although there were some gaps regarding hand hygiene.  HCWs at Mulago Hospital in Kampala, Uganda were unable to adequately practice infection control principles due to a lack of time or inconsistent availability of resources.