Abstract
Background
In the context of Cameroon, where maternal and neonatal mortality remain a serious concern, unsystematic compliance with standard precautions increases the risk of healthcare-associated infections (HAIs) and other medical hazards. The present investigation aimed at assessing the baseline understanding of hand hygiene principles and perceptions, experience of occupational exposure to body fluids, and preventive vaccination coverage among HCWs in the obstetrics-gynecology ward of a referral hospital in Yaoundé.
Methods
A descriptive cross-sectional study was conducted in the obstetrics-gynecology department of the health facility from April to July 2024. A self-administered questionnaire, adapted from the WHO Knowledge Questionnaire for Health Care Workers, was used to collect data from consenting HCWs.
Results
A total of 41 healthcare workers participated in the study. Participants were predominantly female (78%) and ranged in age from 20 to 57 years. Overall staff knowledge of hand hygiene was average, with a median score of 60%. The majority of respondents considered hand hygiene an essential part of their care (90%). A significant proportion of paramedical staff (82%) agreed they had been properly trained on hand hygiene during their training (p = 0.006). More than half of respondents (59%) experienced an accidental exposure to body fluids in the previous 12 months. A high level of education was a significant factor associated with occurrence of occupational exposure to blood and other body fluids (aOR = 14.2; p = 0.044). The coverage of fully vaccinated HCWs was 27% for hepatitis B, 19% for COVID-19, and 0% for cholera. Factors associated with low adherence to vaccination included having received no training in ICP interventions (aOR = 7.4; p = 0.046) for hepatitis B vaccination and having completed tertiary education (aOR = 43.6; p = 0.043) for COVID-19. Half of the HCWs exposed (12/24 = 50%) to blood and body fluids were not fully vaccinated against hepatitis B.
Conclusions
This study revealed gaps in knowledge of hand hygiene, high occupational exposure to biological fluids, and low vaccination coverage. Health facility managers and national health authorities must therefore commit to implementing specific strategies to increase staff training in standard precautions and promote vaccination.
Keywords: Standard precautions, Hand hygiene, Knowledge and perception, Occupational exposure to blood, Vaccination, Hepatitis B, COVID-19, Cameroon
Background
Standard precautions are infection control and prevention (ICP) measures designed to reduce the risk of transmission of infectious agents from both recognized and unrecognized sources to healthcare workers (HCWs), patients, and visitors in healthcare settings [1]. Among these standard precautionary measures, hand hygiene plays a critical role as it offers a simple, yet effective, solution for limiting the spread of infectious agents across healthcare settings, from advanced systems to primary healthcare centers [2, 3].
Unsystematic compliance with these measures increases the risk of healthcare-associated infections (HAIs) and other medical hazards [4]. The high incidence of HAIs, which are among the leading adverse events in healthcare settings, compromises the global healthcare landscape [5]. Globally, nearly 9 million HAIs occur each year, resulting in approximately 1 million deaths, with low- and middle-income countries bearing a disproportionate share of this burden [6, 7].
A study conducted in Cameroon revealed a cumulative incidence rate of HAIs of 3.7/1000 patient-days, with urinary tract infections being the most common [8]. After malaria, urinary tract infection complications are the most common among hospitalized women in the gynecology and obstetrics department in Cameroon [9]. These HAIs can lead to prolonged hospital stays and an increased economic burden, as the healthcare finance system relies on out-of-pocket payments from patients [10]. Moreover, these HAIs often occur as a result of inadequate delivery services, which can result in significant puerperal (9–17%) and post-cesarean wound (2–32%) infections whose complications increase the risk of maternal death [9, 11, 12].
Despite global recommendations, compliance with standard precautions remains challenging in low-resource settings such as Cameroon, where the burden of occupational exposure to body fluids is high across all health facility categories [13–15]. A meta-analysis conducted in Cameroon revealed a prevalence of occupational exposure to blood and other body fluids ranging from 40 to 70% among HCWs, largely due to poor adherence to standard precautions [16]. This exposure can lead to serious and potentially life-threatening diseases, including hepatitis B, COVID-19, cholera, measles, varicella, and other pathogens transmitted through blood and other body fluids [17].
To prevent these bloodborne infections, the vaccination of HCWs is one of the most cost-effective strategies. However, several factors have been identified as potential barriers to HCW vaccination in Cameroon [18–20]. Such barriers, beyond economic accessibility, include vaccine hesitancy, which leads to the refusal or delayed acceptance of vaccines despite the availability of immunization services [21, 22]. Study reports highlight various factors that contribute to this hesitancy, including perceptions of disease risk and severity, mistrust of vaccines, fear of needles and adverse events, vaccine cost, and societal factors such as social norms and religion [14, 20, 21]. These concerns have been fueled by the emergence of COVID-19 and the rapid development of preventive vaccines [20, 22].
To address this issue, sustained efforts are needed to identify and implement effective response strategies [2, 23]. Such strategies will aim at improving the observance of infection prevention measures, including preventive vaccination, among healthcare workers. This is crucial, as healthcare workers are a pillar of the healthcare system and are responsible for providing quality healthcare to mothers and their newborns in obstetrics and gynecology departments [24].
To support data-driven decision-making, an assessment of health facilities providing maternal and neonatal care was needed. The objective of this investigation was to assess the compliance with standard precautions, including preventive vaccination, among HCWs in the obstetrics-gynecology ward of a referral hospital in Yaoundé.
Methods
Design and period
This study was an institutional-based cross-sectional study with descriptive and analytical aims. Data were collected over a three-month period (April to July 2024) in a referral hospital in Yaoundé.
Setting
Yaoundé is a city of approximately 3.2 million inhabitants served by first, second, third, and fourth-level health facilities. Yaoundé is the political capital of Cameroon, with an estimated metropolitan population exceeding 4.3 million in recent years. This study setting is a leading public health institution, serving as the fourth level of reference in the national health pyramid and providing specialized health services. It has a capacity of 138 beds and receives a significant number of patients, with 500 to 1,000 admissions per week [25–27].
Participant and sampling
A total population sampling approach was used to enroll all consenting participants among the 48 HCWs present in the obstetrics-gynecology ward during the study period. These included residents, nurses, midwives/obstetric nurses, nursing assistants, and students.
Data collection tool and procedures
A pre-tested and self-administered questionnaire addressed to HCWs was adapted from the knowledge assessment tool developed by WHO [2, 28]. It included items related to demographic characteristics, hand hygiene, occupational exposure to body fluids, and vaccination against hepatitis B, COVID-19, and cholera.
Statistical analysis
Descriptive analysis
A score of 1 was assigned for each correct response to the hand hygiene knowledge assessment, and the scores were classified into three categories: good (≥ 75%), average (50–74%), and poor (< 50%) [29]. Data were checked, coded, and analyzed using R Statistics version 4.3.3. Fisher’s exact probability test was used to compare proportions. The QQ diagram was used to assess the distribution of quantitative variables against the normal distribution. The non-parametric Kruskal-Wallis’s test was used to compare median scores between three or more study groups.
Regression modelling
Simple binary logistic regressions were used to assess the strength of association between independent variables and occupational exposure during the last 12 months, full vaccination against COVID-19, and hepatitis B. A multiple binary logistic regression was used to remove potential confounders from the model, using Akaike’s Information Criterion (AIC) to progressively select the best predictors that fit the model. Confidence intervals (CIs) were estimated at the 95% level. A p-value < 0.05 was considered statistically significant.
Variables and operational definition
The student variable represented those undergoing training in general medicine who were on placement in the gynecology-obstetrics department. The term resident referred to students undergoing specialization in the gynecology-obstetrics unit. The professional group variable included medical staff (residents), paramedical professionals (nurses, midwives/obstetric nurses, assistant nurses), and medical students. The term knowledge referred to the understanding, awareness, and accurate recall of factual information. The perception assesses healthcare worker’s beliefs, attitudes, and subjective understanding or interpretation of standard precautions. The term practice referred to as the observable actions or reported behaviors of healthcare workers in consistently applying recommended standard precaution measures during their daily clinical activities to prevent the transmission of infections.
Participants were considered fully vaccinated if they had received at least three doses of hepatitis B vaccine according to the recommended schedule. For the COVID-19 vaccine, anyone who had received at least one dose of the Janssen vaccine or at least two doses of the Sinopharm or AstraZeneca vaccine was considered fully vaccinated.
Ethical approval and informed consent
This study received ethical clearance from the Institutional Research Ethics Committee (CIER) of the Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, under protocol number 1017/UYI/FMSB/VDRC/DAASR/CSD. Additional approval was obtained from the General Management of the health facility. Written informed consent was obtained from all participants prior to their enrollment in the study. All procedures adhered strictly to the tenets of the Declaration of Helsinki.
Results
Among 47 contacted HCWs, 46 (98%) participated, with 41 (89%) returning fully completed questionnaires.
Socio-professional characteristics of study participants
Participants ranged in age from 20 to 57 years, with a median age of 30 [22; 47] years. They were predominantly female (78%) and had higher education (73.2%). Their median work experience was 3 [3; 19] years.
Hand hygiene knowledge
A total of 28 out of 41 (68%) respondents identified hand hygiene before touching a patient as the ideal time to prevent the transmission of germs. However, eight out of 41 (20%) had poor knowledge of the ideal time for this practice. Ten out of 41 (24%) had good knowledge of the minimum duration of action of hydroalcoholic gel. Medical staff (5/8 = 63%) had significantly better knowledge (p = 0.027) (Table 1).
Table 1.
Hand hygiene knowledge of healthcare workers in the gynecology-obstetrics department, May 2024 (n = 41)
| Assessed knowledge | Total | Professional group n (%) |
p-value1 | ||
|---|---|---|---|---|---|
|
Medical 8 (100) |
Paramedical 23 (100) |
Student 10 (100) | |||
| Timing of hand hygiene to prevent transmission of germs to the patient | |||||
| Immediately before a clean/aseptic procedure (Yes) | 12 (29) | 2 (25) | 7 (30) | 3 (30) | > 0.999 |
| Immediately after exposure to body fluids (Yes) | 12 (29) | 2 (25) | 7 (30.4) | 3 (30) | > 0.999 |
| Before touching a patient (Yes) | 28 (68) | 7 (88) | 13 (57) | 8 (80) | 0.202 |
| After exposure to the patient’s immediate environment (No) | 8 (20) | 3 (38) | 3 (13) | 2 (2) | 0.322 |
| Minimum duration of efficacy of hydroalcoholic gel (20 s) | 10 (24) | 5 (63) | 4 (17) | 1 (10) | 0.027 |
| Elements associated with an increased probability of germ colonization of hands | |||||
| Injured skin (Yes) | 24 (59) | 4 (50) | 13 (57) | 7 (70) | 0.755 |
| Wearing jewelry (Yes) | 20 (49) | 3 (38) | 10 (43) | 1 (10) | 0.214 |
| Artificial nails (Yes) | 26 (63) | 5 (63) | 16 (70) | 5 (50) | 0.564 |
| Regular use of hand cream (No) | 2 (5) | 0 (0) | 2 (9) | 0 (0) | > 0.999 |
| Best method of hygiene in each situation | |||||
| Before palpating an abdomen (Hydroalcoholic gel) | 26 (63) | 6 (75) | 14 (61) | 6 (60) | 0.822 |
| After removing examination gloves (Washing) | 31 (76) | 7 (86) | 17 (74) | 7 (70) | 0.785 |
| Before administering an injection (Hydro-alcoholic gel) | 19 (46) | 5 (63) | 9 (39) | 5 (50) | 0.534 |
| After emptying a bedpan (Washing) | 36 (88) | 7 (88) | 20 (87) | 9 (90) | > 0.999 |
| After making the patient’s bed (Hydro-alcoholic gel) | 15 (37) | 1 (13) | 10 (43) | 4 (40) | 0.369 |
| After exposure to blood (Washing) | 37 (90) | 7 (88) | 21 (91) | 9 (90) | > 0.999 |
| Knowledge score | |||||
| Median score | 60 | 57 | 60 | 60 | 0.9(2) |
| Interquartile range | 53–67 | 53–63 | 50–67 | 48–65 | |
1 Fisher exact probability test; 2 Kruskal-Wallis’s test
Perception and practice of hand hygiene
Most of respondents reported that they always practiced hand hygiene (36/41 = 88%) and considered it an essential part of their care (37/41 = 90%). Sixteen out of 41 (39%) disagreed with the statement that no hand hygiene courses were offered in their departments (Fig. 1).
Fig. 1.
Attitudes and practices related to hand hygiene among healthcare workers at the gynecology-obstetrics unit, May 2024 (n = 41)
Most of paramedical staff (21/23 = 82%) significantly agreed that they had been properly trained on hand hygiene during their training (p = 0.006). In contrast, medical students were less likely to agree with this statement (20%) (Table 2).
Table 2.
Attitudes and practices relating to hand hygiene according to professional group in the gynecology-obstetrics department, May 2024 (n = 41)
| Attitude & Practice | Professional group n (%) |
p-value1 | |||
|---|---|---|---|---|---|
| Medical 8 (100) |
Paramedical 23 (100) |
Student 10 (100) |
|||
| I adhere to correct hand hygiene at all times | > 0.999 | ||||
| Agree | 7 (88) | 20 (87) | 9 (90) | ||
| Neutral | 1 (13) | 2 (9) | 1 (10) | ||
| Disagree | 0 (0) | 1 (4) | 0 (0) | ||
| Wearing gloves reduces the need for hand hygiene | 0.969 | ||||
| Agree | 2 (25) | 8 (35) | 3 (30) | ||
| Neutral | 1 (13) | 3 (13) | 2 (20) | ||
| Disagree | 5 (62) | 12 (52) | 5 (50) | ||
| I was properly trained in hand hygiene during my training | 0.006 | ||||
| Agree | 4 (50) | 21 (82) | 4 (40) | ||
| Neutral | 3 (37) | 1 (4) | 4 (40) | ||
| Disagree | 1 (13) | 1 (4) | 2 (20) | ||
| Compliance with correct hand hygiene is easy in my department | 0.154 | ||||
| Agree | 2 (25) | 16 (70) | 4 (40) | ||
| Neutral | 2 (25) | 3 (13) | 3 (30) | ||
| Disagree | 4 (50) | 4 (17) | 3 (30) | ||
| Hand hygiene is essential to my work in the department | 0.625 | ||||
| Agree | 7 (88) | 20 (87) | 10 (100) | ||
| Neutral | 1 (13) | 3 (13) | 0 (0) | ||
| Infection control leaflets remind me about hand hygiene | 0.851 | ||||
| Agree | 5 (62) | 14 (61) | 8 (80) | ||
| Neutral | 2 (25) | 6 (26) | 2 (20) | ||
| Disagree | 1 (13) | 3 (13) | 0 (0) | ||
| Hand hygiene courses are not organized in my unit | 0.143 | ||||
| Agree | 3 (37) | 9 (39) | 4 (40) | ||
| Neutral | 4 (50) | 4 (17) | 5 (50) | ||
| Disagree | 1 (13) | 10 (44) | 1 (10) | ||
1Fisher exact probability test
Occupational exposure to body fluids
A total of 24 HCWs out of 41 (59%) experienced an accidental exposure to biological fluids in the last 12 months. Splashes were the main cause of exposure (23/24 = 96% of cases), followed by percutaneous exposure (4/24 = 17%).
The biological fluids most frequently involved were blood (12/24 = 50%) and amniotic fluid (11/24 = 46%) (Fig. 2).
Fig. 2.
Reported types of biological fluids involved in occupational exposures by health care workers in the gynecology-obstetrics, May 2024 (n = 24)
Univariate analysis revealed two factors significantly associated with occupational exposure to biological fluids: grade (cOR = 11; p = 0.046) and hepatitis B vaccination status (cOR = 7.5; p = 0.018). Multivariate analysis revealed that healthcare workers with a higher level of education were significantly 14 times more likely to be accidentally exposed to biological fluids than those with a secondary level of education (aOR = 14.2; p = 0.044). In addition, half of the staff exposed (12/24 = 50%) to blood and body fluids were not fully vaccinated against hepatitis B (Table 3).
Table 3.
Simple and multiple binomial logistic regressions of parameters associated with occupational exposures to biological fluids among healthcare workers in the gynecology-obstetrics, May 2024 (n = 41)
| Factor | Exposition n (%) |
Total n | cOR | p-value | aOR | 95% CI limits | p-value2 | ||
|---|---|---|---|---|---|---|---|---|---|
|
Yes 24 (58) |
No 17 (42) |
Lower | Upper | ||||||
| Age 1 | |||||||||
| ˂25 | 8 (53) | 7 (47) | 15 | 1 | |||||
| 25–34 | 8 (89) | 1 (11) | 9 | 7.0 | 0.099 | ||||
| 35–44 | 2 (40) | 3 (60) | 5 | 0.6 | 0.607 | ||||
| 45 + | 6 (50) | 6 (50) | 12 | 0.9 | 0.863 | ||||
| Gender | |||||||||
| Male | 5 (56) | 4 (44) | 9 | 1 | 1 | ||||
| Female | 19 (59) | 13 (41) | 32 | 1.2 | 0.837 | 2.3 | 0.3 | 24.1 | 0.451 |
| Marital status | |||||||||
| Single | 16 (55) | 13 (45) | 29 | 1 | 1 | ||||
| Married | 8 (67) | 4 (33) | 12 | 1.6 | 0.498 | 1.9 | 0.3 | 16.3 | 0.520 |
| Educational level | |||||||||
| Secondary | 4 (36) | 7 (64) | 11 | 1 | 1 | ||||
| Higher | 20 (67) | 10 (33) | 30 | 3.5 | 0.089 | 14.2 | 1.1 | 503 | 0.044 |
| Grade | |||||||||
| Nurse | 5 (38) | 8 (62) | 13 | 1 | 1 | ||||
| Resident | 7 (87) | 1 (13) | 8 | 11.2 | 0.046 | 12.1 | 0.8 | 483 | 0.112 |
| Midwife/Obstetric nurse | 5 (71) | 2 (29) | 7 | 4.0 | 0.170 | 1.1 | 0.1 | 24.8 | 0.966 |
| Nurse-assistant | 2 (67) | 1 (33) | 3 | 3.2 | 0.389 | 9.4 | 0.3 | 596 | 0.214 |
| Student | 5 (50) | 5 (50) | 10 | 1.6 | 0.581 | 2.4 | 0.2 | 43.7 | 0.510 |
| Professional group | |||||||||
| Student | 5 (50) | 5 (50) | 10 | 1 | |||||
| Paramedical | 12 (52) | 11 (48) | 23 | 1.1 | 0.908 | ||||
| Medical | 7 (87) | 1 (13) | 8 | 7.0 | 0.117 | ||||
| Professional experience 1 1 | |||||||||
| ˂5 | 15 (68) | 7 (32) | 22 | 1 | |||||
| 5 + | 9 (47) | 10 (53) | 19 | 0.4 | 0.181 | ||||
| Professional experience 2 1 | |||||||||
| ˂10 | 16 (67) | 8 (33) | 24 | 1 | |||||
| 10 + | 8 (47) | 9 (53) | 17 | 0.4 | 0.212 | ||||
| Hepatitis B vaccination status | |||||||||
| Unvaccinated | 12 (44) | 15 (56) | 27 | 1 | |||||
| Vaccinated | 12 (86) | 2 (14) | 14 | 7.5 | 0.018 | ||||
1Unit in years; 2Fisher exact probability test; cOR: crude Odds Ratio; aOR: adjusted Odds Ratio; CI: Confidence interval
Most of HCWs (73%) reported that there were no posters on the ward about management of accidental exposures to blood and other biological fluids.
Compliance with preventive vaccination
The coverage of fully vaccinated HCWs was 27% for hepatitis B and 19% for COVID-19. However, no participant was fully vaccinated against cholera, with a small proportion partially vaccinated (5%) (Fig. 3).
Fig. 3.
Vaccination coverage against hepatitis B, COVID-19 and cholera among health workers in the gynecology-obstetrics department, May 2024 (n = 41)
Hepatitis B vaccination
The results of the multivariate analysis showed that the following factors were associated with low adherence to hepatitis B vaccination:
Age: workers aged 45 and over were three times more likely not to be vaccinated than those aged under 25 (aOR = 2.6).
Gender: Men were three times more likely not to be vaccinated than women (aOR = 2.8).
Marital status: married workers were 40% more likely not to be vaccinated than unmarried workers (aOR = 1.4).
Level of education: staff with a higher level of education were 50% more likely not to be vaccinated than those with a secondary level of education (aOR = 1.5).
Training: staff who had not received training in ICP measures were significantly seven times more likely not to be vaccinated than those who reported having received such training (aOR = 7.37; p = 0.046) (Table 4).
Table 4.
Univariate and multivariate analyses of parameters associated with non-adherence to vaccination against hepatitis B among healthcare workers in the gynecology-obstetrics department, May 2024 (n = 41)
| Factor | Fully vaccinated n (%) |
Total n | cOR | p-value | aOR | 95% CI limits | p-value2 | ||
|---|---|---|---|---|---|---|---|---|---|
|
No 27 (66) |
Yes 14 (34) |
Lower | Upper | ||||||
| Age 1 | |||||||||
| ˂25 | 11 (73) | 4 (27) | 15 | 1 | 1 | ||||
| 25–44 | 9 (64) | 5 (36) | 14 | 0.7 | 0.599 | 0.8 | 0.1 | 9.1 | 0.872 |
| 45 + | 7 (58) | 5 (42) | 12 | 0.5 | 0.414 | 2.6 | 0.1 | 91.3 | 0.563 |
| Sex | |||||||||
| Female | 19 (59) | 13 (41) | 32 | 1 | 1 | ||||
| Male | 8 (89) | 1 (11) | 9 | 5.5 | 0.129 | 2.8 | 0.3 | 70.4 | 0.435 |
| Marital status | |||||||||
| Single | 19 (66) | 10 (34) | 29 | 1 | 1 | ||||
| Married | 8 (67) | 4 (33) | 12 | 1.1 | 0.943 | 1.4 | 0.2 | 10.4 | 0.706 |
| Educational level | |||||||||
| Secondary | 6 (55) | 5 (45) | 11 | 1 | 1 | ||||
| Higher | 21 (70) | 9 (30) | 30 | 1.9 | 0.358 | 1.5 | 0.2 | 12.3 | 0.704 |
| Grade | |||||||||
| Nurse-assistant | 1 (33) | 2 (67) | 3 | 1 | |||||
| Nurse | 10 (77) | 3 (23) | 13 | 6.7 | 0.172 | ||||
| Resident | 6 (75) | 2 (25) | 8 | 6.0 | 0.223 | ||||
| Midwife/Maieutician | 3 (43) | 4 (57) | 7 | 1.5 | 0.778 | ||||
| Medical student | 7 (70) | 3 (30) | 10 | 4.7 | 0.273 | ||||
| Professional group | |||||||||
| Paramedical | 14 (61) | 9 (39) | 13 | 1 | 1 | ||||
| Student | 7 (70) | 3 (30) | 10 | 1.5 | 0.617 | 0.7 | 0.1 | 8.9 | 0.798 |
| Medical | 6 (75) | 2 (25) | 8 | 1.9 | 0.476 | 1.3 | 0.1 | 22.3 | 0.849 |
| refresher training received on ICP measures | |||||||||
| Oui | 6 (43) | 8 (57) | 14 | 1 | 1 | ||||
| Non | 21 (78) | 6 (22) | 27 | 4.7 | 0.030 | 7.4 | 1.0 | 97.3 | 0.046 |
| Professional experience 1 1 | |||||||||
| ˂5 | 13 (59) | 9 (41) | 22 | 1 | |||||
| 5 + | 14 (74) | 5 (26) | 19 | 1.9 | 0.328 | ||||
| Professional experience 2 1 | |||||||||
| ˂10 | 15 (63) | 9 (37) | 24 | 1 | |||||
| 10 + | 12 (71) | 5 (29) | 17 | 1.4 | 0.591 | ||||
1Unit in years; 2 Fisher exact probability test; cOR: crude Odds Ratio; aOR: adjusted Odds Ratio; CI: Confidence interval
COVID-19 vaccination
Multivariate analysis showed that healthcare workers with tertiary education were 44 times more likely than those with secondary education not to have been vaccinated against COVID-19, and this was significant (aOR = 43.6; p = 0.043). In addition, although not significant, healthcare workers with ICP training were seven times more likely not to be vaccinated against COVID-19 (Table 5).
Table 5.
Univariate and multivariate analyses of factors associated with non-compliance with COVID-19 vaccination among healthcare workers in the gynecology-obstetrics department, May 2024 (n = 41)
| Factor | Fully vaccinated n (%) |
Total n | cOR | p-value | aOR | 95% CI limits | p-value2 | ||
|---|---|---|---|---|---|---|---|---|---|
|
No 31 (76) |
Yes 10 (24) |
Lower | Upper | ||||||
| Age 1 | |||||||||
| ˂25 | 12 (80) | 3 (20) | 15 | 1 | |||||
| 25–34 | 7 (78) | 2 (22) | 9 | 0.9 | 0.896 | ||||
| 35–44 | 2 (40) | 3 (60) | 5 | 0.2 | 0.109 | ||||
| 45 + | 10 (83) | 2 (17) | 12 | 1.3 | 0.824 | ||||
| Gender | |||||||||
| Female | 24 (75) | 8 (25) | 32 | 1 | 1 | 1 | |||
| Male | 7 (78) | 2 (22) | 9 | 1.2 | 0.864 | 0.1 | 0.0 | 1.7 | 0.140 |
| Marital status | |||||||||
| Married | 9 (75) | 3 (25) | 29 | 1 | 1 | 1 | |||
| Single | 22 (76) | 7 (24) | 12 | 1.1 | 0.953 | 0.5 | 0.0 | 5.4 | 0.593 |
| Educational level | |||||||||
| Secondary | 6 (55) | 5 (45) | 11 | 1 | 1 | 1 | |||
| Higher | 25 (83) | 5 (17) | 30 | 4.2 | 0.066 | 43.6 | 1.4 | 5.2 | 0.043 |
| Grade | |||||||||
| Nurse-assistant | 2 (67) | 1 (33) | 3 | 1 | 1 | 1 | |||
| Nurse | 9 (69) | 4 (31) | 13 | 1.1 | 0.931 | 0.6 | 0.0 | 27.6 | 0.793 |
| Resident | 6 (75) | 2 (25) | 8 | 1.5 | 0.783 | 0.1 | 0.0 | 6.8 | 0.264 |
| Midwife/Maieutician | 5 (71) | 2 (29) | 7 | 1.3 | 0.880 | 0.1 | 0.0 | 24.0 | 0.346 |
| Medical student | 9 (90) | 1 (10) | 10 | 4.5 | 0.351 | 0.2 | 0.0 | 23.4 | 0.479 |
| Professional group | |||||||||
| Paramedical | 16 (70) | 7 (30) | 13 | 1 | |||||
| Student | 9 (90) | 1 (10) | 10 | 3.9 | 0.232 | ||||
| Medical | 6 (75) | 2 (25) | 8 | 1.3 | 0.770 | ||||
| Refresher course received on ICP measures | |||||||||
| Yes | 8 (57) | 6 (43) | 14 | 1 | 1 | 1 | |||
| No | 23 (85) | 4 (15) | 27 | 4.3 | 0.056 | 7.3 | 0.7 | 122 | 0.122 |
| Professional experience 1 1 | |||||||||
| ˂5 | 18 (82) | 4 (18) | 22 | 1 | |||||
| 5 + | 13 (68) | 6 (37) | 19 | 0.5 | 0.324 | ||||
| Professional experience 2 1 | |||||||||
| ˂10 | 19 (79) | 5 (21) | 24 | 1 | |||||
| 10 + | 12 (71) | 5 (29) | 17 | 0.6 | 0.530 | ||||
1Unit in years; 2 Fisher exact probability test; cOR: crude Odds Ratio; aOR: adjusted Odds Ratio; CI: Confidence interval
The Johnson & Johnson vaccine was the vaccine most frequently requested by staff who had received the COVID-19 prophylaxis (70%), followed by the Sinopharm vaccine (30%) (Fig. 4).
Fig. 4.
Type of COVID-19 vaccines received by healthcare workers in the gynecology-obstetrics department, May 2024 (n = 10)
Discussion
Knowledge on hand hygiene
The study revealed that less than one-third of HCWs (24%) had significantly adequate knowledge of the minimum duration of efficacy of hydro-alcoholic gel (p = 0.027). This indicates a lack of awareness of the need for prolonged application of the gel to ensure effective elimination of germs from the hands. This lack of awareness leads to ineffective use of the gel, which favors the persistence of germs and their transmission to patients.
In contrast, medical staff (residents) demonstrated greater knowledge on this topic (63%), reflecting a higher medical culture. A much lower proportion of lower-level health workers (paramedical staff) showed such knowledge (17%), despite the fact that a significant number of them (82%) agreed they had been properly trained on hand hygiene during their schooling (p = 0.006). This discrepancy might reflect significant gaps during primary training regarding this specific topic of hand hygiene, or the need for continuous training to refresh knowledge and avoid forgetting, which can lead to poor practice. Similar studies in Pakistan also found that medical staff (66%) had better knowledge of this standard precaution than paramedics [29].
Perception of hand hygiene
Most respondents reported that they always practice hand hygiene and consider it an essential part of their care. This is encouraging for both HCWs and patients, as a correct perception of the importance of hand hygiene is essential for preventing HAIs. Despite this positive perception, studies report that HCWs do not always comply with hand hygiene guidelines [23, 30]. This suboptimal performance has been attributed to several factors, including the unavailability of wash facilities close to the point of care, the perception that patient care is safe even without strict adherence, and high workloads. These findings are consistent with studies conducted in Yaoundé health districts and the Democratic Republic of Congo [23, 31].
The study reports emphasize that suboptimal adherence to universal precautions indicates inadequate supervision of healthcare facilities and their staff by intermediate or strategic levels [30]. In such circumstances, the role of infection control committees and internal and external monitoring guidelines is critical in promoting compliance. Therefore, measures to improve the accessibility and availability of hand hygiene facilities, reduce staff workload, and increase supervision and training are essential to ensure optimal adherence to universal precautions and reduce the risk of healthcare-associated infections [30, 32].
Hand hygiene is recognized as the single most important measure for preventing the spread of HAIs in healthcare facilities. Current standards state that to promote compliance with hand hygiene, the necessary resources must be readily available in critical locations, and that behavior change must be supported by education, training, monitoring, feedback, and organizational support. Research supporting this approach also indicates that to effectively interrupt the transmission of healthcare-associated pathogens, hand hygiene must be performed at the times and places where transmission is most likely to occur. Educating healthcare workers about effective hand hygiene techniques and compliance is therefore essential. Assessing knowledge, perceptions, and practices related to hand hygiene helps to build capacity in this area [2, 33].
Accidental exposure to blood and other body fluids
More than half of the respondents (59%) experienced an accidental exposure to biological fluids in the past 12 months. Splashes were the main source of exposure, accounting for 96% of cases. Our results confirmed the trends observed in previous studies conducted at the Yaoundé University Teaching Hospital and in the Yaoundé Health Districts [14, 15]. However, they were lower than the proportion of exposure recorded at the referral hospitals in Buea and Bertoua, which reported prevalence rates of over 80% [13, 34]. Environmental factors within the healthcare setting may explain these differences.
Blood and amniotic fluid were the biological fluids most frequently involved in the occupational exposures of HCWs. In maternity wards, childbirth is a major source of blood and amniotic fluid splashes, a trend also reported in other studies in Cameroon, Côte d’Ivoire, and Morocco [23, 35, 36].
Exposures from splashes are common and affect most of HCWs [23, 34, 36]. To manage them, it is essential to systematically and correctly use personal protective equipment, and to be immunized against diseases transmitted by biological fluids, such as hepatitis B and COVID-19 [14, 23]. Although HCWs are aware of these infections, the uptake of preventive vaccination against viral diseases remains insufficient in Cameroon and the rest of the world [14, 18, 20, 23, 37, 38].
The multivariate analysis revealed a strong association between a higher level of education among healthcare workers (HCWs) and an increased likelihood of accidental exposure to biological fluids. Specifically, HCWs with a tertiary education were 14 times more likely to be exposed than those with a secondary education (p = 0.044). This finding can be attributed to the fact that HCWs with higher levels of education are often more involved in high-risk procedures such as emergency care and surgical procedures, which are the primary sources of occupational exposure to blood. Similar results have been documented in studies conducted in Cameroon, Ethiopia, and Iran [39–42].
Healthcare workers adherence to preventive vaccination
he coverage of fully vaccinated HCWs was 27% for hepatitis B and 19% for COVID-19. However, no participants were fully vaccinated against cholera. HCWs cite several reasons for this low vaccination uptake, including the high cost and unavailability of vaccines, lack of time, and doubts about vaccine content and fear of side effects [14, 23, 38]. This low coverage makes healthcare workers particularly vulnerable to life-threatening infectious diseases such as hepatitis B, cholera, and COVID-19, and facilitates their transmission to other HCWs and patients.
Half of the HCWs exposed to blood and body fluids were not fully vaccinated against hepatitis B. This increases the likelihood of seroconversion among HCWs and highlights a critical missed opportunity for preventive vaccination and a consequent reduction in healthcare costs. To address this issue, policymakers and healthcare administrators should consider introducing mandatory pre-employment hepatitis B vaccination for HCWs or implementing employer-funded hepatitis B vaccination programs [14]. By adopting these strategies, health institutions can substantially mitigate the occupational transmission of hepatitis B, protect the health of HCWs, and reduce the financial burden on the healthcare system.
The Johnson & Johnson vaccine was the most commonly requested vaccine by workers who had received the preventive vaccine against COVID-19. Our observations confirmed the trends observed in the Cameroonian population in general and specifically among HCW [23, 43].
Analysis of the determinants of vaccination showed that HCWs with higher levels of education or who had not received training in IPC measures were less likely to be vaccinated. These findings raise the question of whether HCWs with higher levels of education may be more confident in their ability to avoid infection and thus less likely to be vaccinated. Similarly, a lack of training in IPC interventions could lead to a lack of awareness of the risks and benefits of vaccination. These findings suggest that it is essential to set up awareness and training programs to improve knowledge of the infectious risks and benefits of vaccination and to encourage HCWs to be vaccinated.
Limitations
The main limitation of this study is the risk of recall bias regarding previous exposure, or the difficulty in proving that exposure to the risk was prior to the outcome. The risk of social desirability bias was mitigated by allowing the participants to self-administer the questionnaire. In addition, the sample size did not provide sufficient power to detect statistical significance for some variables that were not considered significant. These limitations highlight the need for a more comprehensive study with a larger sample size. In addition, a qualitative research design might be helpful in understanding why HCWs with higher education were less likely to be vaccinated.
Conclusions
This study shows that inadequate knowledge of hand hygiene, high occupational exposure to biological fluids, and low vaccination coverage make HCWs in this ward particularly vulnerable to infectious diseases. The findings of this study underscore critical opportunities to strengthen ICP measures within Cameroon’s healthcare system, particularly in high-risk settings such as obstetrics-gynecology wards. To translate these insights into actionable improvements, a multi-tiered approach is essential. At the hospital level, managers should ensure that observance of standard precautions is reinforced through hands-on refresher training. For national policymakers, the urgency lies in standardizing IPC education by embedding it into medical and nursing curricula, and actively promoting vaccination campaigns among HCWs to combat vaccine hesitancy. IPC trainers within hospitals should play a pivotal role in bridging gaps between policy and practice by providing context-specific simulations that address identified deficiencies and sustaining long-term competency through feedback, audits, and continuous professional development.
Acknowledgements
Our gratitude goes to the health staff who agreed to participate in this study and to the manager of the health facility who gave an authorization to conduct the study.
Abbreviations
- aOR
Adjusted Odds Ration
- CI
Confidence Interval
- cOR
Crude Odds Ratio
- COVID-19
New Coronavirus Disease
- HAI
Healthcare Associated Infection
- HCW
Healthcare Worker
- ICP
Infection Control and Prevention
Author contributions
Conception, drafting of the study protocol, data collection, analysis, and interpretation: F.Z.L.C.; Drafting and editing of manuscript: F.Z.L.C.; Critical revision of the manuscript: E.E.L.; Conception, design and supervision of research protocol and implementation, data analysis plan, revision, and editing: I.T; Final validation of the manuscript: All authors.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
Data availability
All data generated or analyzed during this study are included in this published article.
Declarations
Ethical approval
The protocol was approved by Institutional Review Board (IRB) of the Faculty of Medicine and Biomedical Sciences of Yaoundé and the ethical clearance: N°1017/UYI/FMSB/VDRC/DAASR/CSD issued. Informed consent was obtained from participants prior to inclusion in the study. All methods were performed according to relevant guidelines and regulations.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Fabrice Zobel Lekeumo Cheuyem, Email: zobelcheuyem@gmail.com.
Innocent Takougang, Email: itakougang@gmail.com.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
All data generated or analyzed during this study are included in this published article.