Table 2.

Summary of the characteristics of the included studies that have highlighted potential factors influencing compliance to the IPC precautions among HCWs (n = 16), 2006–2021

Author, year, study location	Study aim	Setting	Responded population	Methodology; and [assessment of study risk of bias (tool used; finding)]	Key findings
Abeje et al. [28], Ethiopia	Evaluate hepatitis B vaccination knowledge among HCWs	Multi-centre	374 HCWs (nurses, health officers, medical doctors, dentists, and laboratory technologists)	Survey: cross-sectional questionnaire; [(Williamson critical appraisal of qualitative evidence, LOW risk of bias)]	Hepatitis B vaccination status of HCWs was low
Albano et al. [16], Italy	Assess knowledge towards influenza A/H1N1 and the vaccination among HCWs	Multi-centre	600 HCWs (physicians, nurses and others)	Survey: cross-sectional questionnaire; [(Hoy critical appraisal checklist, LOW risk of bias)]	Only 16.7% have received the influenza A/H1N1 vaccination and HCWs with more fear of contracting influenza A/H1N1, those considering vaccine more useful and less dangerous were more likely to receive vaccine
Aloush et al. [19], Jordan	Assess compliance of HCWs with the with the CLABSIs IPC guidelines at 58 Middle Eastern hospitals on ICUs	Multi-centre	HCWs in 58 hospitals in the ICUs in three Middle Eastern countries (Jordan, Saudi Arabia and Egypt)	Observational; [(Hoy critical appraisal checklist, LOW risk of bias)]	Hospitals’ characteristics, lower number of beds and a lower patient-to-nurse ratio were related to higher compliance A significant lack of compliance was found in the item of continuing education. Only 14 hospitals had an active continuing education department that provided training and education for the staff on a regular basis
Alsahafi et al. [43], Saudi Arabia	Assess knowledge of HCWs to MERS-CoV	Multi-centre	1216 (687 nurses, 267 physicians, and 262 other HCWs)	Survey: questionnaire; [(Hoy critical appraisal checklist, LOW risk of bias)]	Compliance with immunization recommendations was poor (59.5% for annual influenza vaccine, 74.4% for meningococcal vaccine, and 50.4% for hepatitis B)
Amoran et al. [53], Nigeria	Assess compliance of HCWs with universal precautions in hospital environment	Single centre	421 HCWs (52 doctors, 78 nurses, 54 laboratory scientists, 53 pharmacists, 57 community health workers, 74 hospital orderlies, and 53 other professions)	Survey: cross-sectional questionnaire; [(Williamson critical appraisal of qualitative evidence, LOW risk of bias)]	Major reason for noncompliance to universal precautions is the nonavailability of the equipment. Higher compliance in HCWs who are exposed to blood products and body fluid (p = 0.03), public HCWs when compared to private HCWs (p = 0.001), among those working in secondary and tertiary facilities compared to primary healthcare centers (p = 0.001) and urban areas when compared to rural areas (p = 0.02) Knowledge of National policy on injection safety was not associated with practice of universal precaution among HCWs (χ2 = 0.404, p = 0.39); and recent training in IPC was not associated with the practice of universal precaution (χ2 = 0.013, p = 0.70)
Ashraf et al. [30], United States	Assess compliance with the 2002 CDC hand hygiene guidelines in nursing home settings	Multi-centre	1143 HCWs (386 nursing assistants, 375 nurses, and 382 other healthcare professionals)	Survey: questionnaire; [(Hoy critical appraisal checklist, MODERATE risk of bias)]	Lack of adherence to hand hygiene was due to absence of alcohol-based hand rub or absence of nearby sink or soap and paper towels (p < 0.001) Employees who reported receiving periodic education were significantly more likely to report washing hands when they are visibly dirty, when they are not visibly dirty, and after the use of gloves (p = 0.039, p = 0.002, and p < 0.001, respectively)
Assefa et al. [17], Ethiopia	Evaluate knowledge of HCWs about hand hygiene practices, utilization of PPE, and PEP, healthcare waste management practices, and instrument disinfection practice	Multi-centre	171 HCWs (about 83 were nurses)	Survey: questionnaire; [(Williamson critical appraisal of qualitative evidence, LOW risk of bias)]	The odds of safe practice were higher in participants who received IPC training (AOR: 2.4; 95% CI 1.01–4.75) but lower among HCWs who are working in the facility which has no continuous water supply (AOR = 0.48; 95% CI 0.21–0.83)
Chuc et al. [31], Vietnam	Assess and compare HCWs knowledge and self-reported practices of IPC in a rural and an urban hospital	Multi-centre	339 HCWs (nurses, midwives, physicians and cleaners)	Survey: cross-sectional questionnaire; [(Hoy critical appraisal checklist, LOW risk of bias)]	Self-reported practices in the urban hospital were likely to be better than in the rural one (p = 0.003). The two leading reasons for IPC noncompliance were emergencies (rural hospital: 75.7%, urban hospital: 75.9%) and high workload (rural hospital: 58.3%, urban hospital: 57.4%). Lack of equipment or soap was one of the most frequent reported reasons, followed by dry hands and allergies
Desta et al. [54], Ethiopia	Examine the knowledge and practice of HCWs on IPC and its associated factors among health professionals	Single centre	150 HCWs (21 Physician, 83 nurses, 18 midwives, 3 health officers, 13 lab technicians, 12 others)	Survey: cross-sectional questionnaire; [(Hoy critical appraisal checklist, LOW risk of bias)]	Majority of the HCWs (71.34%) doesn’t vaccinate for the common pathogen
Flores et al. [56], England	Evaluate the effect glove use has on HCWs' compliance with hand hygiene in 2 district general hospitals	Multi-centre	Doctors, nurses and healthcare assistants	Observational; [(Hoy critical appraisal checklist, LOW risk of bias)]	High rate of glove overuse (defined as the use of gloves when not required) (42%) might been a component of poor hand hygiene compliance
Ganczak et al. [26], Poland	Evaluate factors associated with the PPE use compliance and noncompliance among surgical nurses at 18 hospitals	Multi-centre	601 surgical nurses	Survey: questionnaire; [(Hoy critical appraisal checklist, LOW risk of bias)]	Compliance to PPE use was highest in the municipal hospitals and in the operating rooms (mean: 12.1 ± 4.7, p < 0.0001). Nurses who had fear of acquiring HIV were more likely to be compliant (mean: 12.0 ± 4.9, p < 0.005). Significantly higher compliance was found among nurses with previous training in IPC (mean: 12 ± 4.6, p < 0.009) or experience of caring for an HIV patient (mean: 12.9 ± 4.5, p < 0.0001). Most commonly stated reasons for noncompliance were non-availability of PPE (37%), conviction that the source patient was not infected (33%) and concern that following recommended practices actually interfered with providing good patient care (32%)
Geberemariyam et al. [18], Ethiopia	Assess knowledge of HCWs towards IPC	Multi-centre	648 HCWs (physicians, nurses, midwives, anesthetists, laboratory technicians, laboratory technologists, pharmacists, pharmacy technicians, and radiographers)	Survey: cross-sectional questionnaire; [(Hoy critical appraisal checklist, LOW risk of bias)]	There was a strong linear correlation between HCWs IPC knowledge score and the practice score (Pearson correlation coefficient = 0.703, p < 0.001). In addition, HCWs who have ever taken training on IPC were about 5.31 times more likely to practice safe infection prevention than those who have not received training (AOR = 5.31, 95% CI 2.42, 11.63)
Iliyasu et al. [8], Nigeria	Explore compliance of IPC among HCWs in a tertiary referral center	Single centre	200 HCWs (152 nurses and 48 doctors)	Survey: cross-sectional questionnaire; [(Hoy critical appraisal checklist, LOW risk of bias)]	About 52% of doctors and 76% of nurses (p = 0.002) always practice hand hygiene in between patient care. Knowledge on the risk of transmission of BBDs is related to higher compliance with PPE use (r =  − 0.004, p < 0.001)
Loulergue et al. [51], France	Evaluate HCWs knowledge regarding occupational vaccinations (HBV, varicella and influenza)	Single centre	580 HCWs (physicians, nurses, nurses’ assistants)	Survey: cross-sectional questionnaire; [(Hoy critical appraisal checklist, LOW risk of bias)]	Influenza vaccination rate for 2006–2007 was 30% overall, ranging from 50% among physicians to 20% among paramedical staff (p < 0.05). Physicians based their refusal on doubts about vaccine efficacy, although paramedics feared side effects
Michel-Kabamba [42], Democratic Republic of the Congo	HCWs knowledge on COVID-19-related clinical manifestations and patient care approach was assessed using WHO’s “Exposure Risk Assessment in the Context of COVID-19” questionnaire	Multi-centre	613 HCWs (27.2% were medical doctors and 72.8% were other categories of HCWs)	Survey: cross-sectional questionnaire; [(Hoy critical appraisal checklist, MODERATE risk of bias)]	Practices scores were relatively low. About 55% of HCWs complied with good practices; 49.4% wore masks consistently and, surprisingly, only 54.9% used PPE during contact with patients HCWs from towns already affected by the COVID-19 epidemic being more likely to comply with good practices (AOR, 2.79; 95% CI 1.93–4.06) Only 27.7% of HCWs were willing to receive a COVID-19 vaccine when it is available
Ogoina et al. [34], Nigeria	Examine compliance of HCWs with standard precautions in two tertiary hospitals	Multi-centre	290 HCWs (111 doctors, 147 nurses and 32 laboratory scientists)	Survey: cross-sectional questionnaire; [(Hoy critical appraisal checklist, LOW risk of bias)]	Compliance of laboratory scientists (46.2%), house officers (49.2%), and staff nurses (49.2%) were lower than those of consultants (53%), resident doctors (56.9%) and principal nursing officers (50.7%); p < 0.0001) Lack of enough facilities and resources to practice IPC (66.1%), absence of training on IPC (52.4%), lack of IPC committee (38.9%) and excess workload (34.8%) were main challenges to prevent HCWs from practice of standard precautions
Parmeggiani et al. [3], Italy	Assess HCWs compliance with IPC in the EDs	Multi-centre	307 HCWs (nurses, physicians and other healthcare professionals)	Survey: cross-sectional questionnaire; [(Hoy critical appraisal checklist, LOW risk of bias)]	Two independent predictors of compliance were positively associated: fewer patients cared in a day (OR = 0.97; 95% CI 0.95–0.99) and know that hands hygiene measures after removing gloves is a control measure (OR = 8.09; 95% CI 2.83–23.1)
Russell et al. [21], United States	Explore factors for compliance with IPC practices at 2 healthcare agencies	Multi-centre	359 nurses	Survey: questionnaire; [(Hoy critical appraisal checklist, LOW risk of bias)]	A high level of IPC compliance (mean = 0.89, [SD] = 0.16). Positive association of attitude with level of compliance (p = 0.001) Older nurses, non-Hispanic black nurses, and nurses with IPC certification reported greater compliance with IPC practices than younger nurses (β = 0.003, p < 0.05), non-Hispanic white nurses (β = 0.072, p < 0.001), and nurses without IPC certification (β = 0.047, p < 0.05)
Shah et al. [55], England	Identify behaviors of HCWs that facilitated noncompliance with IPC practices at 3 tertiary hospitals	Multi-centre	Doctors, pharmacists, nurses and midwives	Semi-structured interviews; [(Williamson critical appraisal of qualitative evidence, LOW risk of bias)]	Attribution of responsibility, prioritization and risk appraisal, and hierarchy of influence depict HCWs’ different motivations for compliance with IPC practice
Tavolacci et al. [47], France	Compare compliance with hand hygiene between HCWs	Multi-centre	1811 HCWs (physicians, nurses, nursing assistants and others)	A questionnaire; [(Hoy critical appraisal checklist, LOW risk of bias)]	Use of hand hygiene differed according to professional category and experience. Knowledge of hand hygiene efficacy (88.5% by physicians vs 83.8% by other HCWs, p = 0.001), opinion that hand hygiene is easy to use (97.3% by physicians vs 94.9% by other HCWs, p = 0.37) and hand hygiene has acceptable skin tolerance (68.8% by physicians vs 54.3% by other HCWs, p = 0.004) improved hand hygiene compliance
Temesgen et al. [48], Ethiopia	Assess knowledge of TB IPC among HCWs in 4 healthcare facilities	Multi-centre	313 HCWs (59 physicians, 175 nurses, and 79 other healthcare professionals)	Survey: questionnaire; [(Hoy critical appraisal checklist, LOW risk of bias)]	Knowledge about TB IPC was the strong predictor of good TBIC practice, AOR 10.667 and 95% CI (5.769–19.721)
Tenna et al. [49], Ethiopia	Evaluate HCW compliance with hand hygiene and TB IPC measures at 2 university hospitals	Multi-centre	261 HCWs (133 physicians and 128 nurses)	Survey: cross-sectional questionnaire; [(Hoy critical appraisal checklist, LOW risk of bias)]	Self-reported TB IPC practice was suboptimal Physicians reported performing hand hygiene 7% and 48% before and after patient contact, respectively Barriers for performing hand hygiene included lack of hand hygiene agents (77%), sinks (30%), proper training (50%), and irritation and dryness (67%) caused by hand sanitizer

AOR, adjusted odds ratio; BBDs, blood borne diseases; CDC, Centres for Disease Control and Prevention; CI: confidence intervals; CLABSIs, central Line associated bloodstream infections; COVID-19, coronavirus disease 2019; EDs: emergency departments; HBV, hepatitis B virus; HIV, human immunodeficiency virus; ICU, intensive care unit; IPC, infection prevention and control; MERS-CoV, Middle East Respiratory Syndrome Coronavirus; OR: odds ratio; PEP, post-exposure prophylaxes; PPE, personal protective equipment; SD: standard deviation; TB, tuberculosis; WHO, World Health Organization