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Compliance and barriers of infection prevention and control strategies among healthcare workers in Erbil public hospitals

Linda Muhsin
Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq
Samir Mahmood Othman
Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq
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Copyright (c) 2026 Linda Muhsin , Samir Mahmood Othman (Author)

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Abstract

Background and objective: Infection prevention and control (IPC) is essential for protecting patient and healthcare worker safety. IPC adherence within a resource-constrained environment, such as Erbil, Iraq, continues to be suboptimal due to multifactorial barriers. The objective of this study was to determine adherence to IPC among healthcare workers (HCWs) and the associated barriers in public hospitals in Erbil.

Methods: A descriptive cross-sectional study was conducted among healthcare workers between October 2024 and end of May 2025, in five public hospitals in Erbil city. A total of 415 HCWs were surveyed via proportionally allocated convenience sampling, using a validated, pilot-tested questionnaire adapted from a WHO tool. SPSS version 26 was used for data entry and analysis. A p-value ≤0.05 was considered statistically significant.

Results: Of the total study sample, 14.2% were in full compliance with IPC practices. Nurses carried the greatest burden of human and environmental barriers, including inadequate training, inadequate support from staff, and inadequate equipment availability. Occupation and qualification showed statistically significant associations with compliance (p=0.003 and p=0.013, respectively), with nurses — including infection control nurses — and Master's degree holders showing higher compliance. Lack of manpower, role conflict, lack of experience, lack of IPC training, lack of IPC staff contact, equipment shortage, quality of materials and equipment, and non-compliance of healthcare workers with IPC protocol were significantly reported as barriers.

Conclusion: IPC practice among HCWs in Erbil is low, especially among disproportionately exposed nurses. There is an urgent need for routine training, institutional support, better infrastructure, and objective monitoring to strengthen IPC compliance and enhance patient safety.

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References

  1. WHO. Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level [Internet]. Geneva: World Health Organization; 2016 [cited 2024 Oct 21]. 90 p. https://iris.who.int/handle/10665/251730
  2. Puro V, Coppola N, Frasca A, Gentile I, Luzzaro F, Peghetti A, et al. Pillars for prevention and control of healthcare-associated infections: an Italian expert opinion statement. Antimicrob Resist Infect Control. 2022;11(1):87. https://doi.org/10.1186/s13756-022-01125-8
  3. Ameen PJ, Dizaye KF, Mahmood SO. Prevalence of antimicrobial-resistant bacterial infections among neutropenic patients in Hiwa Cancer Hospital, Sulaimani, Iraq. Al-Rafidain J Med Sci. 2024;6(2):48-55. https://doi.org/10.54133/ajms.v6i2.713
  4. Ronak NH. Knowledge about infection control measures among nurses at Hawler Teaching Hospital in Erbil city. Zanco J Med Sci. 2016;20(2):1272-9. https://doi.org/10.15218/zjms.2016.0020
  5. Ahmadipour M, Dehghan M, Ahmadinejad M, Jabarpour M, Mangolian Shahrbabaki P, Ebrahimi Rigi Z. Barriers to hand hygiene compliance in intensive care units during the COVID-19 pandemic: a qualitative study. Front Public Health. 2022;10:968231. https://doi.org/10.3389/fpubh.2022.968231
  6. Bawaji D, Hakim S. Facilitators and barriers of continuing professional development from the perspective of health care providers in Erbil City. Adv Med J. 2025;10(1):36-43. https://doi.org/10.56056/amj.2025.315
  7. Perkins GD, Hawkes CA, Eli K, Griffin J, Jacques C, Huxley CJ, et al. Qualitative study of decision-making processes. Recommended Summary Plan for Emergency Care and Treatment: ReSPECT, a mixed-methods study. Health Soc Care Deliv Res. 2022;10(40). https://doi.org/10.3310/LFPE3627
  8. Houben F, Den Heijer CD, Van Hensbergen M, Dukers-Muijrers NH, De Bont EG, Hoebe CJ. Behavioural determinants shaping infection prevention and control behaviour among healthcare workers in Dutch general practices: a qualitative study reflecting on pre-, during and post-COVID-19 pandemic. BMC Prim Care. 2024;25(1):72. https://doi.org/10.1186/s12875-024-02304-9
  9. Shehade SM, Juma ASM, Ubeid MH, Younus MD. Perceptions and mindset toward infection control and prevention among medical microbiology students. Cihan Univ-Erbil Sci J. 2025;9(1):24-8. https://doi.org/10.24086/cuesj.v9n1y2025.pp24-8
  10. Neama AM, Nasir NA. Assessment of knowledge, attitude, and practice of standard infection control precautions among health-care workers in Baghdad, Al-Rusafa, 2023. Iraqi J Community Med. 2025;38(1):39-45. https://doi.org/10.4103/IRJCM.IRJCM_31_24
  11. Darboe SMK, Darfour-Oduro SA, Kpene GE, Kebbeh A, Fofana N, Ndow M, et al. Factors influencing healthcare workers' perceived compliance with infection prevention and control standards, North Bank East region, The Gambia: a cross-sectional study. BMC Res Notes. 2025;18(1):43. https://doi.org/10.1186/s13104-025-07101-w
  12. Abalkhail A, Alslamah T. Institutional factors associated with infection prevention and control practices globally during the infectious pandemics in resource-limited settings. Vaccines. 2022;10(11):1811. https://doi.org/10.3390/vaccines10111811
  13. Abdulla SA. Evaluation of personal protective equipment usage among construction workers in Erbil City, Iraq. Cureus. 2024;16(9):e68937. https://doi.org/10.7759/cureus.68937
  14. Kubde D, Badge AK, Ugemuge S, Shahu S. Importance of hospital infection control. Cureus. 2023;15(12):e50931. https://doi.org/10.7759/cureus.50931
  15. Alshagrawi S, Alhodaithy N. Determinants of hand hygiene compliance among healthcare workers in intensive care units: a qualitative study. BMC Public Health. 2024;24(1):2333. https://doi.org/10.1186/s12889-024-19461-2
  16. Barbarossa MV, Fuhrmann J. Compliance with NPIs and possible deleterious effects on mitigation of an epidemic outbreak. Infect Dis Model. 2021;6:859-74. https://doi.org/10.1016/j.idm.2021.06.001
  17. Harun MGD, Anwar MMU, Sumon SA, Mohona TM, Hassan MZ, Rahman A, et al. Hand hygiene compliance and associated factors among healthcare workers in selected tertiary-care hospitals in Bangladesh. J Hosp Infect. 2023;139:220-7. https://doi.org/10.1016/j.jhin.2023.07.012
  18. Afework A, Tamene A. Uncovering the obstacles: a comprehensive analysis of barriers to hand hygiene adherence among healthcare providers: a systematic review. BMC Infect Dis. 2025;25:502. https://doi.org/10.1186/s12879-025-10924-4
  19. Gould DJ, Creedon S, Jeanes A, Drey NS, Chudleigh J, Moralejo D. Impact of observing hand hygiene in practice and research: a methodological reconsideration. J Hosp Infect. 2017;95(2):169-74. https://doi.org/10.1016/j.jhin.2016.08.008
  20. Chakma SK, Hossen S, Rakib TM, Hoque S, Islam R, Biswas T, et al. Effectiveness of a hand hygiene training intervention in improving knowledge and compliance rate among healthcare workers in a respiratory disease hospital. Heliyon. 2024;10(5):e27286. https://doi.org/10.1016/j.heliyon.2024.e27286
  21. Harb S, Abu Shosha G, Oweidat IA, Al-Mugheed K, Alzoubi MM, Abdelaliem SMF. Compliance of infection control practices among registered nurses: a cross-sectional study. Medicine (Baltimore). 2025;104(14):e42062. https://doi.org/10.1097/MD.0000000000042062
  22. Alslamah T, Abalkhail A. The national strategies for and challenges in infection prevention and control of the healthcare system in the Kingdom of Saudi Arabia (review study). Vaccines. 2022;10(8):1302. https://doi.org/10.3390/vaccines10081302
  23. Limenyande MJM, Isunju JB, Musoke D. Barriers and facilitators of compliance with infection prevention and control measures during the COVID-19 pandemic in health facilities in Kampala city, Uganda. PLOS Glob Public Health. 2024;4(12):e0004021. https://doi.org/10.1371/journal.pgph.0004021
  24. Cohen J, van der Meulen Rodgers Y. Contributing factors to personal protective equipment shortages during the COVID-19 pandemic. Prev Med. 2020;141:106263. https://doi.org/10.1016/j.ypmed.2020.106263
  25. Amos TB, Griffin C, Schaffzin JK, Ankrum A, Scaggs Huang F. Adherence to personal protective equipment practices during the COVID-19 pandemic: a pilot study. Infect Prev Pract. 2024;6(2):100369. https://doi.org/10.1016/j.infpip.2024.100369
  26. Lohiniva AL, Lehtinen JM, Arifulla D, Ollgren J, Nuorti P, Lyytikäinen O. Factors influencing healthcare workers' compliance with personal protective equipment guidelines in long-term care during the COVID-19 pandemic — a theory-based mixed-methods study. PLoS One. 2025;20(4):e0321851. https://doi.org/10.1371/journal.pone.0321851
  27. Ajzen I. The theory of planned behavior: frequently asked questions. Hum Behav Emerg Technol. 2020;2(4):314-24. https://doi.org/10.1002/hbe2.195
  28. Senbato FR, Wolde D, Belina M, Kotiso KS, Medhin G, Amogne W, et al. Compliance with infection prevention and control standard precautions and factors associated with noncompliance among healthcare workers working in public hospitals in Addis Ababa, Ethiopia. Antimicrob Resist Infect Control. 2024;13:32. https://doi.org/10.1186/s13756-024-01381-w
  29. Alhumaid S, Al Mutair A, Al Alawi Z, Alsuliman M, Ahmed GY, Rabaan AA, et al. Knowledge of infection prevention and control among healthcare workers and factors influencing compliance: a systematic review. Antimicrob Resist Infect Control. 2021;10(1):86. https://doi.org/10.1186/s13756-021-00957-0
  30. Tantum LK, Gilstad JR, Bolay FK, Horng LM, Simpson AD, Letizia AG, et al. Barriers and opportunities for sustainable hand hygiene interventions in rural Liberian hospitals. Int J Environ Res Public Health. 2021;18(16):8588. https://doi.org/10.3390/ijerph18168588
How to Cite
Muhsin , L. ., & Mahmood Othman, S. . (2026). Compliance and barriers of infection prevention and control strategies among healthcare workers in Erbil public hospitals. Zanco Journal of Medical Sciences (ZJMS), 635–646. https://doi.org/10.15218/zjms.2026.044

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