Literature Review on Infection Prevention Among Health Care Workers in Ethiopia

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Peer-reviewed

Research Article

The critical office of infection prevention overlooked in Federal democratic republic of ethiopia, simply half of health-care workers had prophylactic practice: A systematic review and meta-analysis

• Yohannes Tekalegn,
• Demelash Woldeyohannes

The critical role of infection prevention overlooked in Ethiopia, merely i-one-half of health-care workers had safety practise: A systematic review and meta-analysis

• Biniyam Sahiledengle,
• Yohannes Tekalegn,
• Demelash Woldeyohannes

ten

• Published: January 14, 2021
• https://doi.org/10.1371/journal.pone.0245469

Figures

Abstract

Background

Effective infection prevention and command measures, such as proper paw hygiene, the utilize of personal protective equipment, instrument processing, and rubber injection practicein the healthcare facilitiesare essential elements of patient prophylactic and lead to optimal patient outcomes. In Ethiopia, findings regarding infection prevention practices among healthcare workers have been highly variable and uncertain. This systematic review and meta-analysis estimates the pooled prevalence of safe infection prevention practices and summarizesthe associated factors among healthcare workers in Ethiopia.

Methods

PubMed, Science Direct, Google Scholar, and the Cochran library were systematically searched. Nosotros included all observational studies reporting the prevalence of safe infection prevention practices amid healthcare workers in Ethiopia. Two authors independently extracted all necessary information using a standardized data extraction format. Qualitative and quantitative analyseswere employed. The Cochran Q test statistics and I² tests were used to assess the heterogeneity of the studies. A random-effects meta-assay model was used to estimate the pooled prevalence of safe infection prevention practice.

Results

Of the 187 articles identified through our search, ten studies fulfilled the inclusion criteria and were included in the meta-analysis. The pooled prevalence of safe infection prevention practice in Ethiopia was 52.ii% (95%CI: xl.ix–63.4). The highest prevalence of safe do was observed in Addis Ababa (upper-case letter urban center) 66.two% (95%CI: sixty.half dozen–71.viii), followed past Amhara region 54.6% (95%CI: 51.1–58.1), and then Oromia region 48.5% (95%CI: 24.2–72.viii), and the least rubber practices were reported from S Nation Nationalities and People (SNNP) and Tigray regions with a pooled prevalence of 39.4% (95%CI: thirteen.9–64.8). In our qualitative syntheses, the odds of safe infection prevention practice were higher amid healthcare workers who had adept knowledge and a positive attitude towards infection prevention. Also, healthcare workers working in facilities with continuous running water supply, having infection prevention guideline, and those received preparation were significantly associated withhigher odds of safe infection prevention practise.

Conclusions

Infection prevention practices in Ethiopia was poor, with merely one-half of the healthcare workers reporting rubber practices. Further, the written report establish out that there were regional and professional variations in the prevalence of safe infection prevention practices. Therefore, the need to step-up efforts to intensify the current national infection prevention and patient safe initiative equally key policy direction is strongly recommended, along with more attempts to increment healthcare worker's adherence towards infection prevention guidelines.

Commendation: Sahiledengle B, Tekalegn Y, Woldeyohannes D (2021) The critical role of infection prevention overlooked in Ethiopia, only one-half of health-intendance workers had safe do: A systematic review and meta-assay. PLoS One 16(one): e0245469. https://doi.org/10.1371/journal.pone.0245469

Editor: Holly Seale, Academy of New South Wales, AUSTRALIA

Received: May four, 2020; Accepted: January three, 2021; Published: January 14, 2021

Copyright: © 2021 Sahiledengle et al. This is an open access commodity distributed under the terms of the Artistic Eatables Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Information Availability: All relevant data are within the manuscript and its Supporting information files.

Funding: The author(southward) received no specific funding for this work.

Competing interests: The authors accept alleged that no competing interests exist.

Background

Infection prevention and control is a set of practices, protocols, and procedures that are put in place to prevent infections that are associated with the healthcare system. Effective infection prevention and control measures, such equally proper hand hygiene, the utilize of personal protective equipment (PPE), environmental cleaning, instrument processing, prophylactic injection, and prophylactic disposal of infectious wastes in the healthcare facilitiesmaximize patient outcomes and are essential to providing constructive, efficient, and quality wellness intendance services [1–3]. Healthcare workers (HCWs) compliance with these recommended measures is termed as condom infection prevention practice.

Worldwide, healthcare-caused infections (HAIs) affecting the quality of care of hundreds of millions of patients every year, contributing to increased morbidity, mortality, and substantial healthcare cost [i,ii,4,5]. According to the World Wellness Organization (WHO), at whatsoever point in fourth dimension forevery hundred hospitalized patients, 10 will acquire at least one HAI [3]. The Centre for Disease Prevention and Control (CDC) estimates 2 million patients who volition suffer from HAIs every year in the United States (United states), and most ane hundred thousand of them die [5], costing as much as four.25 billion United states of america dollars [half-dozen]. Studies conducted in low-income settings showed that the prevalence of HAIs varies from 5.7% to 19.1%, with a pooled prevalence of x.1% [7]; and the cumulative incidence range from 5.7% to 45.8% [8]. Further,in many cases,adherence towards infection prevention recommendations amongst healthcare workers (HCWs) in many low-income settings in full general is poor [9–13].

In Ethiopia, the burden of HAIs is a major public health problem with a significant impact on hospitalized patients [fourteen–16]. According to the finding of some pocket studies a high prevalence of HAIs has been reported from all corners of the land from 15.4% in north Ethiopia [15], 11.4%-xix.four% in southwest Ethiopia [16,17], to xvi.iv% in central Federal democratic republic of ethiopia [18]. Although, a large proportion of HAIs can be prevented with cheap and cost effectiveinfection prevention and control measures;the show available suggests that healthcare facilities in Federal democratic republic of ethiopia do not accept effective infection control programs [9]. In addition,HCWs compliance towards infection prevention and control (IPC) measures are critically depression and a potential common problem in the country [9,19,20].

There is evidence that demonstrates the office of HCWs infection preventioncompliance on the reduction of HAIs [21–23] for example, Sickbert et al, in their study reported an comeback in hand hygiene compliance of healthcare workers by x%, which associated with a meaning reduction in overall HAIs [22]. Co-ordinate to the World Wellness Organization (WHO) written report, it is estimated that constructive infection prevention and control (IPC) measures reduce HAIs by at least 30% [21]. In this context, adherence to the recommended infection prevention and patient prophylactic do is the best style in preventing patients, healthcare workers, and communities at large from HAIs. And the long-term solution to reduce the issues of HAIslie on actions to implement constructive IPC measures in healthcare facilities [3,9,ten,13]. Despite these facts-in many depression-income settings, with healthcare systems and resources similar to Ethiopia,lack of well-trained HCWs, lack of infection prevention and control policies, and lack of technical guidelines consistent with the available bear witness essential to provide a robust framework to back up the performance of expert IPC practices made the promotion of IPC practices a bit challenging [ix,15,24–28].

To maximize the prevention of HAIs in Ethiopia, there has been a growing recognition of the demand for safe infection prevention practice at all levels. Since the publication of the second Ethiopia National Infection Prevention Guidelines in 2012 [9], considerable progress has been made in understanding the bones principles, credence and use of testify based Infection Prevention (IP) practices, including Clean and Safe Hospital (Greenbacks), Clean Care is Safer Intendance campaigns, and Initiatives-Saving Lives through Safe Surgery (SaLTS). The national Infection Prevention and Patient Safe (IPPS) manual serve as a standardized IP reference manual for healthcare providersin all healthcare delivery systems. Too, information technology is intended to serve HCWs by providing clear guidance in the provisions of standard infection prevention and patient safety practices. The key components in the manual include standard precautions, hand hygiene, personal protective equipment, prophylactic injection exercise, processing instrument, and healthcare waste management [9]. Importantly, the existence of the IPC guidelines lonely is not sufficient to ensure compliance and implementation of IPC recommendations; and findings clearly indicate that HCWs compliance is a prerequisite for successful guideline adoption. Previously conducted primary studies reported inconsistent findings regarding HCWs infection prevention practice in Ethiopia [19,20,27,29–33]. For example, a written report washed in southeast Federal democratic republic of ethiopia showed that only 36.3% of HCWs had safe infection prevention do [xx], xv.0% in southern Ethiopia [33], 66.1% in central Ethiopia [27], andin northern Ethiopia42.9% of HCWs had acceptable practice [19]. Although the reporting of such practices is important for the prevention and command of HAIs and improving quality of care, the existed studies had many differences in the geographical regions and preceded remarkable variations in the reported practices. Due to the same reason, we conducted a systematic review and meta-assay of observational studies to guess the pooled prevalence of prophylactic infection prevention practices amid HCWs in Ethiopia. Besides, we aim to summarize descriptively the factors that were associated with safe infection prevention do.

Materials and methods

Search strategy

The protocol for this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO), the University of York Middle for Reviews and Broadcasting (record ID: CRD42019129167, on the 31^st May 2019).

Databases including PubMed/MEDLINE, Scientific discipline Directly, Cochrane Library, and Google Scholar were systematically searched. As well, we screened the referencelists of identified articles to detect and place additional relevant studies to add together to this review. Furthermore, to detect unpublished papers relevant to this systematic review and meta-assay, Addis Ababa University Digital Library were searched. The search for the literatures was conductedbetweenthe15^thof April to the 31^st of May, 2019. The following terms and keywords were applied for PubMed/MEDLINE search: (infection prevention OR infection command OR standard precaution OR do) AND (healthcare workers OR wellness workers OR health personnel OR healthcare providers) AND (wellness facilities OR hospitals OR public health facilities) AND (Ethiopia) likewise as all possible combinations of these terms. For the other electronic databases, we used database-specific subject headings linked with the above terms and keywords used in PubMed. This review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [34] (S1 File). The search strategy is provided in supplementary certificate S2 and S3 Files.

Inclusion criteria

• Study design: observational studies
• Population: only studies involving healthcare workers
• Language: manufactures published in the English language language
• Reported condition: studies that reported the overall healthcare worker's infection prevention do
• Availability of full texts
• Study area: studies conducted in Ethiopia

Exclusion criteria

Articles with the post-obit characteristics were excluded from this review

• Studies whose full information were not accessible even after requests from the authors
• Studies which did non report the overall prevalence of infection prevention practices
• Studies conducted on medical students (1^st to 4^th year), health scientific discipline students, interns, and housekeeping staff
• Qualitative studies, reviews, commentaries, editorials, letters, interventional studies, and other opinion papers
• Excluded published manufactures with unclear methods

The outcome of the written report

The pooled prevalence of prophylactic infection prevention practices in Federal democratic republic of ethiopia was the main outcome variable of this study,a random-effects meta-analysis model was used to estimate the pooled prevalence of safe infection prevention practice. The second objective of this written report was to summarize descriptively the factors that were associated with safe infection prevention practices in Ethiopia from the included studies.

Operational definition

Safe infection prevention do was defined equally healthcare worker's overall compliance to the cadre components of infection prevention measures that including proper paw hygiene exercise, regular utilization of personal protective equipment's every bit required, correct medical equipment processing practice, proper healthcare waste management, tuberculosis infection control, and rubber injection and medication practices.

Information extraction

Two investigators (BS and YT) independently extracted the information from the studies included in our analysis as recommended past PRISMA guidelines [34]. The data were extracted using a standard data extraction forms. The following data were extracted from the selected studies: first writer'south name, year of publication, the blazon of study design, study setting including region, study population, sample size, sampling methods, the magnitude of infection prevention practice, infection prevention components assessed, and response rateof included studies.

Quality assessment

The cess of methodological quality was carried out independently by two reviewers using the Newcastle-Ottawa Scale (NOS) [35]. Thisscale has three sections: 1^st option (maximum five stars), (2) comparability between groups (maximum 2 stars), and (3) effect cess (maximum 3 stars). In summary,the maximum possible score was ten stars, which represented the highest methodological quality. The ii authors (BS and YT) independently assessed the quality of each original study using the quality assessment tool. Any disagreements during the data extraction were resolved through give-and-take and consensus. Finally, any article with a scale of greater than or equal to ≥ seven out of 10 was included in this Systematic Review and Meta-analysis. A detailed scoring event was described in the supplementary file (S4 File).

Data assay and synthesis

Data obtained from the studies under review was entered into Microsoft Excel spreadsheet, then analyzedwere done using STATA Version 14 statistical software. Characteristics of each principal study were presented in a table. The standard errors for each original study were calculated using the binomial distribution formula. The presence of heterogeneity among the reported prevalencewas assessed past calculating p-values for the Cochran Q exam and I² examination. Cochran'due south Q exam was used to test the cypher hypothesis of no meaning heterogeneity across the studies [36]. Although there tin can be no absolute rule for when heterogeneity becomes of import, Higgins et al. tentatively suggested low for I² values between 25%–50%, moderate for 50%–75%, and high for ≥75% [36]. Subgroup assay was done by the region where master studies were conducted, publication year, sample size, sampling method, and blazon of healthcare facility.

Publication bias was assessed using a funnel plot. In the absenteeism of publication bias, the plot resembles a symmetrical large inverted funnel. Egger's weighted regression and Begg's rank correlation tests were used in checking the publication bias (P < 0.05), considered statistically significant [37]. We too conducted a get out-ane-out sensitivity assay to appraise the master studies that exerted an important bear on on between-study heterogeneity.

Results

Identification of studies

For this review, 1 hundred and lxxx-seven studies were identified in the initial search. Of these, 118 were excluded during the evaluation of the title and abstract. After applying the inclusion and exclusion criteria, a total of x studies were included in the final systematic review and meta-analysis (Fig 1).

Characteristics of included studies

A total of 10 articles [nineteen,20,27,31,33,38–42] were included in meta-analysis. The aggregate study sample included iii,510 participants (a mean of 351 and a median of 314participants). The largest written report conducted by Geberemariyam BS., et al had (648 participants) in the Oromia region [20] while the smallest study by Abreha N., et al. in Addis Ababa had 108 participants [41]. Selected studies were conducted between 2014 and 2019. All the included studies were cross-sectional by design. With regards to regional distribution, almost (30%) of the studies were conducted in Addis Ababa [27,40,41]. The prevalence of safe infection prevention practices ranged between 15% [33], and 72.5% [41] in South Nation Nationalities and People (SNNPs) Region and Addis Ababa, respectively. Concerning the quality score, all included studies were of a reputable methodological quality, scoring 7 out of 10-points (Table i).

Meta-Analysis

Prevalence of safe infection prevention practices.

A full of 10 studies were included in the meta-assay. From these studies, the pooled prevalence of safe infection prevention practices in Ethiopia was 52.2% (95%CI: forty.ix–63.four). A significant higher heterogeneity among the ten included studies was institute (Iⁱⁱ = 98.0%; Q = 453.55, Variance Tau-squared = 319.63, p<0.001). Due to the existence of this heterogeneity, we used a random-effect meta-assay model to judge pooled prevalence (Fig ii). According to the sensitivity assay, there was no single influential study that significantly deemed for information technology (Table 2).

Subgroup analyses

The subgroup analyses of infection prevention do prevalence.

The results of the subgroup analysis showed that the pooled prevalence of safe infection prevention practices were highest in Addis Ababa (capital city) 66.ii% (95%CI: 60.six–71.8) [I² = 51.4%, p = 0.128], and 54.half-dozen% (95%CI: 51.1–58.1) [Iⁱⁱ = 0.0%, p = 0.825] in Amhara Region;48.5% (95%CI: 24.2–72.8) in Oromia Regional State; and the to the lowest degree safe practiceswere reported from other regions (SNNP and Tigray regions)with pooled prevalence of 39.iv% (95%CI:xiii.9–64.viii). A considerable heterogeneity was also plant [I² = 97.7%; p<0.001]; and [I² = 98.8%; p<0.001] for the Oromia Regional State, and other regions (SNNP and Tigray), respectively. The prevalence of infection prevention practices was analyzed separately for either nurses or all other healthcare workers. The findings show the prevalence of condom infection prevention practices more than in studies conducted exclusively on nurses than in other health care workers (66.iv% vs. 48.half dozen%). Nosotros likewise conducted a subgroup analysis based on the study setting. The pooled prevalence of safe infection prevention practice showed more in studies conducted exclusively in hospitals than in those that include health centers (53.5% vs. 49.8%). More details on the prevalence of condom infection prevention practices for subgroups are presented in Table three.

Publication bias

In the present study, Begg'south and Egger's tests were utilized to discover the presence of publication bias. All the same, none of the tests revealed significant publication bias (p-values of 0.210 and 0.246, respectively) for the prevalence of prophylactic infection prevention practice in Federal democratic republic of ethiopia (Fig 3).

Sensitivity assay

Tabular array 2 shows the sensitivity analysis of prevalence for each study being removed at a time. To identify the potential source of heterogeneity in the assay, a exit-ane-out sensitivity analysis on the prevalence of infection prevention practice in Ethiopia was employed. The results of this sensitivity assay showed that the findings were robust and not dependent on a single study. The pooled estimated prevalence of infection prevention practice varied betwixt 56.2 (95%CI: 48.1–64.4) and 50.0 (95%CI: 38.3–61.vi) after removing a single written report.

Moreover, to place the possible sources of variations across studies,the meta-regression model was performed by considering the geographical region, publication year, and sample size as covariates. The geographical region (p-value = 0.260), publication year (p-value = 0.864), and sample size (p-value = 0.820) were not statistically significant source of heterogeneity (Table iii).

Narrative review

From the ten studies, nosotros summarized descriptively the factors that were associated with safe infection prevention practices in Ethiopia. Factors were categorized into the following three domains: socio-demographic factors (four factors), behavior-related factors (iii factors), and healthcare facility-related factors (five factors). The overview of these factors including the strength of association and corresponding manufactures was presented in Table four.

Socio-demographic factors

Four socio-demographic factors were significantly associated with safe infection prevention practices. Healthcare workers historic period [19,41], gender [33,38], profession [19,twenty,27,42], and higher service year [31] were identified as underlying factors associated with safe infection prevention practise.The odds of safety infection prevention practiceswere college among the age groupsbetween 20–29 [xix], 30–39 [19], and 31–40 [41] than HCWs of greater age. The odds of prophylactic infection prevention practiceswere also higher in female HCWs than males [33,38]. Lastly, significantly lower odds onsafe infection prevention practices were observed amongall professionals such as midwives [20], laboratory technicians [27], health officers and health assistants [42], and physicians and nurses [19] (Table iv).

Behavioral related factors

Having practiced knowledge ofinfection prevention measures was identified as a factor associated with rubber infection prevention practices [27]. In the same way, having a positive mental attitude towards infection prevention measures, and awareness on infection prevention guideline were the virtually commonly identified factors associated with the aforementioned practice [27,33] (Table four).

Healthcare facility related factors

As illustrated in Tabular array 4, four healthcare facility-related factors were positively and significantly associated with safe infection prevention practices in Ethiopia. Healthcare workers who worked in facilities with continuous water supply take college odds onsafe infection prevention practise [27]. Similarly, healthcare workers who worked in facilities with access to infection prevention guidelines in the working department have higher odds on the prevention exercise [19,xx,27]. Lastly, factors such as the type of healthcare facility, current working section, and completion of formal infection prevention training, were the most important factors associated with this prevention practice [twenty,27,33,38,42].

Discussion

Infection prevention and patient safety in healthcare settings is a nationwide initiative in Federal democratic republic of ethiopia, that involves the regular implementation of recommended infection prevention practices in every aspect of patient intendance. Such practices include hand hygiene, injection safety and medication safety, and health care waste product management, among others. In Ethiopia, findings regarding the prevalence of safety infection prevention practices have been highly variable. We conducted this systematic review and meta-analysis to guess the pooled prevalence of rubber infection prevention practicesamong HCWs in Ethiopia. Based on the meta-analysis issue, but half of the HCWs in Federal democratic republic of ethiopia had safe infection prevention practices. In our qualitative syntheses, healthcare workers' socio-demographic, behavioral and healthcare facility-related factors were important variables associated with infection prevention practise.

The result of the x included studies noted that the pooled prevalence of safe infection prevention exercise in Ethiopia was 52.2%. This finding brought important data, and these signified that unsafe practices in healthcare facilities are a major public health business in Ethiopia. As the burdens of HAIs are increasing [14–18], the current suboptimal infection prevention practices have serious implications to both the HCWs and patients.

On ane manus, contracting an infection while in the healthcare facilitydue to poor infection prevention do violates the basic idea that healthcare is meant to make people well. In fact, the risk of contracting HAIs is variable and multifaceted:prevalently, it depends on a patient's allowed status, the local prevalence of various pathogens, and the institutional and individual HCW infection prevention practices. Hence, the need for having strong infection prevention programs nationally; and at the healthcare facility level has been not disregarded [29,30,32,43,44]. Un sustained compliance with infection prevention possibly places HCWs at equal, if not at higher take a chance ofcontracting bacterial and viral infections such as HIV, HBV, HCV, and MRSA in healthcare facilities [9]. In lite of this, studies conducted in Ethiopia fifty-fifty showed a positive correlation between poor standard precaution practices and a high prevalence of blood and torso fluid exposure [xx,27,45,46]. For this reason, the Federal Ministry of Health infection control professionals, healthcare facility administrators, and hospital epidemiologists must pay considerable attention to curve the current poor suboptimal infection prevention practices [47,48].

In the subgroup assay, a variation in HCWs infection prevention practices across geographical regions was constitute. Safe infection prevention practices were consistently more frequent in key Federal democratic republic of ethiopia (Addis Ababa) and less in Tigray and SNNP regions-the reason for these regional differences may be explained by studies conducted in cardinal Ethiopia included mainly in 3rd and referral hospitals which and unremarkably staffed are with skilled and experienced healthcare professionals as compared to those in other regions. Another possible explanation for this variation might exist due to the difference in environmental infrastructures and behavioral characteristics of HCWs. Our findings may, therefore, indicate the need to promote advisable infection prevention and patient safety practices for HCWs in Federal democratic republic of ethiopia. Moreover, to address regional variationsthere is a strong demand of implementing readily available, relatively inexpensive, practical and scientifically proven infection prevention and patient safety practices in different regions of Ethiopia.

Our meta-analysis also found that the prevalence of prophylactic infection prevention practices differed between nurses and other healthcare workers. The possible caption for this observed discrepancy may be due to the preparation and roles of healthcare workers; the nurses were engaged in inpatient care, and they may have amend agreement regarding infection prevention. Still, this prevalence is suboptimal and bang-up business concern, therefore, is necessary to strive for a better quality of healthcare.

In this review,we summarize the findings of the included studies on factors associated with safety infection prevention practise identified iii primary domains of determinant factors; namely socio-demographic, behavioral, and healthcare facility-related factors. Healthcare workers in facilities with access to infection prevention guidelines and those receiving formal infection prevention preparation have higher odds onsafe infection prevention practice. Plain, this may exist due to health professionals who accept adequate noesis and attitude to implement the recommended infection prevention and patient safety practices in the healthcare facilities possibly have meliorate IPC compliance [27]. In this sense, the electric current systematic review suggests that it may be more than effective to improve HCWs infection prevention practices through regular in-service training [49]. Furthermore, a holistic arroyo that involves the behaviors of HCWs and facilities that are essential for effective infection prevention and control measures should be integrated. Since infection Prevention and Patient Rubber recommendations could easily be implemented if everyone in the health service delivery system, from the level of policy makers to healthcare providers at the facility level collaborate [ix,27,31].

Finally, despite there were similar trends for many of the African countries in the practice of healthcare worker'southward infection prevention and control practise, we would advise caution against applying the nowadays results to countries located in other regions of the African, as the healthcare arrangement, healthcare workers training, and a government policy may affect HCWs infection prevention compliance.

Limitations of the study

This systematic review and meta-analysis have several limitations. The first limitation considered to conduct this review was to include English language articles only. Second, all of the studies included in this review were cross-exclusive every bit a issue; the outcome variable might be affected past other confounding variables. 3rd, this meta-assay represented only studies that were reported from the iv regions of the country- this irregular distribution of studies from around the state limits the study findings. 4th, the majority of the studies included in this review had relatively small sample sizes which could have affected the estimated safe infection prevention do reports. Fifth, a minor number of studies were included in subgroup analyses which reduce the precision of the gauge and considerable heterogeneity was identified amidst the studies. Sixth, almost all studies included in this meta-assay were often based on self-reported data from healthcare providers, which tended to have overestimated compliance and limited the strengths of the findings. Lastly, since most of the included primary studies did not cover a good range of components of infection prevention practices. We strongly recommend caution while interpreting the estimated pooled prevalence finding.

Conclusions

Infection prevention practices in Ethiopia was poor, with only half of the healthcare workers reportingsafe practices. At that place were regional and professional person variations in the prevalence on the condom practices-it is therefore important for all HCWs to attach to the existing infection control guidelines past embedding them in everyday practice. It is also imperative for healthcare administrators to ensure the implementation of infection prevention and patient safety programs in all healthcare settings. Our report highlights the demand for the Ethiopian Federal Ministry of Health to step-up efforts to intensify the current national infection prevention and patient safety initiatives.

Supporting information

Acknowledgments

The authors would like to thank MaddaWalabu University Goba Referral Hospital Public Health Department staff for providing their unreserved support. Nosotros would like to thank for the valuable back up we received from Mr. John Edward Quisido (assistant professor)as well equally Dr. David Allison for their proofreading back up.

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Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245469