Touba is located in central Senegal, 193 km from Dakar. The population of Touba is estimated at 904,411 residents [11] , although there has been an exponential increase in the population due to migration favored by the city’s religious character. The level 1 PHE of Touba Ndamatou is a referral center for the two Health Districts (Mbacke and Touba) comprising three Health Centers (Mbacke, Khelcom, and Darou Khoudoss), on which 45 Health Posts depend. It includes medical-surgical and support services. Human resources are made up of 28 doctors, including thirteen specialists, a pharmacist-biologist, 16 health technicians, 22 state-approved midwives, 37 nurses, 38 care assistants, six management executives, and 25 administrative staff.

This was a descriptive and analytical cross-sectional study conducted among health care staff at the Touba Ndamatou PHE in 2024.

The study population consisted of all healthcare providers working at the Ndamatou PHE (medical and paramedical staff).

All care providers working at Ndamatou EPS were included.

Providers who refused to participate in the study and those who were unavailable or absent from the facility during the survey period were not included.

An exhaustive recruitment process was carried out, and all providers meeting the inclusion criteria were interviewed. A total of 101 people were enrolled.

Collection tool

An anonymous questionnaire was developed based on a literature review of the assessment of healthcare providers’ knowledge and practices regarding healthcare-associated infections [12] - [15] . The questionnaire focused in particular on: 1) respondents’ socio-professional data, 2) general knowledge of healthcare-associated infections, 3) standard precautions to prevent HAIs, 4) hand hygiene practices, 5) personal protective equipment, 6) use and disposal of sharps, 7) treatment of reusable materials and instruments, and 8) housekeeping and waste disposal.

Collection technique

The questionnaire was administered to service providers during face-to-face interviews.

Operational definition of variables

Definition of HAIs

The definition of healthcare-associated infections was considered correct if the person chose the most precise and complete answer, i.e.: “any infection occurring during or following the management (diagnostic, therapeutic, or preventive) of a patient and if it was neither present nor incubating at the start of the management, all within a period ≥ 48 hours or > the incubation period.”

Examples of HAIs

For the examples of healthcare-associated infections, the answer was considered correct if the respondent chose the following three (3) answers out of five (5): Urinary tract infection caused by Escherichia coli, catheter-related infection caused by Staphylococcus epidermidis, and pneumonia caused by Pseudomonas aeruginosa.

Allied health professionals

For the purpose of this study, the category allied health professionals was operationally defined to include pharmacists, biologists/laboratory technicians, care assistants, medical imaging technicians, nurses, and midwives. This grouping was adopted to capture the broader non-physician workforce directly involved in patient care and support services within health facilities

Risk factors for healthcare-associated infections

To the question concerning the main risk factors contributing to healthcare-associated infections, the answer was considered correct if the respondent chose the following four (4) propositions: Invasive procedures, Length of hospital stay, Immunocompromised patients, and Extreme age.

Transmission modes

As for the modes of transmission of HAIs, the answer was considered correct if the respondent chose the following three (3) propositions: handling, septic material, and lack of asepsis.

Persons exposed to HAIs

To accept that the respondent knew all the categories of people potentially exposed to healthcare-associated infections, he had to choose the following five (5) answers: Patients, Visitors/carers, Nursing staff, Hygiene and maintenance staff, and administrative staff.

Components of personal protective equipment

We considered that respondents were familiar with PPE components if they selected the following items: Gloves, Masks (surgical, FFP), Goggles, Gown, Overblouse or gown cap, Operating theatre scrubs, Face shield, Caps, and Shoe covers.

Simple hand-washing steps

For the steps involved in simple hand washing, the following combination was considered the correct answer: A - C - B - D - E - G - F, (A) Wet your hands with lukewarm water, (C) Apply soap, (B) Rub your hands together for at least 20 seconds, (D) Wash all surfaces of your hands, including your fingernails, thumbs, and between your fingers, (E) Rinse your hands under running water, (G) Dry your hands thoroughly, (F) If possible, turn off the tap with a paper towel or towel.

Surgical hand-washing steps

For the steps involved in surgical handwashing, the following combination was considered the correct answer: C - A - B - F - E - H - D - G, (C) Wet your hands, (A) Apply soap, (B) Rub your hands together for 60 seconds, (F) Wash all surfaces of your hands (including nails, thumbs, between your fingers), your wrists, and forearms, (E) Rinse your hands and arms under running water, starting with your fingertips, (H) Repeat the wash three times, (D) Dry yourself carefully from your hands to your elbows, (G) Keep your hands always above your elbows.

Isolation indications

The respondent knew the situations in which a patient had to be isolated (septic isolation/protective isolation) if he gave the following two (2) answers: Patient carrying a potentially contagious infection and Subject abnormally susceptible to infections.

Disposal of sharp objects

With regard to the choice of container for the disposal of sharp objects, the answer was correct if the respondent chose the proposal: «In a safety box».

Antibiotic prophylaxis

The provider knew the appropriate time to initiate antibiotic prophylaxis if he chose to do so before the potentially contaminating invasive procedure.

Knowledge score

To assess the level of HAIs knowledge, a total knowledge score was established. A score of one (1) point was awarded to those who gave the correct answer to the knowledge questions, and a score of zero (0) was given to those who gave the wrong answer. Providers with a total score ≥ 60% were considered to have good knowledge. On the other hand, those with a score < 60% were considered to have poor knowledge.

Attitude score

To assess the level of HAIs attitude, a total attitude score was established. A score of one (1) point was awarded to those who gave the correct answer to the attitude questions, and a score of zero (0) to those who gave the wrong answer. Providers with a total score ≥ 60% were considered to have a good attitude. On the other hand, those with a score < 60% were considered to have a poor attitude.

Practice score

To assess the level of HAIs preventive practices, a total practices score was established. A score of one (1) point was awarded to those who gave the right answer to the practice questions, and a score of zero (0) to those who gave the wrong answer. Providers with a total score ≥ 60% were considered to have good practices. On the other hand, those with a score < 60% were considered to have poor practices.

Data were analysed using R 4.4.2 software. Quantitative variables were described by mean, median, mode, and standard deviation. For qualitative variables, absolute and relative frequencies were calculated. In the analytical part, bivariate and multivariate analyses were performed, with cross-tabulations between variables to address the concerns formulated in the objectives. The dependent variables were HAIs knowledge, attitude, and practice. Chi-square or Fisher tests were used, depending on their applicability. The test was significant if the p-value was less than 0.05. Variables with a p-value of less than 0.25 were entered into the model using simple logistic regression with R software. The adjusted odds ratio, surrounded by its confidence interval, was used to quantify the strength of the relationships found.

Authorization for the survey was obtained from the Chief Medical Officer of the Touba Ndamatou PHE before the study began. After a verbal explanation of the purpose and interest of the study, a consent form was offered to participants before submission of the questionnaire. Data were collected anonymously and confidentially using identification codes, and no personal identification was left on the questionnaire.

A total of 101 agents were interviewed, 62.4% of whom were women. Their average age was 31.6 ± 6.0. The 25 - 30 age group was the most represented, at 36.6%. The majority of respondents were nurses (36.6%). Less than a third worked in the medical department, accounting for 32.7%. The average length of time in the profession was 5.3 years ± 4.0. More than half the nurses in our series (50.5%) had been in the profession for between 2 and 5 years ( Table 1 ).

Over half of the agents surveyed (64.3%) defined HAIs as any infection occurring during or following care. A further 30.7% defined them as infections contracted in healthcare establishments, and 5% as infections contracted during care provided outside healthcare establishments. Catheter-related infections caused by Staphylococcus epidermidis (92.1%), those caused by Escherichia coli (80.2%), and those caused by Pseudomonas aeruginosa (69.3%) were the main examples of HAIs cited by the agents. With regard to risk factors for HAIs, invasive procedures (89.1%) and length of hospital stay (77.2%), immunocompromised patients (56.4%), and extreme age were known to be risk factors for HAIs. Concerning modes of contamination with HAIs, defects in asepsis (89.1%), septic equipment (67.3%), and handling were indicated by respondents as the modes of HAIs contamination. According to them, the people most exposed to HAIs were patients (90.1%), nursing staff (80.2%), hygiene and maintenance staff (50.5%), and visitors/accompanying persons (46.5%). 37.8% of staff occasionally updated their knowledge of the latest HAIs prevention practices. In all, only 10.9% of those surveyed had a good overall knowledge of HAIs ( Table 2 ).

Strict compliance with HAIs prevention protocols was noted by 39.6% of participants. Among the staff surveyed, 55.4% felt that the equipment needed for care was sufficient in quantity. With regard to HAIs risk assessment within the

healthcare facility, 47.6% of providers stated that it was carried out regularly. Just over half (52.5%) said that they communicate with and educate patients and their families about HAIs risks and preventive measures. According to 60.4% of agents, staff awareness-raising activities on the prevention of healthcare-associated infections were organized at the health facility level. Only 39.6% had good overall attitudes to HAIs ( Table 3 ).

PPE use during care was strict in 36.6% of participants. Hand washing with soap and water was the main hand hygiene technique used by staff (67.3%). The

majority of participants (87.1%) systematically practiced hand hygiene between each patient. The same applied to the mastery of the simple (73.3%) and surgical (71.3%) hand-washing steps. 73.3% felt that there were sufficient functional water points and detergents to perform hand-washing when the indication arose. With regard to instrument handling, the majority of staff (81.2%) stated that reusable equipment was systematically decontaminated and sterilized after each procedure. With regard to the hygiene of the patient’s immediate environment, participants said they systematically disinfected examination tables (53%), operating tables (70%), treatment tables (69%), hospital beds (83%), and bedside tables (62%). Most participants (73.3%) claimed to isolate any patient carrying a potentially contagious infection. Hygiene and cleaning staff were available on a daily basis in 77.2% of cases. More than three quarters of surveys (76.2%) systematically sorted medical waste. 71.3% reported the existence of a waste management plan. Less than half of participants (46.5%) placed sharp objects in a trap box. Concerning the indications for prophylactic antibiotic therapy, 40.6% of them said they would institute antibiotic prophylaxis before the procedure, 5% during the procedure, 31.7% after the procedure, and 12.9% at any time. Furthermore, the majority of staff (52.5%) said they had never been directly involved in the management of a healthcare-associated infection during their practice. In all, 47.5% of participants had good overall HAIs practices ( Table 4 ).

Professional category was statistically related to knowledge of HAIs. Doctors were more likely to have good knowledge than allied health professionals (aOR = 12.5 [2.22 - 33.3]) ( Table 5 ).

Factors associated with attitude to HCAI were gender: women were more likely to have good attitudes than men (aOR = 3.55 [1.15 - 12.0]); professional category: allied health professionals were more likely to have good attitudes than doctors (aOR = 4.45 [1.18 - 20.1]) ( Table 6 ).

No factor was statistically associated with HAIs practices ( Table 7 ).