Infection prevention and control (IPC) is a holistic approach aimed at curbing and halting the transmission of infectious agents and the diseases they cause among healthcare workers (HCWs), patients, their relatives, and the broader community. When IPC measures are not implemented properly, they can lead to a decline in the quality of healthcare, increased harm, and the spread of diseases. Healthcare workers and other staff in health institutions are key stakeholders in the implementation of IPC activities, such as hand hygiene, use of personal protective equipment (PPE), injection safety, and adherence to World Health Organization (WHO) standard guidelines,¹ especially during public health emergencies such as the COVID-19 pandemic. Infection prevention and control practices were compromised during the COVID-19 pandemic because of a shortage of IPC experts and volunteers to support personal hygiene and facility-level infection prevention efforts.²

The United States Centers for Disease Control and Prevention recommended strict IPC guidelines for COVID-19 to help limit its transmission. These guidelines included the use of visible signage (e.g. signs and posters) at entrances and other strategic locations such as waiting areas, elevators and cafeterias. The United States Centers for Disease Control and Prevention also emphasised using respiratory protection, such as respirators, well-fitting face masks, or cloth masks to cover the mouth and nose, thereby reducing the spread of respiratory secretions during breathing, sneezing, talking and coughing. The universal use of PPE by healthcare personnel was encouraged strongly through distancing and avoiding crowded areas. In addition, the United States Centers for Disease Control and Prevention recommended optimising engineering controls to reduce exposure risks. For example, setting up physical barriers in reception and triage areas and establishing designated routes to direct symptomatic patients through waiting rooms and triage areas. Dedicated medical equipment was advised to minimise cross-contamination when managing patients with confirmed or suspected severe acute respiratory syndrome coronavirus 2 infection.³ One of the improvisations of the COVID-19 era in Africa was the provision of Veronica buckets in different locations in the COVID-19 treatment centres (CTCs). This ensured access to running water for hand washing, aligning with hand hygiene principles in IPC protocols.⁴

Furthermore, the WHO has underscored consistently the necessity for well-designed and effectively executed IPC programmes to curb the transmission of the virus both domestically and internationally.⁵ Infection prevention and control encompasses a set of practices and procedures that must be implemented in healthcare settings to prevent the transmission of infections between patients and HCWs.⁶ Effective IPC also maintains a safe hospital environment and safeguards against community transmission of infectious illnesses during outbreaks.⁷

Successful pandemic control, such as during COVID-19, requires IPC strategies guided by well-established policies.⁸ However, poor compliance with IPC measures in low- and middle-income countries, especially in Africa and Asia, has been a significant challenge in managing the COVID-19 pandemic.^9,10,11,12

During the COVID-19 pandemic, the implementation of IPC measures varied between low- and middle-income countries and high-income countries. Differences were observed in compliance strategies, available infrastructure, and the level of facility engagement.

Nigeria, one of Africa’s most populous countries, was globally recognised for its swift and effective containment of the Ebola outbreak in 2014.¹³ However, its capacity and strategy to control the COVID-19 pandemic through effective IPC implementation in treatment centres remains insufficiently documented. A key factor in strengthening future pandemic preparedness is the understanding of the infection control and prevention strategies that were employed in various CTCs in Nigeria. This includes evaluating adherence to IPC policies and assessing the awareness of COVID-19-related protocols among HCWs and volunteers. Such data can serve as a foundation for developing more robust preparedness plans for future emerging infectious diseases.

Therefore, this study aims to evaluate the infection prevention strategies used by HCWs and volunteers in CTCs in Nigeria, along with their knowledge of disease control, confidentiality practices and adherence to facility policies.

Our study observed that 44.2% of respondents had received basic training on IPC related to COVID-19, including hand hygiene, use of PPE, patient informed consent, privacy, confidentiality, and issues surrounding key population stigma and discrimination. The most common IPC practices among HCWs at the treatment centres were the use of face masks, handwashing with soap and water, and the application of alcohol-based hand sanitisers. In addition, 75% of respondents reported wearing full PPE while attending to patients confirmed to have COVID-19. Notably, 93% of HCWs believed that testing individuals without their knowledge or consent was inappropriate.

This study highlighted the knowledge and practices of IPC among HCWs and volunteers who worked in CTCs in Nigeria during the 2020–2022 pandemic, primarily in Lagos State (Table 1). The study also examined their adherence to established policies in these facilities.

The WHO emphasises that IPC is vital for limiting disease transmission and safeguarding both HCWs and the wider community. The attitudes, knowledge and practices of HCWs regarding IPC play a crucial role in ensuring patient safety and improving treatment outcomes.

In this study, years of work experience, age, and gender are not associated with the infection control practices among the respondents (p > 0.05). Of the 113 participants, 61 (54%) were male and 52 (46%) were female. Of the women, 40 (57.8%) demonstrated good IPC, which is lower than the 70.4% reported among 301 female participants in a similar study conducted in Kaduna, Nigeria.¹⁵ These differences may be due to variations in training, occupational roles, and hygiene practices. In a study from Ethiopia, male HCWs were three times more likely to demonstrate good IPC,¹⁶ a trend also seen in China, and attributed to their lighter workloads and differing occupational roles.¹⁷

Our study observed that HCWs with fewer years of work experience (≤ 10 years) demonstrated better IPC in 33 out of 69 (47.8%) cases, which may be attributed to recent updated training methods, adherence to protocols owing to fear of consequences, technological adaptability, supervisory pressure and heightened awareness. In contrast, a study conducted in Ethiopia in 2021 found that HCWs with longer years of experience had good IPC practices compared to those with less than 5 years of experience.¹⁶ Similarly, in Pakistan, logistic regression analysis showed that experienced (> 5 years) HCWs were more likely to adhere to precautionary practices, probably because of their skills and experience in managing with public health emergencies.¹⁸

In our study, healthcare workers and volunteers aged between 31 and 50 demonstrated good IPC practices in 44 (38.9%) cases. This contrasts with findings from South Africa, where younger HCWs achieved higher knowledge scores than their older counterparts, possibly because of their broader use of digital information sources.¹⁹ However, another study suggests that older HCWs may perform better because of their accumulated experience.¹⁸

Only 50 (44.2%) of our study participants had basic knowledge of IPC, confidentiality, and consent, in contrast with studies in Ethiopia (88.2%) and Afghanistan (85%), which reported a higher level of IPC knowledge.^20,21 Similarly, a study in Nepal reported 76% adequate IPC knowledge,²² while another Nigerian study reported 56%.²³ These discrepancies may be because of differences in sampling methods or to the scope of the questionnaire items. The relatively low knowledge level in our study may also reflect the small proportion (33%) of respondents who received COVID-19-specific IPC training (Table 4). Comprehensive training and ongoing education should be prioritised.

Our study showed that 61% of HCWs practised good IPC, including avoiding physical contact, wearing of face masks and gloves during all aspects of patient care, implementing special IPC measures for COVID-19 patients, and wearing full PPE for COVID-19, higher than the 41% reported in another Nigerian study¹⁵ but lower than compliance rates observed in India, Uganda, and Ghana.^24,25,26

The most common IPC practices included wearing face masks (92.9%), followed by wearing gloves during all aspects of patient care (90.3%) (Table 7). These findings align with a Ugandan study reporting 93% mask use.²⁶ However, in Ghana, PPE use was reported to be lower.²⁷ In additional, some other studies highlighted poor adherence to mask and glove use, often because of discomfort and PPE shortages.^28,29,30,31

Most participants in our study reported that IPC supplies were adequately available, reducing their perceived risk of contracting COVID-19. In contrast, a Brazilian study noted significant PPE shortages.³² Adequate PPE is essential to prevent HCW infections and reduce community transmission. Other studies similarly reported good supply availability during COVID-19 management.^33,34

A large majority (93%) of our participants affirmed the availability of standard operating procedures in their facilities, which enhances both patient care and infection prevention. However, Iyal and colleagues attributed low IPC compliance in their study to the lack of COVID-19-specific guidelines.¹⁵ Meanwhile, a study in Ghana reported low protocol adherence despite the availability of guidelines.²⁷ Therefore, making protocols readily accessible and promoting adherence are critical to effective IPC in treatment centres.

Interestingly, 93% of our participants disagreed with testing patients for COVID-19 without their consent. This finding, however, does not align with WHO guidance, which allows for exceptions during public health emergencies under specific legal frameworks.³⁵ A United States study revealed public support for clear communication and consent, although mandatory testing was accepted in high-risk settings like schools or hospitals.³⁶ The study also assessed perceptions of discrimination, with 79.6% of respondents indicating that there would be consequences for discriminating against patients with COVID-19. This probably reflects awareness of professional ethical standards,³⁷ and underscores the role of ethical compliance in building trust and improving patient outcomes. Respect for confidentiality and consent remains fundamental to effective healthcare delivery.