Healthcare Workers' Perspectives on Infection Control Practices: A Study From Mogadishu's Tertiary Care Teaching Hospital

Healthcare Workers' Perspectives on Infection Control Practices: A Study From Mogadishu's Tertiary Care Teaching Hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Healthcare Workers' Perspectives on Infection Control Practices: A Study From Mogadishu's Tertiary Care Teaching Hospital Yasin Mohamed Ali, Ali Mohamed Hussein This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7347612/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Nosocomial infections pose a significant challenge in healthcare settings worldwide, particularly in resource-limited countries, such as Somalia. This study assessed the awareness, attitudes, and practices of healthcare workers regarding nosocomial infection control in a tertiary care teaching hospital in Mogadishu, Somalia. This cross-sectional study was conducted using a structured questionnaire distributed to 83 healthcare professionals, including nurses, doctors, and lab technicians. The majority of participants (58%) were male, and 78% were under 35 years old. The findings revealed a high level of awareness about the modes of transmission and the role of contaminated medical equipment and environmental surfaces in the spread of nosocomial infections. However, attitudes on the way to infection control practices varied, with 85.5% acknowledging the seriousness of the problem, while only 72.3% regularly used personal protective equipment. Notably, 79.5% of respondents received training on infection prevention, and 80.7% recognized the risks associated with neglecting control measures. Poor hand hygiene was identified as a major cause of hospital-acquired infections in 71% of participants. This study highlights the need for targeted interventions to address gaps in infection control practices, such as improving hand hygiene compliance, ensuring consistent use of personal protective equipment, and providing ongoing training and support for healthcare workers. These findings underscore the importance of strengthening institutional policies and resources to promote a culture of infection prevention and control in Somali healthcare facilities. Further research is needed to explore the barriers to and facilitators of implementing effective infection control strategies in resource-constrained settings. Nosocomial infections- Healthcare workers- Tertiary care hospital- Infection control- Developing countries- Hospital-acquired infections- Multidrug-resistant organisms Figures Figure 1 1.0 INTRODUCTION Nosocomial infections, also known as hospital-acquired infections (HAIs), are the most common adverse event in healthcare systems worldwide. These infections can occur at any time and affect people of all ages, especially those with weakened immune systems and elderly populations. HAIs occur when patients develop infections while being treated for other conditions in hospitals or health care facilities. These infections can lead to serious health issues, longer hospital stays, higher healthcare expenses, and death in some cases. Typically, these infections become noticeable in patients after hospitalization for 48 h. For healthcare workers (HCWs), understanding and managing the risk of nosocomial infections is crucial for patient safety and improving the overall quality of hospital care (Fortunka et al. 2024 ). In tertiary care teaching hospitals, the complexity of patient care, variety of healthcare procedures, and exposure to multidrug-resistant organisms (MDROs) make nosocomial infections particularly important. The knowledge and attitudes of healthcare workers, including doctors, nurses, technicians, and support staff, play key roles in preventing and controlling HAIs. According to the World Health Organization (WHO), a hospital-acquired infection (HAI) is defined as "an infection acquired in a hospital by a patient who was admitted for a reason other than that infection but appearing after discharge and also occupational infections among staff of the facility." Developing countries have been reported to have up to 20 times the risk of contracting nosocomial infections compared with developed countries. A prevalence survey conducted in 2002 by the WHO across 55 hospitals in 14 countries found that an average of 8.7% of hospitalized patients had HAIs (Nag et al., 2018 ). In Africa, and notably in Nigeria (Mbon et al., 2023 ), infectious diseases continue to be a major global health issue, ranking among the top causes of illness worldwide. Although hospitals are intended to be places of healing, they can ironically become settings where diseases worsen, and previously healthy individuals may acquire unexpected infections. The potential for infection occurs when patients undergo medical procedures in a clinical setting. In Ethiopia (Bayleyegn et al., 2021 ), hospital-acquired infections (HAIs), also known as nosocomial infections (NIs), are contracted by patients during their hospital stay or by healthcare workers (HCWs) during routine activities in the hospital. These infections are considered nosocomial if they occur within 10 d of discharge. Healthcare workers are at risk of these infections during tasks such as collecting, processing, and disposing of specimens; handling medical equipment; and interacting directly with patients during their examinations. Common nosocomial infections include urinary tract infections (UTIs), surgical site infections, lower respiratory tract infections, bloodstream infections, and other nonbacterial infections. HAIs continue to pose significant public health challenges in Africa, particularly in nations such as Nigeria and Ethiopia. These infections can affect both patients and HCWs in the hospital setting. Patients are vulnerable to developing HAIs during their hospital stay or within 10 days of discharge, whereas HCWs may acquire infections through various activities, such as handling specimens, managing medical equipment, and direct patient interactions. The most common types of nosocomial infections include UTIs, surgical site infections, lower respiratory tract infections, bloodstream infections, and other nonbacterial infections (Mbon et al., 2023 ; Bayleyegn et al., 2021 ).The widespread occurrence of healthcare-associated infections (HAIs) in African medical facilities highlights the critical need for improved infection control strategies and hygiene practices. These infections not only lead to higher rates of illness and death but also place additional strain on already limited healthcare resources. Contributing factors, such as overcrowding, poor sanitation facilities, and insufficient access to personal protective equipment (PPE), may worsen the spread of hospital-acquired infections in African hospitals. Tackling these issues requires a comprehensive approach, including better staff training, adoption of rigorous infection control measures, and investment in infrastructure improvements to ensure safe healthcare settings for both patients and medical staff. Research conducted in Somalia revealed a troubling shortfall in infection control practices among healthcare professionals, with only 42.4% following the correct protocols. This shortcoming poses a considerable threat to healthcare-associated infections, potentially putting both patients and medical staff at risk. The findings of this study suggest that factors such as attitude, work experience, training, needle stick injuries, vaccination against HepB, availability of infection control guidelines, presence of hand rubs in the room, and infection control budget are significantly linked to infection prevention practices (Said et al., 2023 ). These results highlight the pressing need for comprehensive interventions and enhancements in healthcare facilities across Somalia to improve compliance with infection prevention protocols. Various elements have been recognized to have a significant impact on infection prevention practices. These include the attitudes, work experience, and training of healthcare workers, along with the frequency of needle-stick injuries and Hepatitis B vaccination status. Furthermore, institutional factors, such as the availability of infection control guidelines, the presence of hand sanitizers in patient rooms, and dedicated budgets for infection control, play a vital role in ensuring adherence to proper infection control measures. These insights highlight the importance of addressing both individual and systemic factors to improve infection prevention in the Somali healthcare settings. Implementing specific interventions, such as regular training sessions, better resource distribution, and promoting a safety-oriented culture, could lead to notable enhancements in infection control practices and overall healthcare quality (Said et al., 2023 ). Hospital-acquired infections pose a significant challenge to the healthcare systems worldwide. These infections, which patients contract while in medical facilities, can lead to increased illness, extended hospital stay, and death. In Somalia, the healthcare sector faces numerous obstacles such as limited resources, insufficient training, and infrastructure limitations. These challenges may hinder effective infection control and increase the risk of infection for both patients and healthcare staff. However, there is a lack of research on the understanding and attitudes of healthcare workers in Somalia regarding hospital-acquired infections, especially in tertiary care teaching hospitals. Despite this, the researcher acknowledged the necessity of understanding the context in this part of the Banadir region, which has not been thoroughly examined in previous research. This study aimed to assess the knowledge and attitude of healthcare professionals regarding nosocomial infection control measures in a tertiary care teaching hospital in Somalia. The specific goals of this study were to evaluate healthcare professionals' understanding of nosocomial infection control practices and examine their attitudes towards these practices among healthcare workers in a tertiary care teaching hospital located in the Banadir region of Mogadishu, Somalia. The knowledge and perspectives of healthcare workers regarding hospital-acquired infections in tertiary care teaching hospitals in Somalia are important. This comprehension offers researchers valuable insights into the understanding and views of hospital staff regarding nosocomial infections. 2.0 LITERATURE REVIEW 2.1Theoretical Framework To effectively explore healthcare workers' (HCWs) understanding of and perspectives on hospital-acquired infections, it is vital to use a solid theoretical framework that clarifies the factors affecting their behavior, knowledge, and attitudes. Such a framework is essential for directing research on HCWs' awareness of and attitudes toward these infections. Various established theoretical models can be applied to study HCWs' awareness, attitudes, and practices of HCWs related to nosocomial infections. Utilizing theoretical frameworks in designing interventions for health issues offers numerous advantages, including identifying behavioral causes, understanding behavioral change structures, developing intervention strategies, finding practical solutions, and assessing behavioral changes (Reigeluth, 2013). Building on this idea, it is important to recognize that theoretical frameworks provide an organized approach to studying HCWs' awareness of and attitudes toward nosocomial infections. These frameworks offer a systematic way to analyze the complex interactions of factors that affect HCWs' knowledge and behaviors concerning infection control practices. Using established theoretical models, researchers can create more comprehensive and effective interventions to address awareness gaps and improve attitudes among healthcare professionals. Employing theoretical frameworks in the investigation of hospital-acquired infections allows for a deeper understanding of the obstacles and enablers of infection control measure adoption. These frameworks help to identify specific cognitive, social, and environmental elements that affect healthcare professionals' attitudes and behaviors. By systematically analyzing these elements, researchers and healthcare managers can create targeted interventions to address the underlying causes of poor infection control practices. Furthermore, theoretical frameworks provide a basis for assessing the long-term effectiveness of interventions, thus facilitating ongoing improvements in strategies to decrease hospital-acquired infections and to improve patient safety in healthcare settings. 2.1.1. Health Belief Model (HBM) The Health Belief Model (HBM) offers a framework for understanding the various factors that affect healthcare workers' compliance with preventive measures against hospital-acquired infections. Although there may be a high level of awareness of these infections, the model indicates that perceived obstacles can greatly influence behavior. Such obstacles might include overwhelming workloads that limit time for proper infection control, insufficient training on prevention methods, or a complacent attitude towards the seriousness of nosocomial infections. According to the HBM, individuals evaluate the perceived advantages of taking action against these obstacles, along with their perceptions of their vulnerability and severity of the health threat. Research utilizing the HBM in healthcare environments has produced mixed outcomes. Some studies have shown positive results, suggesting that interventions based on HBM principles can effectively enhance preventive behaviors (Jeihooni et al., 2018; Sadeghi et al., 2018; Pinyaphong et al., 2020). However, other studies have pointed out ongoing difficulties in implementing standard precautions among healthcare workers. These difficulties often arise from knowledge gaps and misunderstandings regarding the risks and severity of nosocomial infections (Atalla et al., 2016; Ramlan et al., 2020 ). This implies that, while the HBM can be a valuable tool for understanding and potentially changing health behaviors, its use in healthcare settings may require targeted strategies to address specific barriers and misconceptions unique to the healthcare context. The Health Belief Model (HBM) is a well-established framework in public health that explains and predicts health-related behaviors. In terms of disease prevention, people who understand the seriousness of health issues are more likely to take preventive measures. They recognize that the disease poses a significant threat to their health and can lead to serious complications if not properly addressed. This understanding of severity is a crucial element of the HBM as it encourages individuals to seek information and take proactive steps to protect their health (Elgzar et al., 2020 ). Additionally, the HBM highlights the importance of perceived benefits and barriers in influencing health behaviors. Individuals are more inclined to adopt the recommended preventive actions when they believe in their effectiveness. This belief is strengthened when perceived advantages outweigh the expected obstacles or difficulties associated with implementing these actions in the workplace. The model's success in preventing diseases and modifying behaviors in the short term makes it a valuable resource for healthcare professionals and policymakers to create targeted interventions and educational programmes (Kouhi et al., 2023 ). By addressing the key elements of the HBM, such as perceived severity, benefits, and barriers, health initiatives can more effectively encourage the adoption and maintenance of behaviors that enhance health. 2.1.2. Theory of Planned Behavior (TPB) The Theory of Planned Behavior (TPB) plays a crucial role in assessing various attitudes and social factors that influence healthcare workers' (HCWs) actions concerning infection prevention measures. For example, when HCWs feel that they have control over their actions, such as having sufficient time and resources, they are more likely to adhere to infection prevention guidelines. Thus, the TPB can be used to forecast the intention to comply with hospital elective or inherent contacts through several intermediary factors, including attitudes towards handwashing related to clean or contaminated contacts, subjective norms (i.e., the perception of peer pressure to engage in clean or contaminated handwashing), perceived control (i.e., the perception of the effort needed to perform clean or contaminated handwashing behaviors), similar handwashing practices in the community, and contrasting hospital handwashing practices (i.e., hospital elective for predicting hospital inherent practice and vice versa) (McLaws et al., 2012 ). The TPB offers a comprehensive framework for understanding and predicting HCWs' adherence to infection prevention practices by examining their attitudes, social norms, and perceived behavioral control. This theory provides insights into the complex factors that affect HCWs' decision-making processes. For instance, positive attitudes towards handwashing coupled with strong social pressure from peers and supervisors to maintain hygiene standards can significantly increase the likelihood of compliance. Moreover, the perception of adequate resources, such as easily accessible hand sanitizers or sufficient time between patient interactions, can enhance HCWs' sense of control over their ability to consistently adhere to protocols. The application of TPB in healthcare settings goes beyond merely predicting behavior, allowing for a nuanced understanding of how different types of contact (elective or inherent) within the hospital environment might affect handwashing practices. As McLaws et al. ( 2012 ) suggested, this theory can be used to analyze the interaction between hospital-specific behaviors and similar practices in the community, highlighting the potential for cross-contextual influences on hygiene habits. Additionally, by considering the "opposite" handwashing practice as a predictor, the TPB acknowledges the complex relationships between different types of hygiene behaviors, potentially revealing how adherence in one area might impact compliance in another area. This comprehensive approach enables healthcare administrators and researchers to develop targeted and effective interventions to improve infection prevention practices among HCWs. 2.1.3. Health Promotion Model (HPM) Pender's Health Promotion Model emphasizes the motivational factors and influences that drive individuals to engage in health enhancing behaviors. Employing this model enables researchers to investigate how healthcare workers' (HCWs) previous infection experiences or their understanding of the consequences of hospital-acquired infections on patient health affects their attitudes and actions regarding infection prevention. Consequently, the present study aimed to evaluate the impact of a hospital-based intervention, informed by Pender’s Health Promotion Model, on the hand hygiene (HH) practices of intensive care unit staff as a professional behavior (Khosravi et al., 2021 ). This theoretical framework integrates behavioral sciences with nursing theories to identify the determinants of healthy behaviors within a biopsychosocial context by examining three primary components: personal characteristics and experiences, perceptions and understanding of targeted health promotion behavior, and the outcomes of such conduct (Neri et al., 2021 ). Pender's Health Promotion Model provides a comprehensive framework for understanding and influencing health-promoting behaviors, highlighting the intricate interplay between individual traits, experiences, and environmental factors that shape individuals’ health-related decisions and actions. In the context of HCWs and infection prevention, this model offers valuable insights into the motivations and barriers affecting adherence to practices, such as HH. By examining HCWs' past infection experiences and their comprehension of the impact of nosocomial infections on patient outcomes, researchers can identify the key factors influencing attitudes and behaviors towards infection prevention protocols. The application of the Pender's Health Promotion Model in healthcare settings, particularly in intensive care units, has demonstrated the potential to enhance professional behaviors, such as HH compliance. KHosravi et al. ( 2021 ) showed that hospital-based interventions grounded in this model can effectively address the multifaceted aspects of behavior change among ICU staff. The strength of the model lies in its holistic approach that integrates personal characteristics, experiences, and perceptions with the broader biopsychosocial context of healthcare environments. This comprehensive perspective, as noted by Neri et al. ( 2021 ), facilitates a nuanced understanding of the factors that promote or hinder the adoption of health-promoting behaviors among healthcare professionals, ultimately contributing to improved patient safety and a reduced rate of infection. 2.2 Concept of objectives variables in the study 2.2.1 Awareness about nosocomial infections among doctors and nurses This literature review examined the key findings related to healthcare professionals' awareness of nosocomial infections, focusing particularly on doctors and nurses. This underscores the elements that shape their understanding of and attitudes towards infection control. Recognizing the prevalence and spread of healthcare-acquired infections is crucial for improving infection control measures and developing effective preventive and therapeutic strategies to decrease their occurrence, morbidity, and mortality (Park, 2008). Educating and training healthcare workers in standard infection control practices can reduce the risk of nosocomial infections, encourage safe working practices, and safeguard staff and patients from infections (Development Research & Undefined 2018). For healthcare workers (HCWs), especially physicians and nurses, understanding the risks, prevention methods, and importance of infection control practices are vital for lowering the incidence of healthcare-associated infections (HAIs). Reducing nosocomial infections is a global priority, with various suggested strategies, including the implementation of infection prevention and control measures, prudent antibiotic use, and encouragement of patient education and involvement (Mbon et al., 2023 ). Healthcare workers' knowledge of nosocomial infections is essential for their effective prevention and control. Awareness includes understanding the routes of infection transmission, the common pathogens responsible for healthcare-associated infections, and infection prevention practices. A study by Singh et al. (2020) involving nurses and doctors in a tertiary care hospital in India found that while healthcare workers had sufficient knowledge of basic infection control measures such as hand hygiene, there was a lack of awareness regarding specific nosocomial infection transmission and control strategies. A survey by Kumar et al. (2021) in a tertiary hospital in Nepal showed that 65% of healthcare workers had a strong understanding of the need for sterilization and disinfection, yet only 45% recognized the importance of isolation protocols for infectious diseases. A lack of detailed knowledge about pathogens and specific preventive practices can lead to inadequate infection control and an increased risk of nosocomial infections (Abalkhail & Alslamah, 2022). 2.2.2 Attitude of health care professionals toward nosocomial infections. Healthcare professionals (HCPs), also known as healthcare-associated infections (HAIs), play a crucial role in the prevention and management of these infections. The mindset of healthcare workers towards infection prevention is as vital as their knowledge and understanding. A positive outlook on infection control practices can improve adherence to protocols and decrease the occurrence of healthcare-associated infections (HAIs). Research by Temsah et al. ( 2020 ) in a Middle Eastern teaching hospital revealed that, although most healthcare workers acknowledged the significance of infection control practices, there was a noticeable gap in attitude. Some healthcare workers showed complacency owing to high workloads, lack of staff, and insufficient training. Similarly, a study by Olowe et al. (2021) in a Nigerian hospital discovered that despite healthcare workers expressing a positive attitude towards infection control, the perceived low risk of exposure to certain pathogens in non-critical care units resulted in inconsistent compliance with safety measures. Factors affecting attitudes included stress from workload, organizational support, resource availability (such as personal protective equipment and infection control training), and perceived risk of infection exposure. According to Bayleyegn et al. ( 2021 ), the need for positive attitudes towards infection prevention is undeniable in preventing HAIs. More than half of the respondents (57.2%) showed a favorable attitude towards infection prevention. However, a significant proportion (42.8%) of HCWs in this study displayed unfavorable attitudes towards infection prevention. Additionally, the attitude level of participants in our study was similar to that found in a study conducted in Bahir Dar City, Ethiopia (55.6%). 2.2.3 Infection control practices in a tertiary care teaching hospital. Standard measures to prevent healthcare-acquired infections (HCAI) involve straightforward, yet highly effective practices that significantly reduce infection rates in hospitals. When performed correctly, meticulous hand hygiene can significantly lower the occurrence of HCAI. Improved compliance with hand hygiene guidelines, particularly through the use of standard alcohol-based hand rubs, has been proven to reduce hospital-acquired infection rates by as much as 40 Enhancing healthcare workers' (HCW) understanding of hand hygiene through focused education and awareness initiatives can boost adherence among the medical staff. Healthcare professionals are at the forefront of infection management. They engage in direct patient care and are accountable for executing routine infection control practices, including hand hygiene, utilization of personal protection equipment (PPE), environmental sanitation, and proper antimicrobial stewardship (Yadav et al., 2023 ).. Preventing HCAI requires a comprehensive, multipronged strategy that, when properly executed, can positively impact other areas of healthcare. For example, a study conducted in Indonesia showed a 22% decrease in antibiotic misuse of antibiotics after implementing a multifaceted infection control and antibiotic stewardship program (Iliyasu et al., 2016 ). Nurses are crucial in implementing infection prevention and control strategies, and it is vital for them to engage in ongoing professional development. Therefore, it is crucial for nurses to be familiar with these standard precautions to reduce associated risks. Common hospital-acquired infections include urinary tract, respiratory tract, bloodstream, and surgical site infections. A study by Pezhman et al. ( 2021 ) in a tertiary hospital in Pakistan revealed that approximately 15% of hospitalized patients had at least one nosocomial infection during their stay. Similarly, Gupta et al. (2019) found that healthcare-associated infections accounted for up to 10% of all hospital admissions in India, with surgical site infections being the most common. These infections lead to increased patient morbidity, longer hospital stays, and higher healthcare costs, highlighting the importance of infection control in tertiary-care hospitals. 2.3 Conceptual frame work The conceptual framework illustrated in Fig. 2.1 suggests that the independent variable is characterized by the degree of awareness and attitudes towards healthcare-acquired infections. Conversely, the dependent variable was infection control practices among healthcare workers in a tertiary care teaching hospital. 3.0 MATERIALS AND METHODS This study adopted a descriptive approach, specifically utilizing quantitative techniques. Quantitative methods were considered appropriate for examining numerical data and measurable variables, which aligned with the study's goals. This approach was suitable for evaluating the awareness and attitudes of healthcare workers towards nosocomial infections in a tertiary care teaching hospital in Mogadishu, Somalia. The analysis included frequencies, tables, percentages, and measures of central tendency as the researchers investigated the question, “What is the role of employee compensation on organizational productivity among small businesses in Mogadishu, Somalia?” Structured questionnaires were developed based on a literature review, using Likert scales (3 = Agree, 2 = Neutral, 1 = Disagree) through the Kobo Toolbox to collect data from employees of small businesses in this area. This platform ensured efficiency, reduced manual errors, and facilitated easy data cleaning and export to the statistical software. Data collection will be conducted from March to April 2025. The questionnaires were personally distributed with the help of hospital management to gather information from the staff in hospitals in the Banadir region of Mogadishu, Somalia. The researchers ensured that the questionnaires were completed at times that did not disrupt the respondents' official work schedules and obtained special permission from the hospital managers. Data analysis was conducted after cleaning and verifying the completeness of the questionnaire. The study included 105 health workers from the Banadir region, focusing on nurses, lab technicians, doctors, and other health science professionals, while excluding hospital patients. A simple random sampling technique, a probability sampling method, was used to ensure equal representation of the target population (Oluigbo & Anyiam, 2014). The researcher sampled 83 health professionals by distributing questionnaires to workers in hospitals and lecturers at universities in Mogadishu, Somalia. Slovin’s formula was used to determine the sample size with a maximum acceptable error of 5%, where n = 105/1 + 105 (0.05) 2 = 83, with n representing the sample size, N representing the population, and a representing the acceptable error. This formula was chosen for its ability to sample a population with the desired degree of accuracy. Leung ( 2015 ) suggested that the validity of a research tool is assessed by the degree of inherent error in its measurements. Typically, the validity of individual questions or groups of questions reflects their ability to provide accurate data that aligns with the expected responses. This accuracy depends on whether the respondents understood the questions as intended, matching the researcher's perspective. According to Khidzir et al. ( 2018 ), an instrument's reliability is related to its consistency and stability. In the process of pre-testing a questionnaire, revising and conducting further tests can improve its reliability. Before the questionnaire was distributed, the researcher sought advice from experts, including PhD holders who were actively involved in both the distribution of the questionnaire and the study. Omar (2017) described data analysis as the process of examining collected data to make deductions and draw conclusions. Primary data were collected using questionnaires through the Kobo toolbox, which were then downloaded into Excel and cleaned by checking for completeness. The data were subsequently uploaded to the SPSSV20 software for both qualitative and quantitative analyses. Descriptive statistics were used to organize, summarize, and present the data in tables, showing frequencies, percentages, means, and standard deviations, thus measuring the central tendency and dispersion. 4.0 FINDINGS AND DISCUSSIONS 4.2 Demographic data This section outlines the demographic details of the study participants with the goal of identifying their characteristics. Participants were assured that the information gathered would be used exclusively for academic purposes, and that their identities would remain confidential. A total of 83 health professionals from the Banadir region of Mogadishu, Somalia completed the questionnaires. Table 1 Demographical Study Demographics frequency Percent Gender Male 48 58% Female 35 42% Age in years 46 8 10 Profession of healthcare Nurse 43 52 Doctors 8 10 Lab Technicians 18 22 Other 14 16 Experience level 11 9 11 Developed by the researcher (2025) According to Table 1 the demographic data, men made up the majority of the participants, accounting for 58% of the sample, while women represented 42%. This indicates a slight gender disparity in this healthcare group, with a higher number of male participants. The workforce is largely young, as 78% of the individuals are under 35 years old. In contrast, only 10% were over 46 years of age, pointing to a lack of senior healthcare workers. Nurses were the largest group, accounting for 52% of the workforce, suggesting that nursing perspectives are likely central to the results. Although the sample is varied, it was heavily skewed towards nurses, with lab technicians making up 22% and doctors and other healthcare professionals filling the remaining percentages. A significant proportion of participants (70%) had less than five years of experience, supporting the idea that the workforce is mainly in the early stages of their careers. This suggests that the surveyed group may have had limited contributions from seasoned healthcare professionals and may still be in the initial phases of professional growth. 4.3 Descriptive analysis of variables 4.3.1 Objective one: Awareness/Knowledge about Nosocomial Infections Table 2 Awareness/Knowledge about Nosocomial Infections IV1 D N A Total Mean Std 1.1. I am aware of the modes of transmission of nosocomial infections. 5 12 66 83 2.73 0.565 6 14.5 79.5 100 1.2.Contaminated medical equipment can spread nosocomial infections 5 4 74 83 2.83 0.514 6 4.8 89.2 100 1.3.Environmental surfaces (bed rails, door handles) can harbor infectious agents 3 10 70 83 2.81 0.48 3.6 12 84.3 100 1.4.Respiratory devices (e.g., ventilators) can cause hospital-acquired pneumonia (HAP). 6 11 66 83 2.72 0.591 7.2 13.3 79.5 100 Developed by the researchers (2025) The study results Table 2 revealed that participants had a thorough understanding of how nosocomial infections were transmitted. Notably, 89.2% of the respondents understood that contaminated medical equipment could contribute to the spread of these infections, and 79.5% were aware of the various transmission methods. Furthermore, 79.5% believed that hospital-acquired pneumonia might be linked to respiratory devices, such as ventilators, while 84.3% agreed that environmental surfaces, such as door handles and bed rails, could harbor infectious pathogens. The mean scores for these items, which ranged from 2.72 to 2.83 on a 3-point scale, reflected strong agreement. Additionally, low standard deviations between 0.48 and 0.591 indicated consistency in the responses. Overall, the findings suggest that the respondents had a solid understanding of the main mechanisms through which the infections spread. 4.3.2. Objective 2: Attitudes Toward Nosocomial Infections Table 3 Attitudes Toward Nosocomial Infections IV2 D N A Total Mean Std 1.1.Nosocomial infections are serious problems in healthcare settings. 6 6 71 83 2.78 0.564 7.2 7.2 85.5 100 1.2.Using personal protective equipment (PPE) regularly reduces the spread of infections 7 16 60 83 2.64 0.636 8.4 19.3 72.3 100 1.3.Neglecting infection control measures can harm both patients and healthcare staff 4 12 67 83 2.76 0.532 4.8 14.5 80.7 100 1.4.Poor hand hygiene is a major cause of hospital-acquired infection. 10 21 52 83 2.51 0.705 6 6 71 83 Developed by the researchers (2025) The data revealed Table 3 the views of healthcare workers on infection control and the importance of preventive measures. There was a strong consensus on the seriousness of nosocomial infections, with 85.5% of participants agreeing and a high average score of 2.78 out of 3 indicating significant awareness. The necessity of personal protective equipment (PPE) is also widely acknowledged, although agreement is slightly lower at 72.3%, with an average score of 2.64, possibly reflecting differences in PPE use or availability. Similarly, a large proportion (80.7%) of participants recognized the dangers of neglecting infection control, with an average score of 2.76. However, opinions on hand hygiene showed slightly more disagreement or neutrality, with only 71% agreeing and the lowest average score of 2.51, along with the highest standard deviation (0.705), indicating varied opinions or adherence levels. Overall, while the importance of infection control is recognized, focused efforts to emphasize the role of hand hygiene and consistent PPE use can improve compliance.. 4.4 Dependent variable of infection control practice Table 4 infection control practice DV D N A Total Mean Std 1.1.Training or workshop practice is held to the staff to prevent nosocomial infections 4 13 66 83 2.75 0.537 4.8 15.7 79.5 100 1.2.Appropriate personal protective equipment (PPE), such as gloves, masks, and gowns, is necessary to prevent infection. 6 11 66 83 2.72 0.591 7.2 13.3 79.5 100 1.3.Hospital management plays a critical role in supporting infection-control measures. 9 10 64 83 2.66 0.668 10.8 12 77.1 100 Developed by the researchers (2025) According to Table 4 the data, staff members generally view infection prevention measures as well as support and are crucial. A significant majority (79.5%) agreed that training or workshops were necessary to prevent hospital-acquired infections, as indicated by a high mean score of 2.75 and a low standard deviation (0.537), reflecting strong agreement. Likewise, 79.5% of the participants recognized the importance of personal protective equipment (PPE), such as gloves, masks, and gowns, with a mean score of 2.72, indicating a consistent acknowledgment of PPE's role in the prevention of infections. Perceptions of hospital management support for infection control were slightly less positive, with 77.1% agreement and a mean score of 2.66, along with a higher standard deviation (0.668), suggesting slightly more varied responses than in the other dimensions. Overall, the data indicate positive views on institutional infection control practices, although there may be room to enhance confidence in management involvement. 4.5 Discussion of findings According to Table 1 the demographic data, men made up the majority of the participants, accounting for 58% of the sample, while women represented 42%. This indicates a slight gender disparity in this healthcare group, with a higher number of male participants. The workforce is largely young, as 78% of the individuals are under 35 years old. In contrast, only 10% were over 46 years of age, pointing to a lack of senior healthcare workers. Nurses were the largest group, accounting for 52% of the workforce, suggesting that nursing perspectives are likely central to the results. Although the sample is varied, it was heavily skewed towards nurses, with lab technicians making up 22% and doctors and other healthcare professionals filling the remaining percentages. A significant proportion of participants (70%) had less than five years of experience, supporting the idea that the workforce is mainly in the early stages of their careers. This suggests that the surveyed group may have had limited contributions from seasoned healthcare professionals and may still be in the initial phases of professional growth. Objectives one The study results Table 2 revealed that participants had a thorough understanding of how nosocomial infections were transmitted. Notably, 89.2% of the respondents understood that contaminated medical equipment could contribute to the spread of these infections, and 79.5% were aware of the various transmission methods. Furthermore, 79.5% believed that hospital-acquired pneumonia might be linked to respiratory devices, such as ventilators, while 84.3% agreed that environmental surfaces, such as door handles and bed rails, could harbor infectious pathogens. The mean scores for these items, which ranged from 2.72 to 2.83 on a 3-point scale, reflected strong agreement. Additionally, low standard deviations between 0.48 and 0.591 indicated consistency in the responses. Overall, the findings suggest that the respondents had a solid understanding of the main mechanisms through which the infections spread. Objective 2 The data revealed Table 3 the views of healthcare workers on infection control and the importance of preventive measures. There was a strong consensus on the seriousness of nosocomial infections, with 85.5% of participants agreeing and a high average score of 2.78 out of 3 indicating significant awareness. The necessity of personal protective equipment (PPE) is also widely acknowledged, although agreement is slightly lower at 72.3%, with an average score of 2.64, possibly reflecting differences in PPE use or availability. Similarly, a large proportion (80.7%) of participants recognized the dangers of neglecting infection control, with an average score of 2.76. However, opinions on hand hygiene showed slightly more disagreement or neutrality, with only 71% agreeing and the lowest average score of 2.51, along with the highest standard deviation (0.705), indicating varied opinions or adherence levels. Overall, while the importance of infection control is recognized, focused efforts to emphasize the role of hand hygiene and consistent PPE use can improve compliance.. According to Table 4 the data, staff members generally view infection prevention measures as well as support and are crucial. A significant majority (79.5%) agreed that training or workshops were necessary to prevent hospital-acquired infections, as indicated by a high mean score of 2.75 and a low standard deviation (0.537), reflecting strong agreement. Likewise, 79.5% of the participants recognized the importance of personal protective equipment (PPE), such as gloves, masks, and gowns, with a mean score of 2.72, indicating a consistent acknowledgment of PPE's role in the prevention of infections. Perceptions of hospital management support for infection control were slightly less positive, with 77.1% agreement and a mean score of 2.66, along with a higher standard deviation (0.668), suggesting slightly more varied responses than in the other dimensions. Overall, the data indicate positive views on institutional infection control practices, although there may be room to enhance confidence in management involvement. 5.0 CONCLUSION In summary, the demographic study highlights a healthcare workforce that is largely young and somewhat inexperienced, with significant gender disparity. Awareness of and attitudes towards hospital-acquired infections are generally strong, with a solid understanding of infection control protocols and a positive outlook on infection prevention. However, there are areas that require improvement, such as inconsistent hand hygiene, occasional lapses in protocol adherence, and gaps in training for some staff members. Despite these issues, there was a promising overall commitment to infection control practices, with most respondents confident of their ability to prevent infections. To further enhance infection control, it is crucial to address training gaps, ensure consistent hygiene practices, and strengthen protocol adherence. Additionally, addressing resource-related issues can improve the effectiveness of infection-control measures. Recommendations This study provides actionable suggestions for improving infection control measures among healthcare workers in tertiary-care teaching hospitals. The primary suggestions involve fostering and sustaining awareness and positive attitudes toward infection control, and ensuring that these attitudes are consistently put into practice. This study highlights the necessity of enhancing hand hygiene compliance, addressing protocol adherence gaps, and overcoming resource-related obstacles for effective infection control in the NICU. These recommendations are designed to reduce risk and improve the overall safety of both patients and staff in healthcare settings.. Study Contributions This study offers valuable insights into the awareness, attitudes, and practices of healthcare workers regarding nosocomial infection control. This study bridges gaps in the existing literature, particularly in resource-limited settings, such as Somalia, and provides a foundation for future research and interventions. The findings highlight both the strengths and areas for improvement, contributing to the broader discourse on infection prevention in healthcare systems. This study presents four main contributions divided into three categories: theory, empirical evidence, and practice. Theoretical Contributions This study is grounded in established theoretical frameworks such as the Health Belief Model (HBM), Theory of Planned Behavior (TPB), and Health Promotion Model (HPM). These models help to explain healthcare workers' behaviors and attitudes toward infection control, offering a structured approach to understanding and addressing gaps in knowledge and practice. The application of these theories enriches the conceptual foundation of this study, and supports the development of targeted interventions. Empirical Contributions This study provides empirical evidence for the awareness and attitudes of healthcare workers in a tertiary care teaching hospital in Mogadishu, Somalia. The findings revealed a high awareness of infection transmission routes and control measures but identified inconsistencies in hand hygiene and protocol adherence. This study also highlighted demographic trends, such as the predominance of young and inexperienced workers, which may influence infection control practices. These empirical insights are critical for designing context-specific intervention strategies. Practical Implications This study underscores the need for practical measures to improve infection control, such as regular training, adequate provision of personal protective equipment (PPE), and institutional support for infection prevention protocols. Addressing resource limitations and reinforcing consistent practices among health care workers can significantly reduce the incidence of nosocomial infections. These findings are particularly relevant for hospital administrators and policymakers aiming to enhance healthcare quality in similar settings in the future. Recommendations for Future Research Future research should expand its geographical scope to include diverse regions of Somalia and other low-resource settings to improve the generalizability of the findings. Longitudinal studies can be used to assess the long-term impact of interventions on infection rates. Incorporating qualitative methods such as interviews or focus groups would provide deeper insights into the challenges faced by healthcare workers. Additionally, future studies should explore the role of non-clinical staff in infection control. Limitations of the Study This study has several limitations including its restricted focus on the Banadir region, which limits its broad applicability. The small sample size of 83 respondents may not fully represent the diverse healthcare workforce of the study area. Reliance on self-reported data introduces potential response bias, and the cross-sectional design prevents causal inferences. The exclusion of certain staff categories such as cleaners and technicians also narrows the scope of these findings. Despite these limitations, this study offers valuable preliminary insights into nosocomial infection control in patients with Somalia. Declarations Avoiding Conflicts of Interest The authors declare that they have no conflicts of interest. No collaboration occurred during the course of this study and the findings and recommendations were presented objectively based on the analysis results. Funding details No external funding was received for the study. All research was funded by the authors. About the authors Yasin Mohamed Ali is a distinguished public health specialist with extensive experience in infection prevention and control, healthcare epidemiology, and strengthening the health system in low-resource settings. As a researcher and practitioner, he dedicated his career to improving healthcare quality and patient safety in Somalia through evidence-based interventions and capacity-building initiatives. With specialized training in public health, Yasin brings a unique blend of academic rigor and field expertise to his research. His research focuses on critical gaps in nosocomial infection control, healthcare worker behavior, and institutional infection prevention protocols. His notable study on awareness and attitudes toward hospital-acquired infections among healthcare workers in Mogadishu's tertiary hospitals provides valuable insights for policymakers and health administrators in Somalia and similar contexts. Committed to advancing global health equity, Yasin advocates stronger health infrastructure, improved resource allocation, and continuous professional development for healthcare workers in underserved regions. His contributions continue to shape policies and practices aimed at reducing preventable infections and enhancing health care delivery in Somalia. Ali Mohamed Hussein As a public health expert, Ali Mohamed Hussein positively impacted the community’s health through educational programs, preventative measures, and by maintaining advocacy initiatives. Ali, a health sciences and public health management graduate, has championed numerous projects on disease prevention, sanitation, and health education, especially in underprivileged regions. Hussein is an advocate for the most at risk populations by striving to eliminate disparities in health and to improve the access to clean water, sanitation, hygiene, and health services. Ali collaborated with government and non government bodies and community leaders to ensure local health program integration through sustainable approaches. Ali has effectively helped to raise the vaccination coverage, provided services for better maternal and child health, and educated the community on health issues. Ali Mohamed Hussein strives for the betterment of public health and motivates other public health professionals by fostering the vision of equitable and healthier societies. Authors contribution Credit: Yasin Mohamed Ali was responsible for the conceptualization, data curation, formal analysis, investigation, formal analysis, methodology, writing the original draft, writing the Ali Mohamed Hussein was responsible for the review, visualization, editing, supervision, validation, and visualization. Project administration, resources, and software Potential conflicts of interest The authors declare that they have no conflicts of interest. No financial, personal, or professional relationships influenced the results or interpretation of this study. This transparency ensured the reliability and objectivity of the study, and increased the validity of the results. Gratitude The authors would like to thank the participants of this study for their time and valuable insight. Special thanks to the Faculty of health science Capital University of Science of Somalia , for their support throughout this research. Ethical approval The Capital University Research Ethics Committee examined and approved this work (Reference Number: CUR&D0058/2025), adhering to international ethical norms. The research was executed in complete adherence to the ethical norms for medical research involving human beings as specified in the Declaration of Helsinki. Informed consent Informed consent was acquired from all individual subjects engaged in the study. Participants were comprehensively briefed on the study's objectives, research aims, and the utilization of their data. In the circumstances of this investigation, the ethics committee determined that verbal consent was a sufficient and suitable means of obtaining consent. All participants were assured the confidentiality and anonymity of their responses in accordance with ethical research standards. Data availability statement The corresponding author may provide data to support the conclusions of the study upon request. Owing to ethical and privacy concerns, the data are not publicly accessible. Consent to publish declaration This study was evaluated and approved by the Capital University Research Ethics Committee (Reference Number: CUR&D0058/2025), which adheres to international ethical standards. The study followed the ethical criteria for medical research with human beings specified in the Declaration of Helsinki. Clinical Trial Number in the manuscript Clinical Trial Registration: Gandi hospital (GH) GH0062 Consent to publish declaration Applicable Gandi hospital (GH) GH0062 References Abalkhail A, Alslamah T. Institutional Factors Associated with Infection Prevention and Control Practices during Infectious Pandemics in Resource-Limited Settings. Vaccines. 2022;10(11). https://doi.org/10.3390/vaccines10111811 . Bayleyegn B, Mehari A, Damtie D, Negash M. Knowledge, attitude, and practice of hospital-acquired infection prevention and associated factors among healthcare workers at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Infect Drug Resist. 2021;14:259–66. https://doi.org/10.2147/IDR.S290992 . Elgzar WT, Al-Qahtani AM, Elfeki NK, Ibrahim HA. Covid-19 outbreak: Effect of an educational intervention based on the health belief model on nursing students’ awareness and health beliefs at Najran University, Kingdom of Saudi Arabia. Afr J Reprod Health. 2020;24(2):78–86. https://doi.org/10.29063/ajrh2020/v24i2s.12 . Special Edition COVID-19. Fortunka K, Strzelecka A, Król G, Paprocka P, Mańkowska A, Lesiak A, Karpeta U, Okła S, Spałek J, Kaliniak S, Piktel E, Karasiński M, Durnaś B, Bucki R. (2024). Knowledge and Training Needs in Nosocomial Infection among Hospital Staff in the City of Kielce, Poland: A Cross-Sectional Study. Journal of Nursing Management , 2024 , 1–19. https://doi.org/10.1155/2024/9243232 Iliyasu G, Dayyab FM, Habib ZG, Tiamiyu AB, Abubakar S, Mijinyawa MS, Habib AG. Knowledge and practices of infection control among healthcare workers in a tertiary referral center in northwestern Nigeria. Ann Afr Med. 2016;15(1):34–40. https://doi.org/10.4103/1596-3519.161724 . Khidzir KAM, Ismail NZ, Abdullah AR. Validity and River. Int J Dev Sustain. 2018;7(3):1026–37. Khosravi N, Alami A, Aelami MH, Khosrovan S. Improving Hand Hygiene Compliance in the Intensive Care Unit Using Pender’s Model. Ethiop J Health Sci. 2021;31(3):553–60. https://doi.org/10.4314/ejhs.v31i3.12 . Kouhi R, Panahi R, Ramezankhani A, Amin Sobhani M, Khodakarim S, Amjadian M. The effect of education based on the health belief model on hand hygiene behavior among the staff of Tehran dentistry centers: A quasi-experimental intervention study. Health Sci Rep. 2023;6(7). https://doi.org/10.1002/hsr2.1408 . Leung L. (2015). Validity, reliability, and generalizability in qualitative research . 4 (3), 324–327. https://doi.org/10.4103/2249-4863.161306 Mbon EF, Chimezie OV, Ehioghae O, Adesegun OA, Fikayo BE. Knowledge, Attitude, and Practice of the Prevention of Nosocomial Infections among the Hospital Staff of a Nigerian Tertiary Hospital. West Afr J Med. 2023;40(4):389–96. McLaws ML, Maharlouei N, Yousefi F, Askarian M. Predicting hand hygiene among Iranian healthcare workers using the theory of planned behavior. Am J Infect Control. 2012;40(4):336–9. https://doi.org/10.1016/j.ajic.2011.04.004 . Nag K, Datta A, Karmakar N, Chakraborty T. Knowledge, attitude, and practice of hospital-acquired infection among health care personnel in a tertiary care hospital in Tripura. Int J Res Med Sci. 2018;6(10):3303. https://doi.org/10.18203/2320-6012.ijrms20184037 . Neri MF, de Silva S, Nascimento RA, do JC, Sousa É do, Rocha N, Barros R, Sampaio LM, C. L., Caetano JÁ. (2021). Hand hygiene determinants of informal caregivers in hospitals under Pender’s perspective. Revista Brasileira de Enfermagem , 75 (1), e20210012. https://doi.org/10.1590/0034-7167-2021-0012 of Development Research. M. B.-I. J., & undefined 2018. (2018). awareness about nosocomial infections among nurses in omdurman teaching hospital, October 2017. Researchgate.NetM BilalInternational Journal of Development Research, 2018•researchgate.Net , February . Oluigbo I, Anyiam K. (2014). The Role of compensation on employee performance in an information technology organization. International Journal of Research in Information Technology, 2 (4), pp. 548–558. 2 (4), 548–558. Pezhman B, Fatemeh R, Amir R, Mahboobeh R, Mohammad F. Nosocomial infections in an Iranian educational hospital: an evaluation study of the Iranian nosocomial infection surveillance system. BMC Infect Dis. 2021;21(1):1–8. https://doi.org/10.1186/s12879-021-06948-1 . Ramlan W, Saliluddin SM, Huda BZ, Ismail S, Shahar HK. Health belief model-based intervention on knowledge and practice of standard precautions among primary healthcare workers in a state of Malaysia. Southeast Asian J Trop Med Public Health. 2020;51(6):959–73. Said AS, Kicha D, Omar M, Gushchina Y, Geferso AT, Handuleh JIM. Infection Prevention Practices and Associated Factors Among Health Care Workers in Public Health Facilities of Mogadishu, Somalia, 2022. Archiv Euromedica. 2023;13(3):1–19. https://doi.org/10.35630/2023/13/3.301 . Temsah MH, Alhuzaimi AN, Alamro N, Alrabiaah A, Al-Sohime F, Alhasan K, Kari JA, Almaghlouth I, Aljamaan F, Al Amri M, Barry M, Al-Subaie S, Somily AM, Al-Zamil F. Knowledge, Attitudes, and Practices of Healthcare Workers during the Early Stage of the COVID-19 Pandemic in a Main, Academic Tertiary Care Center in Saudi Arabia. Epidemiol Infect. 2020. https://doi.org/10.1017/S0950268820001958 . Yadav A, Niraula S, Bhandari R, Aryal BD, Chaudhary R. (2023). Assessing Knowledge, Attitudes, and Practices of Healthcare Professionals Regarding Hospital-Acquired Infections in a Tertiary Care Teaching Hospital in Eastern Nepal: A Cross-Sectional Study. International Journal of Advanced Research , 11 (01), 487–500. https://doi.org/10.21474/ijar01 /16041 Questionnaire SECTION A: Demographic Profile Instructions: Please tick () the box [ ] that applies to you or fill in the blank where necessary. Gender. Male [ ] Female [ ]. What is your current age?. Under 35 years [ ] 36–45 years [ ] 46 years or older [ ]. What is your primary professional role?. Nurse [ ] Doctor [ ] Lab Technician [ ] Other (please specify): _________________. How many years of experience do you have. in healthcare? Less than 5 years [ ] 6 to 10 years [ ] 11 years or more [ ] SECTION B: INDEPENDENT VARIABLES Objective one: Awareness/Knowledge about Nosocomial Infections Please tick (√) the appropriate preferred scales. (3 = Agree, 2 = Neutral, 1 = Disagree). Additional Declarations No competing interests reported. Supplementary Files Questionnaire.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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1","display":"","copyAsset":false,"role":"figure","size":12463,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 2.1: Conceptual Framework\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7347612/v1/ede4f73c24b558bb14d525dd.png"},{"id":102742958,"identity":"edfd68f6-67ef-40ff-85de-989100be8067","added_by":"auto","created_at":"2026-02-16 08:11:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1145519,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7347612/v1/ad306e82-2cd2-4c03-ab84-a156cd5e73fb.pdf"},{"id":93775196,"identity":"16e1ccf7-4560-4bcf-a530-a2911b509def","added_by":"auto","created_at":"2025-10-17 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These infections can occur at any time and affect people of all ages, especially those with weakened immune systems and elderly populations. HAIs occur when patients develop infections while being treated for other conditions in hospitals or health care facilities. These infections can lead to serious health issues, longer hospital stays, higher healthcare expenses, and death in some cases. Typically, these infections become noticeable in patients after hospitalization for 48 h. For healthcare workers (HCWs), understanding and managing the risk of nosocomial infections is crucial for patient safety and improving the overall quality of hospital care (Fortunka et al. \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In tertiary care teaching hospitals, the complexity of patient care, variety of healthcare procedures, and exposure to multidrug-resistant organisms (MDROs) make nosocomial infections particularly important. The knowledge and attitudes of healthcare workers, including doctors, nurses, technicians, and support staff, play key roles in preventing and controlling HAIs. According to the World Health Organization (WHO), a hospital-acquired infection (HAI) is defined as \"an infection acquired in a hospital by a patient who was admitted for a reason other than that infection but appearing after discharge and also occupational infections among staff of the facility.\" Developing countries have been reported to have up to 20 times the risk of contracting nosocomial infections compared with developed countries. A prevalence survey conducted in 2002 by the WHO across 55 hospitals in 14 countries found that an average of 8.7% of hospitalized patients had HAIs (Nag et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Africa, and notably in Nigeria (Mbon et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), infectious diseases continue to be a major global health issue, ranking among the top causes of illness worldwide. Although hospitals are intended to be places of healing, they can ironically become settings where diseases worsen, and previously healthy individuals may acquire unexpected infections. The potential for infection occurs when patients undergo medical procedures in a clinical setting. In Ethiopia (Bayleyegn et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), hospital-acquired infections (HAIs), also known as nosocomial infections (NIs), are contracted by patients during their hospital stay or by healthcare workers (HCWs) during routine activities in the hospital. These infections are considered nosocomial if they occur within 10 d of discharge. Healthcare workers are at risk of these infections during tasks such as collecting, processing, and disposing of specimens; handling medical equipment; and interacting directly with patients during their examinations. Common nosocomial infections include urinary tract infections (UTIs), surgical site infections, lower respiratory tract infections, bloodstream infections, and other nonbacterial infections. HAIs continue to pose significant public health challenges in Africa, particularly in nations such as Nigeria and Ethiopia. These infections can affect both patients and HCWs in the hospital setting. Patients are vulnerable to developing HAIs during their hospital stay or within 10 days of discharge, whereas HCWs may acquire infections through various activities, such as handling specimens, managing medical equipment, and direct patient interactions. The most common types of nosocomial infections include UTIs, surgical site infections, lower respiratory tract infections, bloodstream infections, and other nonbacterial infections (Mbon et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Bayleyegn et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).The widespread occurrence of healthcare-associated infections (HAIs) in African medical facilities highlights the critical need for improved infection control strategies and hygiene practices. These infections not only lead to higher rates of illness and death but also place additional strain on already limited healthcare resources. Contributing factors, such as overcrowding, poor sanitation facilities, and insufficient access to personal protective equipment (PPE), may worsen the spread of hospital-acquired infections in African hospitals. Tackling these issues requires a comprehensive approach, including better staff training, adoption of rigorous infection control measures, and investment in infrastructure improvements to ensure safe healthcare settings for both patients and medical staff.\u003c/p\u003e\u003cp\u003eResearch conducted in Somalia revealed a troubling shortfall in infection control practices among healthcare professionals, with only 42.4% following the correct protocols. This shortcoming poses a considerable threat to healthcare-associated infections, potentially putting both patients and medical staff at risk. The findings of this study suggest that factors such as attitude, work experience, training, needle stick injuries, vaccination against HepB, availability of infection control guidelines, presence of hand rubs in the room, and infection control budget are significantly linked to infection prevention practices (Said et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). These results highlight the pressing need for comprehensive interventions and enhancements in healthcare facilities across Somalia to improve compliance with infection prevention protocols. Various elements have been recognized to have a significant impact on infection prevention practices. These include the attitudes, work experience, and training of healthcare workers, along with the frequency of needle-stick injuries and Hepatitis B vaccination status. Furthermore, institutional factors, such as the availability of infection control guidelines, the presence of hand sanitizers in patient rooms, and dedicated budgets for infection control, play a vital role in ensuring adherence to proper infection control measures. These insights highlight the importance of addressing both individual and systemic factors to improve infection prevention in the Somali healthcare settings. Implementing specific interventions, such as regular training sessions, better resource distribution, and promoting a safety-oriented culture, could lead to notable enhancements in infection control practices and overall healthcare quality (Said et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHospital-acquired infections pose a significant challenge to the healthcare systems worldwide. These infections, which patients contract while in medical facilities, can lead to increased illness, extended hospital stay, and death. In Somalia, the healthcare sector faces numerous obstacles such as limited resources, insufficient training, and infrastructure limitations. These challenges may hinder effective infection control and increase the risk of infection for both patients and healthcare staff. However, there is a lack of research on the understanding and attitudes of healthcare workers in Somalia regarding hospital-acquired infections, especially in tertiary care teaching hospitals.\u003c/p\u003e\u003cp\u003eDespite this, the researcher acknowledged the necessity of understanding the context in this part of the Banadir region, which has not been thoroughly examined in previous research. This study aimed to assess the knowledge and attitude of healthcare professionals regarding nosocomial infection control measures in a tertiary care teaching hospital in Somalia. The specific goals of this study were to evaluate healthcare professionals' understanding of nosocomial infection control practices and examine their attitudes towards these practices among healthcare workers in a tertiary care teaching hospital located in the Banadir region of Mogadishu, Somalia.\u003c/p\u003e\u003cp\u003eThe knowledge and perspectives of healthcare workers regarding hospital-acquired infections in tertiary care teaching hospitals in Somalia are important. This comprehension offers researchers valuable insights into the understanding and views of hospital staff regarding nosocomial infections.\u003c/p\u003e"},{"header":"2.0 LITERATURE REVIEW","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1Theoretical Framework\u003c/h2\u003e\u003cp\u003eTo effectively explore healthcare workers' (HCWs) understanding of and perspectives on hospital-acquired infections, it is vital to use a solid theoretical framework that clarifies the factors affecting their behavior, knowledge, and attitudes. Such a framework is essential for directing research on HCWs' awareness of and attitudes toward these infections. Various established theoretical models can be applied to study HCWs' awareness, attitudes, and practices of HCWs related to nosocomial infections. Utilizing theoretical frameworks in designing interventions for health issues offers numerous advantages, including identifying behavioral causes, understanding behavioral change structures, developing intervention strategies, finding practical solutions, and assessing behavioral changes (Reigeluth, 2013). Building on this idea, it is important to recognize that theoretical frameworks provide an organized approach to studying HCWs' awareness of and attitudes toward nosocomial infections. These frameworks offer a systematic way to analyze the complex interactions of factors that affect HCWs' knowledge and behaviors concerning infection control practices. Using established theoretical models, researchers can create more comprehensive and effective interventions to address awareness gaps and improve attitudes among healthcare professionals. Employing theoretical frameworks in the investigation of hospital-acquired infections allows for a deeper understanding of the obstacles and enablers of infection control measure adoption. These frameworks help to identify specific cognitive, social, and environmental elements that affect healthcare professionals' attitudes and behaviors. By systematically analyzing these elements, researchers and healthcare managers can create targeted interventions to address the underlying causes of poor infection control practices. Furthermore, theoretical frameworks provide a basis for assessing the long-term effectiveness of interventions, thus facilitating ongoing improvements in strategies to decrease hospital-acquired infections and to improve patient safety in healthcare settings.\u003c/p\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003ch2\u003e2.1.1. Health Belief Model (HBM)\u003c/h2\u003e\u003cp\u003eThe Health Belief Model (HBM) offers a framework for understanding the various factors that affect healthcare workers' compliance with preventive measures against hospital-acquired infections. Although there may be a high level of awareness of these infections, the model indicates that perceived obstacles can greatly influence behavior. Such obstacles might include overwhelming workloads that limit time for proper infection control, insufficient training on prevention methods, or a complacent attitude towards the seriousness of nosocomial infections. According to the HBM, individuals evaluate the perceived advantages of taking action against these obstacles, along with their perceptions of their vulnerability and severity of the health threat. Research utilizing the HBM in healthcare environments has produced mixed outcomes. Some studies have shown positive results, suggesting that interventions based on HBM principles can effectively enhance preventive behaviors (Jeihooni et al., 2018; Sadeghi et al., 2018; Pinyaphong et al., 2020). However, other studies have pointed out ongoing difficulties in implementing standard precautions among healthcare workers. These difficulties often arise from knowledge gaps and misunderstandings regarding the risks and severity of nosocomial infections (Atalla et al., 2016; Ramlan et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This implies that, while the HBM can be a valuable tool for understanding and potentially changing health behaviors, its use in healthcare settings may require targeted strategies to address specific barriers and misconceptions unique to the healthcare context.\u003c/p\u003e\u003cp\u003eThe Health Belief Model (HBM) is a well-established framework in public health that explains and predicts health-related behaviors. In terms of disease prevention, people who understand the seriousness of health issues are more likely to take preventive measures. They recognize that the disease poses a significant threat to their health and can lead to serious complications if not properly addressed. This understanding of severity is a crucial element of the HBM as it encourages individuals to seek information and take proactive steps to protect their health (Elgzar et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Additionally, the HBM highlights the importance of perceived benefits and barriers in influencing health behaviors. Individuals are more inclined to adopt the recommended preventive actions when they believe in their effectiveness. This belief is strengthened when perceived advantages outweigh the expected obstacles or difficulties associated with implementing these actions in the workplace. The model's success in preventing diseases and modifying behaviors in the short term makes it a valuable resource for healthcare professionals and policymakers to create targeted interventions and educational programmes (Kouhi et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). By addressing the key elements of the HBM, such as perceived severity, benefits, and barriers, health initiatives can more effectively encourage the adoption and maintenance of behaviors that enhance health.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\u003ch2\u003e2.1.2. Theory of Planned Behavior (TPB)\u003c/h2\u003e\u003cp\u003eThe Theory of Planned Behavior (TPB) plays a crucial role in assessing various attitudes and social factors that influence healthcare workers' (HCWs) actions concerning infection prevention measures. For example, when HCWs feel that they have control over their actions, such as having sufficient time and resources, they are more likely to adhere to infection prevention guidelines. Thus, the TPB can be used to forecast the intention to comply with hospital elective or inherent contacts through several intermediary factors, including attitudes towards handwashing related to clean or contaminated contacts, subjective norms (i.e., the perception of peer pressure to engage in clean or contaminated handwashing), perceived control (i.e., the perception of the effort needed to perform clean or contaminated handwashing behaviors), similar handwashing practices in the community, and contrasting hospital handwashing practices (i.e., hospital elective for predicting hospital inherent practice and vice versa) (McLaws et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). The TPB offers a comprehensive framework for understanding and predicting HCWs' adherence to infection prevention practices by examining their attitudes, social norms, and perceived behavioral control. This theory provides insights into the complex factors that affect HCWs' decision-making processes. For instance, positive attitudes towards handwashing coupled with strong social pressure from peers and supervisors to maintain hygiene standards can significantly increase the likelihood of compliance. Moreover, the perception of adequate resources, such as easily accessible hand sanitizers or sufficient time between patient interactions, can enhance HCWs' sense of control over their ability to consistently adhere to protocols. The application of TPB in healthcare settings goes beyond merely predicting behavior, allowing for a nuanced understanding of how different types of contact (elective or inherent) within the hospital environment might affect handwashing practices. As McLaws et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) suggested, this theory can be used to analyze the interaction between hospital-specific behaviors and similar practices in the community, highlighting the potential for cross-contextual influences on hygiene habits. Additionally, by considering the \"opposite\" handwashing practice as a predictor, the TPB acknowledges the complex relationships between different types of hygiene behaviors, potentially revealing how adherence in one area might impact compliance in another area. This comprehensive approach enables healthcare administrators and researchers to develop targeted and effective interventions to improve infection prevention practices among HCWs.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e2.1.3. Health Promotion Model (HPM)\u003c/h2\u003e\u003cp\u003ePender's Health Promotion Model emphasizes the motivational factors and influences that drive individuals to engage in health enhancing behaviors. Employing this model enables researchers to investigate how healthcare workers' (HCWs) previous infection experiences or their understanding of the consequences of hospital-acquired infections on patient health affects their attitudes and actions regarding infection prevention. Consequently, the present study aimed to evaluate the impact of a hospital-based intervention, informed by Pender\u0026rsquo;s Health Promotion Model, on the hand hygiene (HH) practices of intensive care unit staff as a professional behavior (Khosravi et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). This theoretical framework integrates behavioral sciences with nursing theories to identify the determinants of healthy behaviors within a biopsychosocial context by examining three primary components: personal characteristics and experiences, perceptions and understanding of targeted health promotion behavior, and the outcomes of such conduct (Neri et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Pender's Health Promotion Model provides a comprehensive framework for understanding and influencing health-promoting behaviors, highlighting the intricate interplay between individual traits, experiences, and environmental factors that shape individuals\u0026rsquo; health-related decisions and actions. In the context of HCWs and infection prevention, this model offers valuable insights into the motivations and barriers affecting adherence to practices, such as HH. By examining HCWs' past infection experiences and their comprehension of the impact of nosocomial infections on patient outcomes, researchers can identify the key factors influencing attitudes and behaviors towards infection prevention protocols. The application of the Pender's Health Promotion Model in healthcare settings, particularly in intensive care units, has demonstrated the potential to enhance professional behaviors, such as HH compliance. KHosravi et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) showed that hospital-based interventions grounded in this model can effectively address the multifaceted aspects of behavior change among ICU staff. The strength of the model lies in its holistic approach that integrates personal characteristics, experiences, and perceptions with the broader biopsychosocial context of healthcare environments. This comprehensive perspective, as noted by Neri et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), facilitates a nuanced understanding of the factors that promote or hinder the adoption of health-promoting behaviors among healthcare professionals, ultimately contributing to improved patient safety and a reduced rate of infection.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Concept of objectives variables in the study\u003c/h2\u003e\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\u003ch2\u003e2.2.1 Awareness about nosocomial infections among doctors and nurses\u003c/h2\u003e\u003cp\u003eThis literature review examined the key findings related to healthcare professionals' awareness of nosocomial infections, focusing particularly on doctors and nurses. This underscores the elements that shape their understanding of and attitudes towards infection control. Recognizing the prevalence and spread of healthcare-acquired infections is crucial for improving infection control measures and developing effective preventive and therapeutic strategies to decrease their occurrence, morbidity, and mortality (Park, 2008). Educating and training healthcare workers in standard infection control practices can reduce the risk of nosocomial infections, encourage safe working practices, and safeguard staff and patients from infections (Development Research \u0026amp; Undefined 2018). For healthcare workers (HCWs), especially physicians and nurses, understanding the risks, prevention methods, and importance of infection control practices are vital for lowering the incidence of healthcare-associated infections (HAIs). Reducing nosocomial infections is a global priority, with various suggested strategies, including the implementation of infection prevention and control measures, prudent antibiotic use, and encouragement of patient education and involvement (Mbon et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Healthcare workers' knowledge of nosocomial infections is essential for their effective prevention and control. Awareness includes understanding the routes of infection transmission, the common pathogens responsible for healthcare-associated infections, and infection prevention practices. A study by Singh et al. (2020) involving nurses and doctors in a tertiary care hospital in India found that while healthcare workers had sufficient knowledge of basic infection control measures such as hand hygiene, there was a lack of awareness regarding specific nosocomial infection transmission and control strategies. A survey by Kumar et al. (2021) in a tertiary hospital in Nepal showed that 65% of healthcare workers had a strong understanding of the need for sterilization and disinfection, yet only 45% recognized the importance of isolation protocols for infectious diseases. A lack of detailed knowledge about pathogens and specific preventive practices can lead to inadequate infection control and an increased risk of nosocomial infections (Abalkhail \u0026amp; Alslamah, 2022).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003e2.2.2 Attitude of health care professionals toward nosocomial infections.\u003c/h2\u003e\u003cp\u003eHealthcare professionals (HCPs), also known as healthcare-associated infections (HAIs), play a crucial role in the prevention and management of these infections. The mindset of healthcare workers towards infection prevention is as vital as their knowledge and understanding. A positive outlook on infection control practices can improve adherence to protocols and decrease the occurrence of healthcare-associated infections (HAIs). Research by Temsah et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) in a Middle Eastern teaching hospital revealed that, although most healthcare workers acknowledged the significance of infection control practices, there was a noticeable gap in attitude. Some healthcare workers showed complacency owing to high workloads, lack of staff, and insufficient training. Similarly, a study by Olowe et al. (2021) in a Nigerian hospital discovered that despite healthcare workers expressing a positive attitude towards infection control, the perceived low risk of exposure to certain pathogens in non-critical care units resulted in inconsistent compliance with safety measures. Factors affecting attitudes included stress from workload, organizational support, resource availability (such as personal protective equipment and infection control training), and perceived risk of infection exposure. According to Bayleyegn et al. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), the need for positive attitudes towards infection prevention is undeniable in preventing HAIs. More than half of the respondents (57.2%) showed a favorable attitude towards infection prevention. However, a significant proportion (42.8%) of HCWs in this study displayed unfavorable attitudes towards infection prevention. Additionally, the attitude level of participants in our study was similar to that found in a study conducted in Bahir Dar City, Ethiopia (55.6%).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\u003ch2\u003e2.2.3 Infection control practices in a tertiary care teaching hospital.\u003c/h2\u003e\u003cp\u003eStandard measures to prevent healthcare-acquired infections (HCAI) involve straightforward, yet highly effective practices that significantly reduce infection rates in hospitals. When performed correctly, meticulous hand hygiene can significantly lower the occurrence of HCAI. Improved compliance with hand hygiene guidelines, particularly through the use of standard alcohol-based hand rubs, has been proven to reduce hospital-acquired infection rates by as much as 40 Enhancing healthcare workers' (HCW) understanding of hand hygiene through focused education and awareness initiatives can boost adherence among the medical staff. Healthcare professionals are at the forefront of infection management. They engage in direct patient care and are accountable for executing routine infection control practices, including hand hygiene, utilization of personal protection equipment (PPE), environmental sanitation, and proper antimicrobial stewardship (Yadav et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).. Preventing HCAI requires a comprehensive, multipronged strategy that, when properly executed, can positively impact other areas of healthcare. For example, a study conducted in Indonesia showed a 22% decrease in antibiotic misuse of antibiotics after implementing a multifaceted infection control and antibiotic stewardship program (Iliyasu et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Nurses are crucial in implementing infection prevention and control strategies, and it is vital for them to engage in ongoing professional development. Therefore, it is crucial for nurses to be familiar with these standard precautions to reduce associated risks. Common hospital-acquired infections include urinary tract, respiratory tract, bloodstream, and surgical site infections. A study by Pezhman et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) in a tertiary hospital in Pakistan revealed that approximately 15% of hospitalized patients had at least one nosocomial infection during their stay. Similarly, Gupta et al. (2019) found that healthcare-associated infections accounted for up to 10% of all hospital admissions in India, with surgical site infections being the most common. These infections lead to increased patient morbidity, longer hospital stays, and higher healthcare costs, highlighting the importance of infection control in tertiary-care hospitals.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Conceptual frame work\u003c/h2\u003e\u003cp\u003eThe conceptual framework illustrated in Fig.\u0026nbsp;2.1 suggests that the independent variable is characterized by the degree of awareness and attitudes towards healthcare-acquired infections. Conversely, the dependent variable was infection control practices among healthcare workers in a tertiary care teaching hospital.\u003c/p\u003e\u003c/div\u003e"},{"header":"3.0 MATERIALS AND METHODS","content":"\u003cp\u003eThis study adopted a descriptive approach, specifically utilizing quantitative techniques. Quantitative methods were considered appropriate for examining numerical data and measurable variables, which aligned with the study's goals. This approach was suitable for evaluating the awareness and attitudes of healthcare workers towards nosocomial infections in a tertiary care teaching hospital in Mogadishu, Somalia. The analysis included frequencies, tables, percentages, and measures of central tendency as the researchers investigated the question, \u0026ldquo;What is the role of employee compensation on organizational productivity among small businesses in Mogadishu, Somalia?\u0026rdquo; Structured questionnaires were developed based on a literature review, using Likert scales (3\u0026thinsp;=\u0026thinsp;Agree, 2\u0026thinsp;=\u0026thinsp;Neutral, 1\u0026thinsp;=\u0026thinsp;Disagree) through the Kobo Toolbox to collect data from employees of small businesses in this area. This platform ensured efficiency, reduced manual errors, and facilitated easy data cleaning and export to the statistical software. Data collection will be conducted from March to April 2025. The questionnaires were personally distributed with the help of hospital management to gather information from the staff in hospitals in the Banadir region of Mogadishu, Somalia. The researchers ensured that the questionnaires were completed at times that did not disrupt the respondents' official work schedules and obtained special permission from the hospital managers. Data analysis was conducted after cleaning and verifying the completeness of the questionnaire. The study included 105 health workers from the Banadir region, focusing on nurses, lab technicians, doctors, and other health science professionals, while excluding hospital patients. A simple random sampling technique, a probability sampling method, was used to ensure equal representation of the target population (Oluigbo \u0026amp; Anyiam, 2014). The researcher sampled 83 health professionals by distributing questionnaires to workers in hospitals and lecturers at universities in Mogadishu, Somalia. Slovin\u0026rsquo;s formula was used to determine the sample size with a maximum acceptable error of 5%, where n\u0026thinsp;=\u0026thinsp;105/1\u0026thinsp;+\u0026thinsp;105 (0.05) 2\u0026thinsp;=\u0026thinsp;83, with n representing the sample size, N representing the population, and a representing the acceptable error. This formula was chosen for its ability to sample a population with the desired degree of accuracy.\u003c/p\u003e\u003cp\u003eLeung (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) suggested that the validity of a research tool is assessed by the degree of inherent error in its measurements. Typically, the validity of individual questions or groups of questions reflects their ability to provide accurate data that aligns with the expected responses. This accuracy depends on whether the respondents understood the questions as intended, matching the researcher's perspective. According to Khidzir et al. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), an instrument's reliability is related to its consistency and stability. In the process of pre-testing a questionnaire, revising and conducting further tests can improve its reliability. Before the questionnaire was distributed, the researcher sought advice from experts, including PhD holders who were actively involved in both the distribution of the questionnaire and the study. Omar (2017) described data analysis as the process of examining collected data to make deductions and draw conclusions. Primary data were collected using questionnaires through the Kobo toolbox, which were then downloaded into Excel and cleaned by checking for completeness. The data were subsequently uploaded to the SPSSV20 software for both qualitative and quantitative analyses. Descriptive statistics were used to organize, summarize, and present the data in tables, showing frequencies, percentages, means, and standard deviations, thus measuring the central tendency and dispersion.\u003c/p\u003e"},{"header":"4.0 FINDINGS AND DISCUSSIONS","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e4.2 Demographic data\u003c/h2\u003e\u003cp\u003eThis section outlines the demographic details of the study participants with the goal of identifying their characteristics. Participants were assured that the information gathered would be used exclusively for academic purposes, and that their identities would remain confidential. A total of 83 health professionals from the Banadir region of Mogadishu, Somalia completed the questionnaires.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographical Study\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDemographics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003efrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e58%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge in years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfession of healthcare\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDoctors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLab Technicians\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExperience level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003eDeveloped by the researcher (2025)\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAccording to Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e the demographic data, men made up the majority of the participants, accounting for 58% of the sample, while women represented 42%. This indicates a slight gender disparity in this healthcare group, with a higher number of male participants. The workforce is largely young, as 78% of the individuals are under 35 years old. In contrast, only 10% were over 46 years of age, pointing to a lack of senior healthcare workers. Nurses were the largest group, accounting for 52% of the workforce, suggesting that nursing perspectives are likely central to the results. Although the sample is varied, it was heavily skewed towards nurses, with lab technicians making up 22% and doctors and other healthcare professionals filling the remaining percentages. A significant proportion of participants (70%) had less than five years of experience, supporting the idea that the workforce is mainly in the early stages of their careers. This suggests that the surveyed group may have had limited contributions from seasoned healthcare professionals and may still be in the initial phases of professional growth.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e4.3 Descriptive analysis of variables\u003c/h2\u003e\u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\u003ch2\u003e4.3.1 Objective one: Awareness/Knowledge about Nosocomial Infections\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAwareness/Knowledge about Nosocomial Infections\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIV1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eStd\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.1. I am aware of the modes of transmission of nosocomial infections.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.565\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.2.Contaminated medical equipment can spread nosocomial infections\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.514\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e89.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.3.Environmental surfaces (bed rails, door handles) can harbor infectious agents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.4.Respiratory devices (e.g., ventilators) can cause hospital-acquired pneumonia (HAP).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.591\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cb\u003eDeveloped by the researchers (2025)\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe study results Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e revealed that participants had a thorough understanding of how nosocomial infections were transmitted. Notably, 89.2% of the respondents understood that contaminated medical equipment could contribute to the spread of these infections, and 79.5% were aware of the various transmission methods. Furthermore, 79.5% believed that hospital-acquired pneumonia might be linked to respiratory devices, such as ventilators, while 84.3% agreed that environmental surfaces, such as door handles and bed rails, could harbor infectious pathogens. The mean scores for these items, which ranged from 2.72 to 2.83 on a 3-point scale, reflected strong agreement. Additionally, low standard deviations between 0.48 and 0.591 indicated consistency in the responses. Overall, the findings suggest that the respondents had a solid understanding of the main mechanisms through which the infections spread.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\u003ch2\u003e4.3.2. Objective 2: Attitudes Toward Nosocomial Infections\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAttitudes Toward Nosocomial Infections\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIV2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eStd\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.1.Nosocomial infections are serious problems in healthcare settings.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.564\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.2.Using personal protective equipment (PPE) regularly reduces the spread of infections\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.636\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.3.Neglecting infection control measures can harm both patients and healthcare staff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.532\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.4.Poor hand hygiene is a major cause of hospital-acquired infection.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.705\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eDeveloped by the researchers (2025)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe data revealed Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e the views of healthcare workers on infection control and the importance of preventive measures. There was a strong consensus on the seriousness of nosocomial infections, with 85.5% of participants agreeing and a high average score of 2.78 out of 3 indicating significant awareness. The necessity of personal protective equipment (PPE) is also widely acknowledged, although agreement is slightly lower at 72.3%, with an average score of 2.64, possibly reflecting differences in PPE use or availability. Similarly, a large proportion (80.7%) of participants recognized the dangers of neglecting infection control, with an average score of 2.76. However, opinions on hand hygiene showed slightly more disagreement or neutrality, with only 71% agreeing and the lowest average score of 2.51, along with the highest standard deviation (0.705), indicating varied opinions or adherence levels. Overall, while the importance of infection control is recognized, focused efforts to emphasize the role of hand hygiene and consistent PPE use can improve compliance..\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e4.4 Dependent variable of infection control practice\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003einfection control practice\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDV\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eStd\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.1.Training or workshop practice is held to the staff to prevent nosocomial infections\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.537\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.2.Appropriate personal protective equipment (PPE), such as gloves, masks, and gowns, is necessary to prevent infection.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.591\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.3.Hospital management plays a critical role in supporting infection-control measures.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.668\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e77.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cb\u003eDeveloped by the researchers (2025)\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAccording to Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e the data, staff members generally view infection prevention measures as well as support and are crucial. A significant majority (79.5%) agreed that training or workshops were necessary to prevent hospital-acquired infections, as indicated by a high mean score of 2.75 and a low standard deviation (0.537), reflecting strong agreement. Likewise, 79.5% of the participants recognized the importance of personal protective equipment (PPE), such as gloves, masks, and gowns, with a mean score of 2.72, indicating a consistent acknowledgment of PPE's role in the prevention of infections. Perceptions of hospital management support for infection control were slightly less positive, with 77.1% agreement and a mean score of 2.66, along with a higher standard deviation (0.668), suggesting slightly more varied responses than in the other dimensions. Overall, the data indicate positive views on institutional infection control practices, although there may be room to enhance confidence in management involvement.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e4.5 Discussion of findings\u003c/h2\u003e\u003cp\u003eAccording to Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e the demographic data, men made up the majority of the participants, accounting for 58% of the sample, while women represented 42%. This indicates a slight gender disparity in this healthcare group, with a higher number of male participants. The workforce is largely young, as 78% of the individuals are under 35 years old. In contrast, only 10% were over 46 years of age, pointing to a lack of senior healthcare workers. Nurses were the largest group, accounting for 52% of the workforce, suggesting that nursing perspectives are likely central to the results. Although the sample is varied, it was heavily skewed towards nurses, with lab technicians making up 22% and doctors and other healthcare professionals filling the remaining percentages. A significant proportion of participants (70%) had less than five years of experience, supporting the idea that the workforce is mainly in the early stages of their careers. This suggests that the surveyed group may have had limited contributions from seasoned healthcare professionals and may still be in the initial phases of professional growth.\u003c/p\u003e\u003cp\u003eObjectives one The study results Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e revealed that participants had a thorough understanding of how nosocomial infections were transmitted. Notably, 89.2% of the respondents understood that contaminated medical equipment could contribute to the spread of these infections, and 79.5% were aware of the various transmission methods. Furthermore, 79.5% believed that hospital-acquired pneumonia might be linked to respiratory devices, such as ventilators, while 84.3% agreed that environmental surfaces, such as door handles and bed rails, could harbor infectious pathogens. The mean scores for these items, which ranged from 2.72 to 2.83 on a 3-point scale, reflected strong agreement. Additionally, low standard deviations between 0.48 and 0.591 indicated consistency in the responses. Overall, the findings suggest that the respondents had a solid understanding of the main mechanisms through which the infections spread.\u003c/p\u003e\u003cp\u003eObjective 2 The data revealed Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e the views of healthcare workers on infection control and the importance of preventive measures. There was a strong consensus on the seriousness of nosocomial infections, with 85.5% of participants agreeing and a high average score of 2.78 out of 3 indicating significant awareness. The necessity of personal protective equipment (PPE) is also widely acknowledged, although agreement is slightly lower at 72.3%, with an average score of 2.64, possibly reflecting differences in PPE use or availability. Similarly, a large proportion (80.7%) of participants recognized the dangers of neglecting infection control, with an average score of 2.76. However, opinions on hand hygiene showed slightly more disagreement or neutrality, with only 71% agreeing and the lowest average score of 2.51, along with the highest standard deviation (0.705), indicating varied opinions or adherence levels. Overall, while the importance of infection control is recognized, focused efforts to emphasize the role of hand hygiene and consistent PPE use can improve compliance..\u003c/p\u003e\u003cp\u003eAccording to Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e the data, staff members generally view infection prevention measures as well as support and are crucial. A significant majority (79.5%) agreed that training or workshops were necessary to prevent hospital-acquired infections, as indicated by a high mean score of 2.75 and a low standard deviation (0.537), reflecting strong agreement. Likewise, 79.5% of the participants recognized the importance of personal protective equipment (PPE), such as gloves, masks, and gowns, with a mean score of 2.72, indicating a consistent acknowledgment of PPE's role in the prevention of infections. Perceptions of hospital management support for infection control were slightly less positive, with 77.1% agreement and a mean score of 2.66, along with a higher standard deviation (0.668), suggesting slightly more varied responses than in the other dimensions. Overall, the data indicate positive views on institutional infection control practices, although there may be room to enhance confidence in management involvement.\u003c/p\u003e\u003c/div\u003e"},{"header":"5.0 CONCLUSION","content":"\u003cp\u003eIn summary, the demographic study highlights a healthcare workforce that is largely young and somewhat inexperienced, with significant gender disparity. Awareness of and attitudes towards hospital-acquired infections are generally strong, with a solid understanding of infection control protocols and a positive outlook on infection prevention. However, there are areas that require improvement, such as inconsistent hand hygiene, occasional lapses in protocol adherence, and gaps in training for some staff members. Despite these issues, there was a promising overall commitment to infection control practices, with most respondents confident of their ability to prevent infections. To further enhance infection control, it is crucial to address training gaps, ensure consistent hygiene practices, and strengthen protocol adherence. Additionally, addressing resource-related issues can improve the effectiveness of infection-control measures.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRecommendations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study provides actionable suggestions for improving infection control measures among healthcare workers in tertiary-care teaching hospitals. The primary suggestions involve fostering and sustaining awareness and positive attitudes toward infection control, and ensuring that these attitudes are consistently put into practice. This study highlights the necessity of enhancing hand hygiene compliance, addressing protocol adherence gaps, and overcoming resource-related obstacles for effective infection control in the NICU. These recommendations are designed to reduce risk and improve the overall safety of both patients and staff in healthcare settings..\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy Contributions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study offers valuable insights into the awareness, attitudes, and practices of healthcare workers regarding nosocomial infection control. This study bridges gaps in the existing literature, particularly in resource-limited settings, such as Somalia, and provides a foundation for future research and interventions. The findings highlight both the strengths and areas for improvement, contributing to the broader discourse on infection prevention in healthcare systems.\u003c/p\u003e\u003cp\u003eThis study presents four main contributions divided into three categories: theory, empirical evidence, and practice.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheoretical Contributions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study is grounded in established theoretical frameworks such as the Health Belief Model (HBM), Theory of Planned Behavior (TPB), and Health Promotion Model (HPM). These models help to explain healthcare workers' behaviors and attitudes toward infection control, offering a structured approach to understanding and addressing gaps in knowledge and practice. The application of these theories enriches the conceptual foundation of this study, and supports the development of targeted interventions.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEmpirical Contributions\u003c/b\u003e\u003c/p\u003e\u003cp\u003e This study provides empirical evidence for the awareness and attitudes of healthcare workers in a tertiary care teaching hospital in Mogadishu, Somalia. The findings revealed a high awareness of infection transmission routes and control measures but identified inconsistencies in hand hygiene and protocol adherence. This study also highlighted demographic trends, such as the predominance of young and inexperienced workers, which may influence infection control practices. These empirical insights are critical for designing context-specific intervention strategies.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePractical Implications\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study underscores the need for practical measures to improve infection control, such as regular training, adequate provision of personal protective equipment (PPE), and institutional support for infection prevention protocols. Addressing resource limitations and reinforcing consistent practices among health care workers can significantly reduce the incidence of nosocomial infections. These findings are particularly relevant for hospital administrators and policymakers aiming to enhance healthcare quality in similar settings in the future.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRecommendations for Future Research\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFuture research should expand its geographical scope to include diverse regions of Somalia and other low-resource settings to improve the generalizability of the findings. Longitudinal studies can be used to assess the long-term impact of interventions on infection rates. Incorporating qualitative methods such as interviews or focus groups would provide deeper insights into the challenges faced by healthcare workers. Additionally, future studies should explore the role of non-clinical staff in infection control.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations of the Study\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study has several limitations including its restricted focus on the Banadir region, which limits its broad applicability. The small sample size of 83 respondents may not fully represent the diverse healthcare workforce of the study area. Reliance on self-reported data introduces potential response bias, and the cross-sectional design prevents causal inferences. The exclusion of certain staff categories such as cleaners and technicians also narrows the scope of these findings. Despite these limitations, this study offers valuable preliminary insights into nosocomial infection control in patients with Somalia.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAvoiding Conflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest. No collaboration occurred during the course of this study and the findings and recommendations were presented objectively based on the analysis results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo external funding was received for the study. All research was funded by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbout the authors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYasin Mohamed Ali is a distinguished public health specialist with extensive experience in infection prevention and control, healthcare epidemiology, and strengthening the health system in low-resource settings. As a researcher and practitioner, he dedicated his career to improving healthcare quality and patient safety in Somalia through evidence-based interventions and capacity-building initiatives.\u003c/p\u003e\n\u003cp\u003eWith specialized training in public health, Yasin brings a unique blend of academic rigor and field expertise to his research. His research focuses on critical gaps in nosocomial infection control, healthcare worker behavior, and institutional infection prevention protocols. His notable study on awareness and attitudes toward hospital-acquired infections among healthcare workers in Mogadishu's tertiary hospitals provides valuable insights for policymakers and health administrators in Somalia and similar contexts.\u003c/p\u003e\n\u003cp\u003eCommitted to advancing global health equity, Yasin advocates stronger health infrastructure, improved resource allocation, and continuous professional development for healthcare workers in underserved regions. His contributions continue to shape policies and practices aimed at reducing preventable infections and enhancing health care delivery in Somalia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAli Mohamed Hussein\u0026nbsp;\u003c/strong\u003eAs a public health expert, Ali Mohamed Hussein positively impacted the community’s health through educational programs, preventative measures, and by maintaining advocacy initiatives. Ali, a health sciences and public health management graduate, has championed numerous projects on disease prevention, sanitation, and health education, especially in underprivileged regions. Hussein is an advocate for the most at risk populations by striving to eliminate disparities in health and to improve the access to clean water, sanitation, hygiene, and health services. Ali collaborated with government and non government bodies and community leaders to ensure local health program integration through sustainable approaches. Ali has effectively helped to raise the vaccination coverage, provided services for better maternal and child health, and educated the community on health issues. Ali Mohamed Hussein strives for the betterment of public health and motivates other public health professionals by fostering the vision of equitable and healthier societies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCredit: \u003cstrong\u003eYasin Mohamed Ali\u003c/strong\u003e was responsible for the conceptualization, data curation, formal analysis, investigation, formal analysis, methodology, writing the original draft, writing the\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAli Mohamed Hussein\u003c/strong\u003e was responsible for the review, visualization, editing, supervision, validation, and visualization. Project administration, resources, and software\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePotential conflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest. No financial, personal, or professional relationships influenced the results or interpretation of this study. This transparency ensured the reliability and objectivity of the study, and increased the validity of the results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGratitude\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the participants of this study for their time and valuable insight. Special thanks to the Faculty of health science Capital University of Science of Somalia , for their support throughout this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Capital University Research Ethics Committee examined and approved this work (Reference Number: CUR\u0026amp;D0058/2025), adhering to international ethical norms. The research was executed in complete adherence to the ethical norms for medical research involving human beings as specified in the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was acquired from all individual subjects engaged in the study. Participants were comprehensively briefed on the study's objectives, research aims, and the utilization of their data. In the circumstances of this investigation, the ethics committee determined that verbal consent was a sufficient and suitable means of obtaining consent. All participants were assured the confidentiality and anonymity of their responses in accordance with ethical research standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe corresponding author may provide data to support the conclusions of the study upon request. Owing to ethical and privacy concerns, the data are not publicly accessible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was evaluated and approved by the Capital University Research Ethics Committee (Reference Number: CUR\u0026amp;D0058/2025), which adheres to international ethical standards. The study followed the ethical criteria for medical research with human beings specified in the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number in the manuscript\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical Trial Registration: \u0026nbsp;Gandi hospital (GH) GH0062\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApplicable Gandi hospital (GH) GH0062\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbalkhail A, Alslamah T. Institutional Factors Associated with Infection Prevention and Control Practices during Infectious Pandemics in Resource-Limited Settings. Vaccines. 2022;10(11). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/vaccines10111811\u003c/span\u003e\u003cspan address=\"10.3390/vaccines10111811\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBayleyegn B, Mehari A, Damtie D, Negash M. Knowledge, attitude, and practice of hospital-acquired infection prevention and associated factors among healthcare workers at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Infect Drug Resist. 2021;14:259\u0026ndash;66. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2147/IDR.S290992\u003c/span\u003e\u003cspan address=\"10.2147/IDR.S290992\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElgzar WT, Al-Qahtani AM, Elfeki NK, Ibrahim HA. Covid-19 outbreak: Effect of an educational intervention based on the health belief model on nursing students\u0026rsquo; awareness and health beliefs at Najran University, Kingdom of Saudi Arabia. Afr J Reprod Health. 2020;24(2):78\u0026ndash;86. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.29063/ajrh2020/v24i2s.12\u003c/span\u003e\u003cspan address=\"10.29063/ajrh2020/v24i2s.12\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Special Edition COVID-19.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFortunka K, Strzelecka A, Kr\u0026oacute;l G, Paprocka P, Mańkowska A, Lesiak A, Karpeta U, Okła S, Spałek J, Kaliniak S, Piktel E, Karasiński M, Durnaś B, Bucki R. (2024). Knowledge and Training Needs in Nosocomial Infection among Hospital Staff in the City of Kielce, Poland: A Cross-Sectional Study. \u003cem\u003eJournal of Nursing Management\u003c/em\u003e, \u003cem\u003e2024\u003c/em\u003e, 1\u0026ndash;19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1155/2024/9243232\u003c/span\u003e\u003cspan address=\"10.1155/2024/9243232\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIliyasu G, Dayyab FM, Habib ZG, Tiamiyu AB, Abubakar S, Mijinyawa MS, Habib AG. Knowledge and practices of infection control among healthcare workers in a tertiary referral center in northwestern Nigeria. Ann Afr Med. 2016;15(1):34\u0026ndash;40. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/1596-3519.161724\u003c/span\u003e\u003cspan address=\"10.4103/1596-3519.161724\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhidzir KAM, Ismail NZ, Abdullah AR. Validity and River. Int J Dev Sustain. 2018;7(3):1026\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhosravi N, Alami A, Aelami MH, Khosrovan S. Improving Hand Hygiene Compliance in the Intensive Care Unit Using Pender\u0026rsquo;s Model. Ethiop J Health Sci. 2021;31(3):553\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4314/ejhs.v31i3.12\u003c/span\u003e\u003cspan address=\"10.4314/ejhs.v31i3.12\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKouhi R, Panahi R, Ramezankhani A, Amin Sobhani M, Khodakarim S, Amjadian M. The effect of education based on the health belief model on hand hygiene behavior among the staff of Tehran dentistry centers: A quasi-experimental intervention study. Health Sci Rep. 2023;6(7). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/hsr2.1408\u003c/span\u003e\u003cspan address=\"10.1002/hsr2.1408\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLeung L. (2015). \u003cem\u003eValidity, reliability, and generalizability in qualitative research\u003c/em\u003e. \u003cem\u003e4\u003c/em\u003e(3), 324\u0026ndash;327. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/2249-4863.161306\u003c/span\u003e\u003cspan address=\"10.4103/2249-4863.161306\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMbon EF, Chimezie OV, Ehioghae O, Adesegun OA, Fikayo BE. Knowledge, Attitude, and Practice of the Prevention of Nosocomial Infections among the Hospital Staff of a Nigerian Tertiary Hospital. West Afr J Med. 2023;40(4):389\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcLaws ML, Maharlouei N, Yousefi F, Askarian M. Predicting hand hygiene among Iranian healthcare workers using the theory of planned behavior. Am J Infect Control. 2012;40(4):336\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ajic.2011.04.004\u003c/span\u003e\u003cspan address=\"10.1016/j.ajic.2011.04.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNag K, Datta A, Karmakar N, Chakraborty T. Knowledge, attitude, and practice of hospital-acquired infection among health care personnel in a tertiary care hospital in Tripura. Int J Res Med Sci. 2018;6(10):3303. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.18203/2320-6012.ijrms20184037\u003c/span\u003e\u003cspan address=\"10.18203/2320-6012.ijrms20184037\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNeri MF, de Silva S, Nascimento RA, do JC, Sousa \u0026Eacute; do, Rocha N, Barros R, Sampaio LM, C. L., Caetano J\u0026Aacute;. (2021). Hand hygiene determinants of informal caregivers in hospitals under Pender\u0026rsquo;s perspective. \u003cem\u003eRevista Brasileira de Enfermagem\u003c/em\u003e, \u003cem\u003e75\u003c/em\u003e(1), e20210012. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1590/0034-7167-2021-0012\u003c/span\u003e\u003cspan address=\"10.1590/0034-7167-2021-0012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eof Development Research. M. B.-I. J., \u0026amp; undefined 2018. (2018). awareness about nosocomial infections among nurses in omdurman teaching hospital, October 2017. \u003cem\u003eResearchgate.NetM BilalInternational Journal of Development Research, 2018\u0026bull;researchgate.Net\u003c/em\u003e, \u003cem\u003eFebruary\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOluigbo I, Anyiam K. (2014). \u003cem\u003eThe Role of compensation on employee performance in an information technology organization. International Journal of Research in Information Technology, 2 (4), pp. 548\u0026ndash;558. 2\u003c/em\u003e(4), 548\u0026ndash;558.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePezhman B, Fatemeh R, Amir R, Mahboobeh R, Mohammad F. Nosocomial infections in an Iranian educational hospital: an evaluation study of the Iranian nosocomial infection surveillance system. BMC Infect Dis. 2021;21(1):1\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12879-021-06948-1\u003c/span\u003e\u003cspan address=\"10.1186/s12879-021-06948-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRamlan W, Saliluddin SM, Huda BZ, Ismail S, Shahar HK. Health belief model-based intervention on knowledge and practice of standard precautions among primary healthcare workers in a state of Malaysia. Southeast Asian J Trop Med Public Health. 2020;51(6):959\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSaid AS, Kicha D, Omar M, Gushchina Y, Geferso AT, Handuleh JIM. Infection Prevention Practices and Associated Factors Among Health Care Workers in Public Health Facilities of Mogadishu, Somalia, 2022. Archiv Euromedica. 2023;13(3):1\u0026ndash;19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.35630/2023/13/3.301\u003c/span\u003e\u003cspan address=\"10.35630/2023/13/3.301\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTemsah MH, Alhuzaimi AN, Alamro N, Alrabiaah A, Al-Sohime F, Alhasan K, Kari JA, Almaghlouth I, Aljamaan F, Al Amri M, Barry M, Al-Subaie S, Somily AM, Al-Zamil F. Knowledge, Attitudes, and Practices of Healthcare Workers during the Early Stage of the COVID-19 Pandemic in a Main, Academic Tertiary Care Center in Saudi Arabia. Epidemiol Infect. 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S0950268820001958\u003c/span\u003e\u003cspan address=\"10.1017/S0950268820001958\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYadav A, Niraula S, Bhandari R, Aryal BD, Chaudhary R. (2023). Assessing Knowledge, Attitudes, and Practices of Healthcare Professionals Regarding Hospital-Acquired Infections in a Tertiary Care Teaching Hospital in Eastern Nepal: A Cross-Sectional Study. \u003cem\u003eInternational Journal of Advanced Research\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(01), 487\u0026ndash;500. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.21474/ijar01\u003c/span\u003e\u003cspan address=\"10.21474/ijar01\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e/16041 Questionnaire SECTION A: Demographic Profile Instructions: Please tick () the box [ ] that applies to you or fill in the blank where necessary.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGender. Male [ ] Female [ ].\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWhat is your current age?. Under 35 years [ ] 36\u0026ndash;45 years [ ] 46 years or older [ ].\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWhat is your primary professional role?. Nurse [ ] Doctor [ ] Lab Technician [ ] Other (please specify): _________________.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHow many years of experience do you have. in healthcare? Less than 5 years [ ] 6 to 10 years [ ] 11 years or more [ ] SECTION B: INDEPENDENT VARIABLES Objective one: Awareness/Knowledge about Nosocomial Infections Please tick (\u0026radic;) the appropriate preferred scales. (3\u0026thinsp;=\u0026thinsp;Agree, 2\u0026thinsp;=\u0026thinsp;Neutral, 1\u0026thinsp;=\u0026thinsp;Disagree).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Nosocomial infections- Healthcare workers- Tertiary care hospital- Infection control- Developing countries- Hospital-acquired infections- Multidrug-resistant organisms","lastPublishedDoi":"10.21203/rs.3.rs-7347612/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7347612/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eNosocomial infections pose a significant challenge in healthcare settings worldwide, particularly in resource-limited countries, such as Somalia. This study assessed the awareness, attitudes, and practices of healthcare workers regarding nosocomial infection control in a tertiary care teaching hospital in Mogadishu, Somalia. This cross-sectional study was conducted using a structured questionnaire distributed to 83 healthcare professionals, including nurses, doctors, and lab technicians. The majority of participants (58%) were male, and 78% were under 35 years old. The findings revealed a high level of awareness about the modes of transmission and the role of contaminated medical equipment and environmental surfaces in the spread of nosocomial infections. However, attitudes on the way to infection control practices varied, with 85.5% acknowledging the seriousness of the problem, while only 72.3% regularly used personal protective equipment. Notably, 79.5% of respondents received training on infection prevention, and 80.7% recognized the risks associated with neglecting control measures. Poor hand hygiene was identified as a major cause of hospital-acquired infections in 71% of participants. This study highlights the need for targeted interventions to address gaps in infection control practices, such as improving hand hygiene compliance, ensuring consistent use of personal protective equipment, and providing ongoing training and support for healthcare workers. These findings underscore the importance of strengthening institutional policies and resources to promote a culture of infection prevention and control in Somali healthcare facilities. Further research is needed to explore the barriers to and facilitators of implementing effective infection control strategies in resource-constrained settings.\u003c/p\u003e","manuscriptTitle":"Healthcare Workers' Perspectives on Infection Control Practices: A Study From Mogadishu's Tertiary Care Teaching Hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-17 12:28:36","doi":"10.21203/rs.3.rs-7347612/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"870b8742-e763-4236-928d-0702a9cdf9ba","owner":[],"postedDate":"October 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T08:11:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-17 12:28:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7347612","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7347612","identity":"rs-7347612","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}