Infection prevention and control practices and their associated factors among anesthesia service providers at health facilities in central Uganda

In hospitals around the world, a silent threat lurks behind the scenes of surgery and medical care. These are infections that patients catch while receiving treatment, known as hospital-acquired infections. They can turn a routine procedure into a life-threatening crisis, causing severe illness, prolonged hospital stays, and even death. To stop these infections, medical teams rely on a set of rules and habits called infection prevention and control. This involves simple but critical actions like washing hands, sterilizing tools, and using clean equipment to ensure that germs do not spread from one person to another. While these practices are standard in many parts of the world, the reality on the ground can vary greatly, especially in regions where resources are stretched thin. The stakes are particularly high for patients undergoing anesthesia, the medicine that puts them to sleep or numbs them during surgery. Because anesthesia often involves inserting tubes, needles, and catheters deep into the body, a single lapse in hygiene can introduce dangerous bacteria directly into the bloodstream or nervous system.

Researchers in Uganda recently turned their attention to this specific vulnerability. They wanted to understand how well the people who administer anesthesia in central Uganda were following these life-saving safety rules. The team, led by scholars from Makerere University and Liverpool John Moores University, traveled to hospitals and health centers across the region to interview nearly two hundred anesthesia providers. They asked detailed questions about daily habits, such as how often they washed their hands, whether they changed gloves between patients, and if they followed strict protocols for cleaning their equipment. The goal was not just to count mistakes, but to uncover what factors in a hospital's environment might help or hinder these providers from doing their best work. The findings revealed a stark picture: while the desire to keep patients safe is clearly present, the actual execution of these safety measures is critically low, and the solution lies less in individual willpower and more in the structure of the hospitals themselves.

The study began by gathering a group of 216 anesthesia providers from 83 different health facilities in central Uganda. This region was chosen because it is home to the majority of the country's anesthesia specialists and has seen reports of infections related to anesthesia care. The researchers spoke with both physician anesthetists and non-physician providers, as both groups play a vital role in keeping patients safe during surgery. They used a structured interview process, asking the same set of questions to every participant to ensure fairness and accuracy. The questions covered a wide range of safety behaviors, from the frequency of handwashing to the specific methods used for cleaning laryngoscopes, the tools used to look into a patient's throat. The researchers also asked about the environment of the hospital, such as whether there was a dedicated supervisor for infection control, if a committee existed to oversee safety, and if there were written rules for how to handle anesthesia safely.

When the data was analyzed, the results were sobering. Only 12 percent of the anesthesia providers were found to be practicing infection prevention and control at an optimal level. This means that for every one hundred providers, only about twelve were consistently following all the necessary safety steps. The most common area of success was handwashing; every single provider reported washing their hands before invasive procedures, and most said they did so always. However, this strength in one area was not enough to compensate for gaps in others. Many providers admitted to rarely soaking their laryngoscopes in a disinfectant solution, infrequently wearing double gloves during airway manipulation, and sometimes reusing trays or syringes in ways that could spread infection. Perhaps most concerning was the finding that only a small fraction of providers consistently used breathing circuit filters or cleaned their anesthesia machines after every single procedure. These are not minor oversights; they are critical failures that leave patients exposed to severe infections.

The researchers then looked deeper to understand why these gaps existed. They expected that personal factors, such as a provider's age, education level, or whether they had received formal training in infection control, would be the main drivers of good or bad practices. Surprisingly, the data showed the opposite. The most significant factors were not about the individual worker, but about the hospital they worked in. Providers were much more likely to follow safety rules if their hospital had a dedicated supervisor for infection control, an active committee to oversee safety, and written standard procedures for anesthesia care. For instance, providers working in hospitals with a dedicated infection control supervisor were more than three times as likely to practice optimal safety measures compared to those without one. Similarly, the presence of an infection control committee made providers nearly nine times more likely to follow the rules. The strength of the hospital's safety culture also mattered immensely; in facilities where the culture was described as very strong, providers were nearly seven times more likely to practice optimal infection control.

One of the most unexpected findings challenged a common assumption in medical training. The researchers discovered that providers who had received formal training in infection prevention and control in the past were actually less likely to practice optimal safety measures than those who had not. This counterintuitive result suggests that the training these providers received may have focused too much on theory and not enough on practical application, or that the training was outdated. It indicates that simply having a certificate or having attended a class in the past does not guarantee that a provider will follow safety protocols in the real world. Instead, the environment in which they work appears to be the deciding factor. When a hospital has clear policies, active supervision, and a culture that prioritizes safety, providers are empowered to do the right thing, regardless of their personal training history.

The implications of these findings are serious for the future of patient safety in Uganda. With the number of surgeries increasing, the risk of anesthesia-related infections is likely to rise if the current situation remains unchanged. The study suggests that trying to fix this problem by simply training more individuals will not work. Instead, the focus must shift to strengthening the institutions themselves. Hospitals need to appoint dedicated infection control supervisors, form active committees, and create clear, written guidelines for anesthesia care. They must also foster a culture where safety is a shared responsibility and where staff feel supported in following these rules. The researchers recommend that medical associations and hospital administrators work together to bring these changes to life, ensuring that every anesthesia provider, regardless of their background, has the tools and support they need to keep patients safe. Without these structural changes, the gap between knowing what to do and actually doing it will remain, leaving patients vulnerable to preventable harm.