Multilevel Determinants of Environmental Hygiene: Integrating Waste Management, Human Behavior, and Institutional Systems in the Prevention of Nosocomial Infections in Resource-Limited Hospitals in Yaoundé, Cameroon

Abstract

Purpose: This study investigated the standard of environmental cleanliness in hospitals that do not have sufficient resources, specifically looking at how waste is handled, how human behaviors affect those practices and how institutions can help to eliminate or prevent healthcare-associated infections in two referral hospitals in Cameroon. Methodology: Using a converging parallel mixed method research design, the study collected both quantitative and qualitative data. Quantitative data was collected using World Health Organization (WHO) standard checklists to evaluate the level of hygiene in hospitals and qualitative data was collected during interviews and through direct observation of hospital staff at both sites. Findings: The results of the quantitative analysis indicated low compliance with standard hygienic practices across the three areas measured: waste segregation (38% compliance), sanitary standards (41% compliance) and infection prevention and control (IPC) infrastructure (45%-52% compliance), but higher rates of compliance in controlled settings such as the operating room (70% compliance) versus a general ward setting (40%-44% compliance). Qualitative analysis of the interview data identified themes that included human behavior adaptability, institutional failure, the breakdown of waste management systems, and the normalizing of unsafe sanitation and hygiene practices. Conclusion: The results of the research indicate that environmental hygiene failures are related to structural and cultural aspects of health care organizations as opposed to individual behaviors. Unique contributions to theory, practice, and policy: The authors recommend a system-wide approach to reducing the risk of infection, addressing both infrastructure, governance, and organizational culture. A conceptual framework for understanding the role of environmental hygiene is also presented, emphasizing the need for multi-dimensional interventions as opposed to individual compliance with standards; and the necessity for dedicated resources to improve the IPC infrastructure and methodologies to be used to reduce the risk of healthcare-associated infections in resource constrained environments.