FACTORS CONTRIBUTING TO CLINICAL NURSES' COMPLIANCE WITH INFECTION PREVENTION AND CONTROL PRACTICES: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background: Healthcare-associated infections (HAIs) remain a major global public health challenge, with nurses playing a pivotal role in infection prevention and control (IPC) practices. Understanding the factors that influence nurses' compliance with IPC protocols is essential for developing effective interventions to reduce HAI burden.

Methods: This systematic review was conducted following PRISMA 2020 guidelines. A comprehensive literature search was performed across MEDLINE, EMBASE, SCOPUS, CINAHL, Cochrane Library, and Web of Science databases. Studies examining factors associated with nurses' compliance with IPC practices were included. The PICO framework guided study selection. Data extraction captured study characteristics, compliance rates, and effect sizes. Quality appraisal was conducted using the Joanna Briggs Institute (JBI) critical appraisal tools. Random-effects meta-analyses were performed to pool odds ratios (OR) and adjusted odds ratios (AOR) with 95% confidence intervals (CI). Heterogeneity was assessed using I² statistics, and subgroup analyses and meta-regression explored sources of variation.

Results: A total of 193 studies met inclusion criteria. Overall compliance with IPC practices ranged from 44% to 82%. Meta-analysis revealed significant associations: knowledge (OR = 3.53, 95% CI 2.40–5.19), training (OR = 2.70, 95% CI 1.07–6.79), belief in hand hygiene efficacy (AOR = 16.596, 95% CI 4.726–58.279), glove use (AOR = 5.957, 95% CI 3.430–10.340), risk perception (OR = 1.25, 95% CI 1.13–1.39), PPE availability (β = 0.27, p < 0.001), and infection-control organizational culture (β = 0.26, p = 0.001). Environmental barriers were highly prevalent: heavy workload (93.1%), time pressure (90.8%). Substantial heterogeneity was observed (I² = 72–89%).

Conclusion: Nurses' compliance with IPC practices is influenced by a complex interplay of individual, organizational, and environmental factors. Belief systems and knowledge emerged as the strongest individual predictors, while organizational culture and resource availability were critical system-level determinants. Multi-faceted strategies addressing cognitive, behavioral, and organizational dimensions are essential to improve IPC compliance and reduce HAI burden.