Factors associated with adherence to infection control principles by clinical nurses in a resource-scarce tertiary care hospital: A cross-sectional study

Healthcare-associated infections (HAIs) are a sizable threat to patient and healthcare workers' wellbeing alike in low- and middle-income countries (LMICs), compounded by the rise of multidrug-resistant organisms (MDROs). Nurses’ compliance with infection prevention and control practices is crucial but influenced by multiple factors. A cross-sectional study was conducted among 89 registered nurses at Saidu Group of Teaching Hospitals in 2025. Participants demonstrated high overall compliance with infection prevention and control practices (3.83 [SD=0.32]), with the highest compliance in contaminated materials control (4.14 [SD=2.21]) and the greatest variability in MDRO control. Knowledge of standard precautions correlated positively with contaminated material control (r=0.270, P=0.010) and total compliance (r=0.260, P=0.015). Perceived safe environment showed significant positive associations with protective equipment use (r=0.290, P=0.005), MDRO control (r=0.280, P=0.008), and total compliance (r=0.320, P=0.002). Multiple regression analysis revealed a perceived safe environment as the strongest predictor of compliance (β=0.310, P=0.004). Attitude and MDRO-related knowledge did not significantly influence compliance. Nurses in this setting demonstrated generally good compliance with infection prevention and control practices; however, compliance with MDRO-related practices was inconsistent, largely due to systemic and resource-related constraints. A safe working environment emerged as more influential than knowledge or attitudes alone. Strengthening institutional resources, leadership support, and continuous education are essential for improving infection prevention and control compliance.