Barriers and facilitators to translating infection prevention knowledge into clinical practice at Bule Hora University Teaching Hospital, Ethiopia: mixed-methods study

Healthcare-associated infections remain a significant global challenge, with systemic and behavioral barriers often impeding the translation of knowledge into practice. This study assessed the barriers and facilitators to applying infection prevention knowledge among frontline healthcare workers at Bule Hora University Teaching Hospital in Southern Ethiopia. A concurrent triangulation (convergent parallel) mixed-methods design was employed from August to September 2025. Quantitative data were collected from 186 randomly selected healthcare workers using stratified sampling with proportional allocation, while qualitative data were obtained from eight purposively selected key informants. The Capability, Opportunity, and Motivation (COM-B) behavioral framework guided this study. Quantitative data were processed using Epi Info version 4.6.1 and analyzed with SPSS version 26. Multivariable logistic regression identified independent predictors of compliance, and qualitative data were analyzed using a hybrid deductive-inductive thematic analysis. Findings were integrated at the interpretation stage using a joint display, with statistical significance set at p < 0.05. Overall, 66.7% (95% CI: 59.9–73.5) of frontline staff had moderate knowledge, whereas only 57.53% (95% CI: 50.0–64.2) had good compliance with infection prevention and control (IPC) practices. Key physical opportunity gaps included the lack of ward-level handwashing facilities (55.4%), improper waste segregation at the point of generation (60.2%), and the absence of Hepatitis B vaccination (54.8%). In the multivariable logistic regression model, poor IPC compliance was significantly more likely among healthcare workers with a high workload (adjusted odds ratio [AOR] = 3.4; 95% CI: 1.4–8.4), those without ward-level handwashing facilities (AOR = 5.7; 95% CI: 2.2–14.3), and those working in departments with inadequate infrastructure (AOR = 5.1; 95% CI: 2.06–12.7). Qualitative findings supported these structural barriers and further identified automatic motivational constraints, including optimism bias, cognitive overload, and habitual routines. A substantial knowledge-practice gap exists among frontline staff, driven primarily by structural limitations as well as cognitive and motivational barriers. Closing this gap requires more than guideline dissemination; hospital management should prioritize infrastructure improvements, including ward-level hand hygiene stations, regular formal training, and active local IPC committees to strengthen standard clinical compliance.