1.1 Introduction
Nosocomial infections, also referred to as hospital-acquired infections, are infections that are neither present nor incubating at the time of a patient's admission into a hospital but occur 48 hours or more after admission (World Health Organization, 2016). These infections remain a global health challenge as they significantly increase morbidity, and the cost of healthcare delivery. In maternal and child health settings, particularly labour wards, nosocomial infections are of critical concern because both mothers and newborns are highly susceptible due to compromised immunity, invasive procedures, and constant exposure to hospital environments (Allegranzi & Pittet, 2008).
The labour ward is a highly sensitive unit of the hospital where infection prevention and control practices are indispensable for the safety of mothers and infants. Infection in this setting may arise from poor hand hygiene, improper sterilization of instruments, contaminated surfaces, overcrowding, or inadequate use of personal protective equipment. When such infections occur, they have devastating consequences including neonatal sepsis, puerperal sepsis, prolonged hospitalization, increased healthcare costs, and in some cases, maternal or neonatal death (Akanbi et al., 2017).
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitation of the study and Definition of terms.
1.2 Background of Study
Nosocomial infections, also known as hospital-acquired infections, have been recognized as one of the most persistent challenges affecting healthcare delivery worldwide. According to the World Health Organization (2016), these infections are acquired in healthcare facilities and pose significant risks to both patients and healthcare workers. In maternal and neonatal care, particularly in labour wards, the consequences of such infections are often severe, contributing to high rates of morbidity and mortality. Allegranzi and Pittet (2008) asserted that nosocomial infections are responsible for extended hospital stays, increased healthcare costs, and unnecessary complications that undermine patient safety.
Several scholars have highlighted the dangers associated with nosocomial infections in labour wards. Obi, Eze, and Nwankwo (2021) reported that inadequate infection prevention practices in Nigerian hospitals continue to expose mothers and newborns to preventable infections, with puerperal sepsis and neonatal sepsis being among the most common outcomes. Akanbi, Ukah, and Olayinka (2017) stated that lapses such as poor hand hygiene, reuse of medical equipment without proper sterilization, and overcrowded facilities are leading causes of infection transmission in Nigerian labour wards. Similarly, Okeke and Ibe (2019) affirmed that one of the greatest challenges in preventing hospital-acquired infections in the country is the inconsistency between knowledge of infection control protocols and their practical application.
The importance of infection prevention measures has been widely emphasized in healthcare literature. According to Adebimpe (2018), effective measures such as proper handwashing, use of personal protective equipment, sterilization of instruments, and environmental sanitation are fundamental to reducing the risk of nosocomial infections. On the other hand, Udo and Akpan (2020) contended that the absence of adequate resources, limited training opportunities for health workers, and insufficient monitoring systems have continued to undermine infection prevention and control efforts in Nigerian tertiary hospitals (Udo and Akpan, 2020).
At the University of Calabar Teaching Hospital (UCTH), which serves as a major referral centre in Cross River State, the labour ward receives a large number of patients daily. This high patient turnover increases the likelihood of overcrowding and strains available resources. As such, effective infection prevention practices are not only desirable but essential for ensuring safe delivery outcomes. Ekanem and Eyo (2019) reported that maternal and neonatal infections remain a significant contributor to poor health outcomes in southern Nigeria, with tertiary institutions like UCTH facing unique challenges in sustaining effective infection control practices.
The burden of nosocomial infections in labour wards is not merely a medical concern but also a socio-economic one. Families are often left with the financial costs of prolonged hospitalization, purchase of additional medications, and the psychological stress of maternal or neonatal complications. From the institutional perspective, these infections waste scarce resources, strain health systems, and erode public confidence in healthcare services (Obi et al., 2021).
The prevention of nosocomial infections in labour wards requires strict adherence to standard precautions such as proper handwashing, sterilization of instruments, adequate waste disposal, environmental cleanliness, and continuous staff training. However, studies have shown that in many Nigerian hospitals, adherence to these preventive measures is inconsistent due to challenges such as limited resources, poor infrastructure, understaffing, and inadequate supervision (Okeke & Ibe, 2019). On the other hand, even when guidelines exist, the gap between knowledge and practice among healthcare workers often undermines the effectiveness of infection control strategies (Obi et al., 2021). At the University of Calabar Teaching Hospital (UCTH), a tertiary health institution serving Calabar and its environs, the labour ward receives a high number of patients daily. This study is set against the backdrop of the urgent need to examine the measures utilized for the prevention of nosocomial infection in the labour ward of the University of Calabar Teaching Hospital (UCTH), Calabar.
1.3 Statement of Problems
Nosocomial infections, also referred to as hospital-acquired infections, remain a major public health concern in developing countries like Nigeria. in the labour ward, where both mothers and newborns are highly vulnerable, the risk of such infections is particularly heightened due to exposure to invasive procedures, prolonged labour, frequent examinations, and potential lapses in aseptic techniques (World Health Organization, 2020).
Furthermore, the burden of nosocomial infections is not only medical but also socio-economic. Families are left to bear the costs of extended hospitalization, additional treatments, and in severe cases, the emotional toll of maternal or neonatal loss. For the healthcare system, this translates into resource wastage, strained infrastructure, and loss of public trust in the health facility (Obi et al., 2021). It is against this backdrop that this study seeks to evaluate the measures utilized for the prevention of nosocomial infection in the labour ward of University of Calabar Teaching Hospital (UCTH), Calabar.
1.4 Purpose of the Study
The purpose of this study is to examine the measures utilized for the prevention of nosocomial infection in the labour ward of the University of Calabar Teaching Hospital (UCTH), Calabar. It seeks to evaluate the extent to which existing infection prevention practices are implemented, identify the challenges faced in sustaining these practices, and recommend strategies that will improve infection control for the safety of both mothers and newborns.
1.5 Aim and Objectives of Study
The aim of this study is to assess the measures utilized for the prevention of nosocomial infections in the labour ward of the University of Calabar Teaching Hospital (UCTH), Calabar. The specific objectives of the study are as follows:
- To examine the challenges hindering effective implementation of infection control measures in the labour ward.
- To assess the level of compliance of healthcare workers with standard infection prevention practices.
- To determine the impact of infection prevention practices on maternal and neonatal health outcomes.
- To identify the existing infection prevention measures used in the labour ward of University of Calabar Teaching Hospital.
- To suggest recommendations for improving infection prevention and control in the labour ward of University of Calabar Teaching Hospital.
1.6 Research Questions
Based on the objectives of the study, the following research questions have been formulated:
- What are the existing infection prevention measures used in the labour ward of UCTH?
- To what extent do healthcare workers comply with standard infection prevention practices in the labour ward?
- What challenges hinder the effective implementation of infection control measures in the labour ward?
- How do infection prevention practices affect maternal and neonatal health outcomes in the labour ward?
- What recommendations will improve infection prevention and control in the labour ward of UCTH?
1.7 Significance of Study
It is believed that at the completion of the study, the findings will serve as a valuable resource for healthcare workers, administrators, policymakers, and researchers in understanding how nosocomial infections can be effectively prevented. In addition, the outcome will improve maternal and neonatal health outcomes, reduce hospital costs associated with infections, and strengthen public trust in University of Calabar Teaching Hospital (UCTH) as a safe healthcare institution.
Furthermore, healthcare workers will benefit from improved knowledge and awareness of infection prevention practices. Also, mothers and newborns will benefit directly from reduced infection risks and safer healthcare services.
Lastly, researchers and academics will find the study useful as a reference for further work on nosocomial infections and maternal health.
1.8 Scope of Study
The study is confined to the labour ward of the University of Calabar Teaching Hospital (UCTH), Calabar, in Cross River State. It will examine infection prevention measures and their effectiveness in preventing nosocomial infections.
1.9 Limitations of the Study
During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Establishment Policies: Establishment policies posed a serious limitation as most staffs are not ready to release information needed for this research work. There were lots of information needed from the staffs of this establishment to enhance the study which took them time to release or they did not release at all for security purposes, hence the scope was reduced.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
- Initial Cooperation Delay from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.
1.10 Definition of Terms
Nosocomial Infection: These are infections acquired in a hospital or healthcare facility that were not present at the time of admission. They usually appear 48 hours or more after admission (World Health Organization, 2016).
Labour Ward: This is a specialized hospital unit where women are admitted for childbirth and are closely monitored by medical professionals throughout labour and delivery (Ekanem & Eyo, 2019).
Infection Prevention Measures: These are standard practices such as hand hygiene, sterilization of instruments, environmental sanitation, use of personal protective equipment, and safe waste disposal designed to reduce the risk of hospital-acquired infections (Adebimpe, 2018).
Compliance: Compliance refers to the extent to which healthcare workers adhere to established guidelines and protocols for infection prevention in their daily practice (Okeke & Ibe, 2019).
Maternal and Neonatal Outcomes: These are the health results and conditions experienced by mothers and newborns during and after delivery, including the presence or absence of infections and complications (Obi, Eze, & Nwankwo, 2021).
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