Knowledge, Attitude, and the Practice in Nosocomial Infection Control Among Afghan Healthcare Workers in Herat...

Hospital-acquired infections (HIAs) remain a major threat to patient and healthcare worker (HCW) safety globally, with higher burden in low-resource settings. Despite moderate knowledge among HCWs in many low-income contexts, actual adherence to infection prevention practices is often poor. In Afghanistan, reductions in trained personnel and recurrent shortages of infection prevention supplies have further weakened routine infection control capacity. Evidence from the country is limited and data from western Afghanistan are lacking. This study assessed knowledge, attitude, and practice (KAP) regarding nosocomial infection control among HCWs in Herat.

A cross-sectional study of 433 HCWs in 14 Herat health facilities used a self-administered, validated Persian KAP questionnaire to assess KAP toward nosocomial infection control; data were analyzed with SPSS 27 using descriptive statistics, chi-square tests, and logistic regression.

A total of 433 HCWs participated (mean age 27.35 ± 6.16 years; 52.9% female). The overall median KAP scores were 53.8%, 76.9%, and 32.3%, respectively, revealing a substantial knowledge-practice gap. Higher knowledge was significantly associated with older age, higher education, being a doctor, longer experience, and employment in private hospitals (p < 0.05). Positive attitude was more common among females, married participants, those with advanced education, longer working hours, and private sector staff (p < 0.05). Better practice was observed among single participants and those working ≤ 8 h per day (p = 0.024). Multivariate analysis showed that Bachelor's/MD degree, medical profession, and official or volunteer status independently predicted higher knowledge; female gender, lower economic status, and working in private hospitals predicted higher attitude; while shorter working hours predicted higher practice (p < 0.05).

HCWs in Herat, Afghanistan, exhibited moderate knowledge and positive attitudes toward nosocomial infection prevention, but adherence to infection control practices was low. Professional role, education, experience, training, and workload significantly influenced KAP, highlighting the combined impact of individual competencies and institutional factors. Strengthening infection control requires coordinated policies, adequate resources, hands-on training, and workload management to bridge the knowledge-practice gap, reduce nosocomial infections, and improve patient safety.