"Everyone in this together": a qualitative study on mothers as partners in infection prevention in a neonatal unit in...

Infection prevention and control (IPC) is critical in neonatal units to prevent healthcare-associated infections, yet research on IPC has primarily focused on healthcare workers, overlooking the role of family caregivers. In low-resource settings, mothers often take on essential caregiving responsibilities including IPC-related tasks, both a logistic necessity and a cultural norm, but their perspectives and experiences remain underexplored. This qualitative descriptive study aimed to explore mothers' experiences and perceptions of IPC in a neonatal unit in Gaborone, Botswana. Understanding maternal involvement in IPC is essential for developing effective interventions, particularly in settings where health systems face workforce shortages and resource constraints.

Fifteen semi-structured interviews were conducted with mothers of infants admitted to the neonatal unit between June and December 2022. Data were analysed using thematic analysis.

Six themes were identified. Major themes related to (1) mothers' strong sense of responsibility for IPC and concerns about infection risks, (2) health system constraints (including supply shortages) that limited consistent IPC practice, (3) competing demands within restricted visiting times that required mothers to balance IPC with feeding and bonding, (4) variable communication with health care workers (HCWs) and limited comfort reminding staff about IPC, and (5) peer dynamics between mothers, including mutual reminders as well as tensions arising from shared feeding equipment. A minor theme that emerged was (6) mothers' emotional distress and its perceived impact on remembering and enacting IPC behaviours. Overall, mothers described high motivation to protect their infants but reported that time pressures, insufficient communication with HCWs, and resource limitations constrained IPC adherence, underscoring the need for structured IPC orientation and ongoing support for families in neonatal care.

Mothers in this neonatal unit viewed themselves as key partners in IPC and were highly motivated to protect their infants, but their ability to consistently follow IPC practices was constrained by limited supplies, staffing pressures, restricted time for caregiving and bonding, and variable communication with HCWs. Mothers also expressed concerns about HCW adherence to IPC and described how emotional distress and peer dynamics could shape IPC behaviour. These findings underscore the need for structured IPC education and support for mothers in neonatal units, and the importance of integrating family-centred IPC policies into neonatal care. Future research should evaluate interventions that strengthen caregiver support, improve communication, and address contextual barriers and constraints to sustained IPC practice.