Influence of Organizational Factors on ICU Nurses’ Preventive Behaviors for Nosocomial Infections in Three Tertiary Hospitals in Botswana

Abstract

Background: Nosocomial infections NIs) are one of the leading causes of morbidity and mortality in hospital settings, particularly in the ICUs. In Botswana, their prevalence in the ICUs was estimated at 9.2% in 2023. They continue to remain a burning issue in healthcare facilities affecting not only patients but also causing financial burden to the healthcare institutions. Nurses play a vital part in the prevention of NIs. Several studies have been done to investigate NIs, however, the determinants of NIs preventive behaviors among ICU nurses have not been investigated by researchers in Botswana. The study aimed at assessing the organizational determinants of NIs preventive behaviors among ICU nurses in three tertiary hospitals in Botswana. Methodology: A cross-sectional study was conducted with a sample of 107 ICU nurses obtained from a target of 129 ICU nurses by purposive sampling. The study criteria included nurses in the adult ICU, PICU and NICU with more than 6 months’ experience in the ICU settings from the three hospitals in Botswana. Data was collected from 95 respondents with a self-administered online questionnaire designed on Google Forms. Pre-testing of the tool was done to evaluate the validity of the tool on 10% of the sample size. All data was analyzed using SPSS version 27. A logistic regression analysis was done to assess the relationship between dependent and independent variables and, Chi-square tested the hypotheses. Additionally, tables and graphs were used to present data. Results: The study findings revealed significant gaps in organizational support for NIs prevention. A large proportion of respondents (93.7%) confirmed the availability of IPC policies and guidelines in their hospitals. Only 24.2% indicated that IPC training schedule was available, and a mere 17.9% reported routine IPC training was done highlighting a substantial training gap. Significance & Implications: In conclusion, the study clearly demonstrates that organizational support is a critical enabler of effective NIs preventive behaviors among ICU nurses in Botswana. While having IPC policies is a positive step, their practical implementation through resource provision, routine training, and infrastructure support is essential. Strengthening institutional capacity across these dimensions is vital for fostering a consistent, safe, and responsive infection control culture in critical care settings both in Botswana and globally. A customized framework should be developed and adopted for ICU settings, distinct from general IPC protocols to enhance relevance and address the unique challenges in critical care units.