Epidemiology and Control of Healthcare-Associated Infections in Nigerian District Hospitals: A Review of Practice in Borno and Plateau States

Healthcare-associated infections (HAIs) impose a significant and preventable disease burden in Nigerian district hospitals, consuming limited resources and increasing patient mortality. This study reviews the epidemiology and infection control practices relevant to HAIs at district hospitals in Borno (North East) and Plateau (North Central) States, two zones with contrasting health system challenges. Data were collected through structured facility assessments, review of ward infection records, and interviews with 25 infection control focal persons and ward heads. Incidence rates, pathogen profiles, and infection prevention and control (IPC) practice scores were determined. HAI incidence was estimated at 12.4 per 100 admissions in Borno and 9.1 per 100 admissions in Plateau district facilities. Catheter-associated urinary tract infections, surgical site infections, and ventilator-associated pneumonia were the most common HAI categories. Klebsiella pneumoniae, Staphylococcus aureus, and Acinetobacter baumannii dominated pathogen profiles. IPC practice scores were low, with hand hygiene compliance below 40 percent in all assessed facilities and no functioning HAI surveillance systems in any district hospital. The study proposes an adapted WHO IPC minimum requirements checklist applicable to resource-limited Nigerian district hospitals and recommends dedicated IPC nurse training funded by State Primary Health Care Development Agencies. Keywords: healthcare-associated infections, infection control, district hospital, Borno, Plateau