The Role of Nurses in Infection Prevention and Control: Post-COVID-19 Challenges and Practices in Iraqi Healthcare Systems

Abstract

Background: COVID-19 has had a significant impact on global health care, revealing significant deficiencies in infection prevention and control (IPC) systems and nursing capacities, especially in low- and middle-income settings like Iraq. Nurses are at the forefront of IPC implementation, but little is known about how the pandemic has long-term reshaped their knowledge, practices and the enabling factors in the Iraqi context. This study sought to compare IPC knowledge and practice adherence, healthcare-associated infection (HAI) prevalence and other barriers across three groups of nurses - pre-COVID, COVID-19 era, and post-COVID - in Iraq's hospitals. Methods: A cross-sectional multi-site design was used. A sample of 294 registered nurses from eight tertiary-care hospitals in Baghdad, Basra, Salah al-Din, and Kirkuk governorates were divided into three cohorts based on the time period of their data collection: Pre-COVID (n=97), COVID-Era (n=101), and Post-COVID (n=96). We used a validated IPC knowledge questionnaire, a World Health Organization (WHO)-compatible direct-observation practice assessment tool, and HAI surveillance data from participating hospitals. One-way ANOVA and Tukey post-hoc tests, and chi-squared tests were performed. Results: IPC composite knowledge scores improved significantly from Pre-COVID (52.4 ± 9.8) through COVID-Era (71.6 ± 8.4) to Post-COVID (81.3 ± 7.2) (p<0.001). Hand hygiene compliance rose from 61.4 ± 10.2% to 92.8 ± 5.7% (p<0.001). Overall HAI rates declined from 14.8 ± 3.6% to 5.9 ± 1.9% (p<0.001), with corresponding falls in CLABSI (4.8 to 1.6 per 1,000 device-days), VAP, CAUTI, and SSI rates. IPC fatigue was highest in COVID-Era (56.4%) and decreased post-pandemic (32.3%). Widespread availability of PPE rose from 38.1% to 91.7% (p<0.001). Conclusion: COVID-19 inadvertently provided the impetus for ongoing IPC improvements in Iraq's hospitals. There remain issues with staffing levels and fatigue, which highlight the need for structured strategies to consolidate and build on post-pandemic gains, and to focus on long-term workforce resilience in nursing.