Healthcare-associated infections (HAIs) remain a major threat to patient safety. The World Health Organization emphasizes comprehensive infection prevention and control (IPC) programs that integrate organizational infrastructure, staff education, monitoring, and adherence to standard precautions [1]. Global evidence confirms that inadequate IPC implementation contributes to preventable morbidity and mortality [2]. Even when protocols are available, adherence may remain suboptimal because of workload, resource limitations, and insufficient recurrent training [3].

Strengthening workforce competency is therefore central to effective infection control. CDC guidance emphasizes standardized hand hygiene, safe handling of equipment, environmental measures, and safe management of sharps and waste [4]. Integrated surveillance is equally important: long-term-care IPC systems depend on systematic data collection, standardized definitions, and routine review of prevention-process measures [5]. SHEA/APIC guidance for long-term-care facilities similarly links sustainable infection prevention to surveillance, staff education, employee health, and organizational support [6]. NHSN surveillance definitions and the revised McGeer criteria provide standardized approaches for identifying infectious events in long-term-care populations [7,8]. At the health-system level, stronger IPC programs and better adherence to standard precautions are associated with safer care and more consistent implementation [9,10].

Nurses are particularly important because they perform a large proportion of direct-care procedures. Evidence from the Philippines shows that good theoretical knowledge may coexist with suboptimal IPC practice, with workload, dissemination of guidance, and discomfort with personal protective equipment acting as barriers [12]. In a catheter-associated urinary tract infection prevention study from the University of Gondar, only 37.7% of nurses demonstrated good knowledge and 51.8% good practice; work experience, training, and availability of guidelines were associated with better outcomes [11]. At Debre Tabor Comprehensive Specialized Hospital, knowledge and practice were 59.4% and 53%, respectively, and both were associated with work experience and IPC training [13]. A Georgian study likewise reported sufficient knowledge but incomplete translation into practice, including lower adherence during high workload [14]. Studies from Yemen and Saudi Arabia have documented heterogeneous knowledge and practice and a continuing need for structured IPC education [15,16], while work from Türkiye emphasizes the importance of reliable measurement and reinforcement of compliance with standard precautions [17].

Palliative-care populations are especially vulnerable to infection because of advanced illness, age, multimorbidity, invasive procedures, and complex cancer treatment. Modern oncological therapies, including immune checkpoint inhibitors, can produce immune-mediated toxicities that complicate clinical assessment and supportive care [20]. In older and palliative-care patients, infection may present atypically, sometimes without fever or marked laboratory abnormalities, and antimicrobial decisions must remain aligned with individual clinical goals [21].

Evidence-based infection surveillance has also been implemented in hospice and home-care services. Standardized surveillance supports systematic detection of infectious events, identification of risk patterns, and quality improvement, including reduction of selected healthcare-associated infections [22]. These findings suggest that even in resource-constrained settings, infection burden can be addressed through organized surveillance, reliable infrastructure, and targeted staff education.

Despite substantial international literature, hospice-specific data on nurses’ IPC knowledge and practice from Central Asia remain limited. Given the vulnerability of palliative-care patients and nurses’ central role in daily care, a setting-specific assessment is relevant for service improvement. The objective of this study was to assess IPC knowledge/awareness, self-reported practices, and resource availability among nurses in a hospice in Almaty and to explore differences according to work experience.

Study design and setting

A cross-sectional study was conducted in a hospice in Almaty, Kazakhstan, providing continuous palliative and long-term nursing care. Data collection took place during 2024–2025. The study was designed as a single-center assessment of nurses involved in direct patient care.

Participants and selection criteria

A total of 32 nurses participated: ward nurses (n = 18), post nurses (n = 8), procedure nurses (n = 4), and nursing assistants performing basic care tasks (n = 2). Inclusion criteria were at least three months of employment in the hospice, active duty during the survey period, and voluntary participation. Nurses on leave and those who declined participation were excluded. All participants provided written informed consent.

Study size

No formal a priori sample-size calculation was reported in the source study. Accordingly, the analysis should be interpreted as an exploratory single-center assessment of the 32 participating nurses rather than as a population-representative estimate.

Study instrument and adaptation

A structured self-administered questionnaire was adapted from the instrument developed by Tafere et al. [13]. The adaptation process included: (1) translation into Russian, with partial Kazakh-language adaptation and forward–backward translation for linguistic equivalence; (2) limited rephrasing of selected items to reflect palliative/hospice care and prolonged patient contact without intentionally changing item meaning; (3) expansion of the resource section to capture hospice-specific infrastructure, including bedside access to antiseptics; and (4) a pilot test with five nurses to assess comprehension and feasibility. The original questionnaire structure and scoring approach were retained to support comparability with the source instrument.

The final questionnaire contained four sections: sociodemographic characteristics; an 18-item knowledge/IPC-awareness domain; a 15-item self-reported IPC practice domain; and resource availability. Several items in the 18-item domain reflect organizational awareness or previous training in addition to factual knowledge; the composite score is therefore described here as a knowledge/awareness score.

Outcomes and scoring

The primary outcomes were the total knowledge/awareness score (0–18) and the total self-reported practice score (0–15). Secondary outcomes were item-level response proportions, reported availability of IPC resources, and between-group differences according to work experience (≤10 years vs. >10 years). One point was assigned for each correct knowledge/awareness response. Practice items were scored dichotomously; the needle-stick injury item was reverse scored, and the chlorine-disinfection item was evaluated using the specified soaking time. Two classification approaches were retained from the source manuscript: an operational 50% threshold (≥9 points for knowledge/awareness and ≥8 points for practice) and comparison with the sample mean. Missing responses, if present, were recorded as “no data” and excluded from the relevant denominator.

Data collection, participant safety, and confidentiality

Questionnaires were completed individually and returned in sealed envelopes to reduce social-desirability pressure and protect confidentiality. Participation was voluntary and withdrawal was permitted at any time. The study involved questionnaire-based data collection and did not alter clinical care or expose participants to an interventional procedure.

Ethical considerations

Participants were informed about the purpose of the study, confidentiality principles, and their right to withdraw. Written informed consent was obtained from all participants. The study was approved by the local ethics committee and conducted in accordance with the Declaration of Helsinki.

Statistical analysis

Data were analyzed using IBM SPSS Statistics version 26. Quantitative variables were summarized using means and standard deviations or medians and interquartile ranges, with minimum–maximum values where available; categorical variables were summarized as frequencies and percentages. Normality was assessed using the Shapiro–Wilk test and visual inspection of histograms and Q–Q plots. Depending on distributional assumptions, between-group comparisons of quantitative variables used either the independent-samples t test or the Mann–Whitney U test. Categorical variables were compared using Pearson’s χ² test when expected cell counts were ≥5 and Fisher’s exact test when expected counts were <5. All tests were two-sided, and p < 0.05 was considered statistically significant. Because numerous item-level comparisons were exploratory, no adjustment for multiple testing was applied; individual item p-values should therefore be interpreted cautiously.

Participant characteristics

All 32 participants were female. Mean age was 34.8 ± 7.2 years (range 23–52). Seventeen nurses (53.1%) had ≤10 years of work experience and 15 (46.9%) had >10 years. Most participants were Kazakh (68.8%), followed by Russian (21.9%) and other nationalities (9.3%). All had college-level nursing education. Nineteen nurses (59.4%) reported completing IPC training within the previous 12 months.

Table 1 – Sociodemographic and professional characteristics by work experience

Note. Values are n (%) unless otherwise indicated. Fisher’s exact test was used when expected cell counts were small. “—” indicates that a meaningful p-value was not calculated for a zero-variance or complementary category.

IPC knowledge/awareness

The mean total knowledge/awareness score was 14.6 of 18, and all participants scored ≥9 points, meeting the study’s operational definition of adequate knowledge/awareness. Median scores were 14 in the ≤10-year group and 15 in the >10-year group; no statistically significant difference in overall knowledge/awareness was reported. Across individual items, no between-group difference reached statistical significance. Numerically larger gaps were observed for awareness of TB/HIV protocols, hepatitis B vaccination requirements, accidental-exposure reporting, and the needle-stick injury response algorithm.

Table 2 – IPC knowledge and organizational-awareness items by work experience

Note. The original 18-item domain includes factual knowledge as well as awareness of organizational resources/training. Item-level p-values are exploratory and were not adjusted for multiple comparisons.

Figure 1 - Box-and-whisker plot of total IPC knowledge scores among hospice nurses by work experience

Self-reported IPC practices

Most individual practice items showed high reported adherence, particularly safe disposal of sharps, waste segregation, chlorine-based equipment disinfection, and appropriate soaking time. However, lower adherence was reported among nurses with ≤10 years of experience for hand hygiene before and after patient care, not recapping needles, use of masks and aprons, covering personal cuts or wounds, and hepatitis B vaccination. None of the individual item-level differences reached statistical significance.

The total practice score showed a clear between-group difference. Nurses with ≤10 years of experience had a median score of 11 (IQR 10–12), compared with 14 (IQR 13–15) among nurses with >10 years of experience. The Mann–Whitney U test indicated a statistically significant difference (p < 0.001), showing higher self-reported overall adherence in the more experienced group.

Table 3 – Self-reported IPC practices among hospice nurses (n = 32)

Note. For C12, the table presents the proportion answering “Yes” to a needle-stick injury in the previous year; the score was reverse coded, with “No” treated as the correct/safe response. Item-level p-values are exploratory and unadjusted.

Figure 2 - Box-and-whisker plots of total IPC practice scores among hospice nurses by work experience group

Resource availability

All participants reported availability of alcohol-based hand-rub dispensers at ward entrances, sharps containers in procedure areas, and color-coded waste bags. Regular IPC training was reported as being provided for staff by 15/17 (88.2%) nurses in the ≤10-year group and 13/15 (86.7%) in the >10-year group (p = 0.999). This organizational availability measure should be distinguished from actual training attendance: only 19/32 participants (59.4%) reported having completed IPC training within the preceding 12 months.

Table 4 - Reported resource availability for IPC in the hospice (n = 32)

Note. D4 refers to perceived provision/availability of regular staff training, not to individual completion of IPC training within the previous 12 months.