Audit of nosocomial infection control’s committee operation and internal policy on hospital hygiene and use of antibiotics in Benin: similarities and gaps between norms and practices

Abstract

Healthcare-associated infections cause substantial morbidity in countries of the global South, where infection prevention and control (IPC) programmes face structural constraints. Since 2006, Benin has mandated a multidisciplinary Infection Prevention and Control Committee (IPCC) in every hospital, but no empirical evaluation has been published. We characterised the operational status, organisation, perceived roles and measurable performance of IPCCs in southern Benin, and identified gaps between framework and practice. We conducted a multicentre, mixed-methods cross-sectional study in six hospitals (two tertiary, one intermediate, three peripheral; five public, one faith-based; ~100–700 beds). Between March and November 2019, three data sources were combined: a desk review of 89 institutional documents (2013–2018), the French ICALIN.2 composite indicator (organisation/20, means/30, actions/50; total/100), and qualitative inquiry (3 focus groups, 22 participants; 12 interviews). Quantitative data were summarised in SPSS v26.0; transcripts were thematically coded in Microsoft Word by two researchers until saturation. Triangulation validated findings. Five of six hospitals had a functioning IPCC, with male-dominated, physician-led membership in which pharmacists, biologists and hygienists were under-represented. In line with authorities’ requirements, three main roles for the committee emerged: (1) a decision-making body that sets priorities for sanitation, care and other actions in hospitals, (2) a training and awareness-raising role for caregivers about hygiene and rational use of antibiotics, (3) a key collaborator with other structures or bodies of the hospital. The median ICALIN.2 score was strikingly low: 8.5/100 (IQR 7.4–10.6; range 5.5–15.5). No centre met criteria for an operational hygiene team, surveillance, environmental control or root-cause analysis. Persistent barriers included team instability, no dedicated budget, lack of incentives and weak documentation. The level of functioning of the IPCCs is low. The implementation of IPCCs reveals gaps between the normative and the practices observed in situ, which are likely to lead to dysfunctions of this key public health committee. Closing this gap will require member training, dedicated funding, a formal antibiotic-use policy, systematic documentation and active engagement of national coordination bodies.