Infection Prevention and Control Systems in Nigerian Tertiary Hospitals: A Systematic Review Study of Policy Implementation and Clinical Outcomes

Background: Healthcare-associated infections (HAIs) remain a major public health challenge globally, particularly in low- and middle-income countries. In Nigeria, tertiary hospitals provide specialized healthcare services but continue to face challenges in the implementation of infection prevention and control (IPC) measures. Effective IPC systems are essential for reducing HAIs, improving patient safety, enhancing healthcare quality, and minimizing antimicrobial resistance. Objective: This systematic review examined infection prevention and control systems in Nigerian tertiary hospitals, focusing on policy implementation, healthcare workers’ compliance, barriers and facilitators, and associated clinical outcomes. Methods: A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) framework was conducted. Literature searches were performed in PubMed, Scopus, Web of Science, CINAHL, ScienceDirect, Google Scholar, and African Journals Online (AJOL). A total of 2,847 records were identified, of which 2,315 remained after duplicate removal and were screened. Following full-text assessment of 143 articles, 28 studies met the inclusion criteria and were included in the review. Eligible studies were conducted in Nigerian tertiary healthcare facilities between 2015 and 2025. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT 2018), and findings were synthesized narratively and thematically. Results: Most tertiary hospitals had established IPC policies and committees; however, implementation varied considerably across institutions. Compliance with hand hygiene, personal protective equipment use, environmental sanitation, sterilization, and waste management practices ranged from moderate to poor in many facilities. Major barriers included inadequate funding, shortages of IPC resources, insufficient staff training, workforce shortages, weak monitoring systems, and limited institutional support. Key facilitators were continuous professional education, leadership commitment, regular audits, resource availability, and effective policy enforcement. Stronger IPC systems were associated with lower healthcare-associated infection rates, improved patient safety, shorter hospital stays, and reduced morbidity and mortality. Conclusion: Although IPC policies exist in many Nigerian tertiary hospitals, implementation challenges persist. Strengthening institutional commitment, staff training, surveillance systems, and resource allocation is essential for improving IPC effectiveness and patient outcomes