Barriers to Aseptic Practice in the Operating Room: A Cross-Sectional Study at Mama Balako Reference Health Center, Democratic Republic of Congo
Abstract
Background
Healthcare-associated infections, particularly surgical site infections (SSIs), remain a major public health challenge in low-resource countries. The operating room (OR) is a critical environment where any breach in aseptic technique can have devastating consequences for patients. In the Democratic Republic of Congo, structural and organizational barriers severely compromise the application of aseptic standards.
Objective
This study aimed to analyze the determinants of barriers to the application of aseptic measures in the operating room of the Mama Balako Reference Health Center in Mbandaka, Democratic Republic of Congo.
Methods
A descriptive, cross-sectional, analytical study was conducted from March to June 2025. All 52 healthcare professionals working in the operating room (surgeons, anesthetists, nurses, anesthesiology technicians, and cleaning staff) were included through exhaustive sampling. Data were collected using a semi-structured questionnaire, direct interviews, and a systematic observation grid. Data analysis included descriptive statistics, bivariate analysis (chi-square tests), and multivariate logistic regression.
Results
The sample was predominantly experienced (>1 year: 78.8%) but severely under-trained (only 15.4% had received continuing education in the past 12 months). Critical infrastructure gaps included complete absence of running water (100%), no alcohol-based hand rub available (100%), non-functional autoclaves (94.2%), and absence of written protocols (84.6%). Only 25.0% of staff knew the WHO's "five moments for hand hygiene," and only 15.4% never placed instruments on non-sterile surfaces. SSIs were observed by 71.2% of respondents. Multivariate analysis identified lack of running water/ABHR (OR=18.4, p<0.001), non-functional autoclave (OR=6.7, p=0.003), non-compliance with PPE (OR=5.2, p=0.008), and time pressure (OR=4.1, p=0.024) as independent predictors of SSIs. Fear of reprisals was reported by 63.5%, and 92.3% had witnessed uncorrected aseptic breaches.
Conclusion
Barriers to aseptic practice in this OR are predominantly structural (absence of water, non-functional equipment, lack of consumables) and organizational (absence of protocols, no audits, punitive culture). Addressing these requires a systemic approach combining infrastructure investment, continuing education, establishment of non-punitive reporting systems, and implementation of the WHO Surgical Safety Checklist.
Keywords
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How to cite
Wanza Basenge, S. (2026). Barriers to Aseptic Practice in the Operating Room: A Cross-Sectional Study at Mama Balako Reference Health Center, Democratic Republic of Congo. SDF Journal of Public Health. https://sfoundation.one/articles/sdf-2026-0046-barriers-to-aseptic-practice-in-the-operating-room-a-cross-sectional-s