Abstract / Summary
Healthcare-associated infections (HAIs) remain a major challenge in low- and middle-income countries due to structural constraints and suboptimal infection prevention and control (IPC) practices, contributing to substantial morbidity and mortality. Nurses, as frontline healthcare providers, play a crucial role in implementing IPC measures. However, evidence from Pakistan indicates considerable variability in nurses’ knowledge, attitudes, and practices (KAP) regarding IPC. This systematic review and meta-analysis aimed to estimate the overall levels of nurses’ KAP related to IPC in Pakistan. This review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD42025118014). A comprehensive search of multiple databases was conducted up to October 3, 2025. Cross-sectional studies and baseline data from quasi-experimental studies assessing nurses’ KAP toward IPC were included. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. Random-effects meta-analyses were performed to pool the reported proportions of knowledge, attitudes, and practices. Heterogeneity, subgroup analyses, meta-regression, and publication bias were also examined. Twenty-nine studies (30 datasets) involving 3,383 participants were included. Across the included studies, “adequate knowledge,” “favorable attitudes,” and “good practices” were defined according to the scoring systems used in each study; however, specific cut-off points were not consistently reported. Based on the classifications reported in the original studies, the pooled proportion of nurses with adequate knowledge was 67% (95% CI: 60–74), favorable attitudes were 76% (95% CI: 65–88), and good practices were 56% (95% CI: 47–65). Very high heterogeneity was observed across studies (I² > 90%). Subgroup analyses and meta-regression did not show significant effects of publication year or province, and no eligible studies were identified from Baluchistan. Publication bias appeared to have minimal influence on the pooled estimates. Nurses in Pakistan demonstrate moderately adequate IPC knowledge and generally favorable attitudes; however, IPC practices remain below desirable levels, indicating a persistent knowledge–practice gap. Given the substantial heterogeneity and key evidence gap, particularly the lack of data from underrepresented regions such as Baluchistan and the variability in measurement approaches these findings should be interpreted cautiously. Strengthening IPC practices likely requires multifaceted strategies beyond education alone, including ongoing training, organizational support, adequate resources, effective supervision, and a strong patient-safety culture, alongside future studies using standardized and validated KAP assessment tools. Not applicable.