Infection prevention and control practices in hospitals across Pakistan: a nationwide assessment using the WHO infection prevention and control assessment framework

Background: Healthcare-associated infections are a globally recognized adverse event of healthcare delivery due to their associated morbidity, mortality and costs. Infection prevention and control (IPC) measures are predefined sets of activities necessary to ensure safe, high-quality care, not only for patients but also for healthcare workers. However, low- and middle-income countries may have difficulties with executing appropriate IPC measures due to less developed healthcare systems. Methods: A nationwide cross-sectional survey was undertaken to gather information about the current status of IPC among both public and private secondary and tertiary care hospitals across Pakistan, using the World Health Organization Infection Prevention and Control Assessment Framework (IPCAF) between September and October 2025. Results: In total, 108 hospitals from across Pakistan participated in this study, with the majority from the public sector (82.4%) and tertiary care (52.8%). The median IPCAF score was 349.25 [interquartile range (IQR) 183.88–511.86], indicating basic implementation of IPC core components, with secondary and tertiary care hospitals scoring 293.5 (IQR 183–445) and 393.5 (IQR 201–547.5), respectively. The difference in IPCAF scores between secondary and tertiary care settings was significant, indicating better resources and structures in tertiary care hospitals. Whilst median IPCAF scores were higher for private hospitals compared with public hospitals (431 vs 337.5, respectively), the difference was not significant (P=0.116). The majority of surveyed hospitals had basic to intermediate IPC (29.6%), and 27.8% had inadequate IPC. Conclusion: There appeared to be only basic implementation of IPC activities among hospitals across Pakistan. This needs to be addressed urgently, alongside training and appropriate finances, to enhance future IPC activities.