Hospital Sanitation and Hygiene Audit in South-West Nigeria: An Evaluation of Infection Control Infrastructure and Compliance across Tertiary Healthcare Facilities

Hospital-acquired infections (HAIs) pose a severe threat to patient safety in resource-constrained tertiary healthcare settings. Effective environmental sanitation and hygiene infrastructure are frontline defenses against microbial transmission. An observational audit evaluated 24 inpatient wards across three federal tertiary hospitals in South-West Nigeria (LUTH, FETHI, FMC Owo). Data collection comprised 48 unannounced audit visits using a 16-indicator checklist spanning four core IPC domains. A composite Sanitation Performance Index (SPI %) was formulated with equal domain weighting and evaluated against WHO risk benchmarks. Non-parametric Kruskal-Wallis and post-hoc Mann-Whitney U tests evaluated institutional differences. The overall composite grand mean score was 1.42 out of 2.00 (Available but Not Adequate). Environment and Cleaning Practices recorded the lowest performance score (1.17), driven by absent cleaning rosters (1.00), lack of mop separation between toilets and wards (1.00), and unmaintained high-touch surfaces (1.00). Overall SPI compliance differed significantly across institutions (Kruskal-Wallis H = 6.42, p = 0.040), with LUTH (90.6%) scoring significantly higher than FMC Owo (50.0%, p = 0.018). Substantial institutional gaps persist in environmental cleaning and waste segregation. Targeted interventions including mandatory color-coded double-bucket systems, chemical dosing controls, and automated water backups are urgently required.