Sanitation in Selected Hospitals in the Accra Metropolis: A Public Health Assessment from the Perspectives of Users (Patients/Caregivers and Staff)

Abstract

Background: Sanitation and hand hygiene are fundamental to safe healthcare delivery and infection prevention, yet urban hospitals frequently struggle with infrastructure, supply, and maintenance gaps. This study assessed the functionality, management, and user experiences of sanitation facilities across four hospitals in the Accra Metropolis. Methods: Using a descriptive cross-sectional design, stratified systematic sampling surveyed 311 patients and caregivers, while 13 key sanitation and infection prevention staff were conveniently sampled. Data were analyzed using descriptive statistics and univariate summaries of user perceptions, facility conditions, and staff practices. Result: The study revealed that while 70.7% of users found toilets easily locatable, 56.3% reported them as non-functional. Cleanliness perceptions were evenly distributed across good, fair, and poor categories, with 63.3% noting unpleasant odors and 44.1% experiencing inconsistent water supply. Notably, 64.0% rated their ability to wash hands effectively as poor. Although staff confirmed structured cleaning schedules and regular supervision, 87.5% cited severe shortages of cleaning materials. Key institutional challenges included inadequate cleaning staff (76.9%), funding constraints, weak supervision, and high patient loads. Despite management’s stated commitment to sanitation, systemic logistical gaps severely compromise service delivery. Conclusion: This study highlights an urgent need for targeted investments in hygiene supplies, staffing, maintenance responsiveness, and standardized monitoring tools. Addressing these operational constraints is essential to enhancing user satisfaction, reducing healthcare-associated infection risks, and ensuring dignified, safe clinical environments in high-density urban settings.