From the Patient to the Healthcare Worker: The Transmission Chain of Healthcare-Associated Infections in Cameroon, an Integrated Approach

Background: Healthcare-associated infections (HAIs) arise from a transmission chain involving reservoirs (patients, the environment, medical devices), routes (hand-borne contact, equipment, air, body fluids, percutaneous exposure), and upstream system determinants (water, sanitation and hygiene [WASH], organization, training, safety culture, and access to diagnostics and antibiotics). Objective: To propose an integrated interpretation of patient-healthcare worker transmission in Cameroon by identifying dominant links and points where the chain can be interrupted. Sources and Approach: A critical narrative review grounded in the international infection prevention and control (IPC) literature and the available evidence from Africa and Cameroon, without a systematic review protocol or pooled quantitative synthesis. Main Findings: The literature suggests 1) a measurable burden of HAIs in selected units, 2) heterogeneous implementation of IPC programmes across facilities, and 3) substantial underestimation in the absence of structured surveillance, particularly for surgical site infections (SSIs) after discharge. The most directly actionable determinants lie at the patient-healthcare worker-environment interfaces (hands, devices, high-touch surfaces) as well as in upstream system factors. Implications: Prioritizing an integrated package combining IPC governance, a WASH foundation, uninterrupted availability of essential consumables, multimodal strategies, healthcare worker protection, and alignment between IPC and antibiotic stewardship appears appropriate.