Background: Hand hygiene (HH) is one of the most effective practices to reduce healthcare-associated infection (HAI) transmission, though compliance remains inadequate among hospital personnel. The aim of this study was to explore perceived barriers and enablers of HH compliance in hospital care and healthcare workers’ (HCW) HAI risk and severity perceptions. Methods: Qualitative study using semi-structured interviews and observations. Interview recordings were transcribed verbatim and supplemented with transcribed observations and field notes. Data was aggregated and coded thematically using a qualitative data analysis software. Results: 65 interviews and 18 observations with HCWs were conducted in nine hospital centres in Quebec, Canada. Data analysis revealed several factors that may influence HCWs’ compliance with HH recommendations. These included clinical environment factors (e.g., lack of sinks), organizational factors (e.g., inadequate staffing, demanding workloads), and communication factors (e.g., dissemination of infection prevention and control [IPAC] information, feedback, and interpersonal professional relationships). At the individual level, knowledge of IPAC and HAI risk perceptions were associated with the adoption of HH. Conclusion: Understanding the determinants of HH adoption is crucial for improving current practices and reducing HAI rates in hospital care. Our findings suggest that environmental strategies (e.g., additional sinks and HH stations) and organizational and communication strategies (e.g., continuing education and training sessions, support from hospital management, positive feedback) could help raise HCWs’ awareness of HAI prevention and adoption of HH guidelines.

Background: The respiratory syncytial virus (RSV) is a major cause of hospitalisation in young Inuit children. Prophylaxis with palivizumab is routinely recommended for premature infants and those with severe pulmonary or cardiac diseases. In the fall 2016, the Quebec Ministry of Health expanded the criteria to include healthy full-term (HFT) newborns from Nunavik based on their high RSV hospitalisation rates. Objectives: The aim of this study was to describe the impact of this programme on Nunavik health services during the first RSV season after its implementation (2016-2017) by studying challenges, concerns and needs of healthcare workers (HCWs). Methods: An ethnographic approach was used. Semi-structured interviews focusing on HCWs experiences, and opinions to improve the new programme were conducted with 20 HCWs involved in its implementation. Results: Main reported challenges and concerns were: additional work(over)load, lack of information and evidence about the need and efficacy of palivizumab in HFT newborns, communication issues between stakeholders, and ethical issues regarding the Inuit population. Conclusion: The study revealed significant feasibility and acceptability issues. The programme was highly resource consuming. To address HCWs' concerns, evidence-based data regarding palivizumab effectiveness in HFT infants, as well as consultation and involvement of Inuit population are warranted. ARTICLE HISTORY

Objective:To describe barriers and facilitators to the adoption of recommended infection prevention and control (IPC) practices among healthcare workers (HCWs).Methods:A qualitative research design was used. Individual semistructured interviews with HCWs and observations of clinical practices were conducted from February to May 2018 in 8 care units of 2 large tertiary-care hospitals in Montreal (Québec, Canada).Results:We interviewed 13 managers, 4 nurses, 2 physicians, 3 housekeepers, and 2 medical laboratory technologists. We conducted 7 observations by following IPC nurses (n = 3), nurses (n = 2), or patient attendants (n = 2) in their work routines. Barriers to IPC adoption were related to the context of care, workplace environment issues, and communication issues. The main facilitator of the IPC adoption by HCWs was the “development of an IPC culture or safety culture.” The “IPC culture” relied upon leadership support by managers committed to IPC, shared belief in the importance of IPC measures to limit healthcare-associated infections (HAIs), collaboration and good communication among staff, as well as proactivity and ownership of IPC measures (ie, development of local solutions to reduce HAIs and “working together” toward common goals).Conclusions:Adoption of recommended IPC measures by HCWs is strongly influenced by the “IPC culture.” The IPC culture was not uniform within hospital and differences in IPC culture were identified between care units.

tome 94, n° 1 Les péripéties cynégétiques des Noirs d'Équateur. De l'art de rester humain et chrétien tout en chassant Armelle Lorcy Édition électronique