Implementing infection prevention practices across European hospitals: an in-depth qualitative assessment

Abstract

ObjectiveThe Prevention of Hospital Infections by Intervention and Training (PROHIBIT) project included a cluster-randomised, stepped wedge, controlled study to evaluate multiple strategies to prevent catheter-related bloodstream infection. We report an in-depth investigation of the main barriers, facilitators and contextual factors relevant to successfully implementing these strategies in European acute care hospitals.MethodsQualitative comparative case study in 6 of the 14 European PROHIBIT hospitals. Data were collected through interviews with key stakeholders and ethnographic observations conducted during 2-day site visits, before and 1 year into the PROHIBIT intervention. Qualitative measures of implementation success included intervention fidelity, adaptation to local context and satisfaction with the intervention programme.ResultsThree meta-themes emerged related to implementation success: ‘implementation agendas’, ‘resources’ and ‘boundary-spanning’. Hospitals established unique implementation agendas that, while not always aligned with the project goals, shaped subsequent actions. Successful implementation required having sufficient human and material resources and dedicated change agents who helped make the intervention an institutional priority. The salary provided for a dedicated study nurse was a key facilitator. Personal commitment of influential individuals and boundary spanners helped overcome resource restrictions and intrainstitutional segregation.ConclusionThis qualitative study revealed patterns across cases that were associated with successful implementation. Consideration of the intervention–context relation was indispensable to understanding the observed outcomes.

Beyond barriers and facilitators: the central role of practical knowledge and informal networks in implementing infection prevention interventions

“…Their findings highlight the value of methodological approaches that are more flexible than the ‘barriers and facilitators’ trope 27. The study, termed InDepth, was a component of the Prevention of Hospital Infections by Intervention and Training (PROHIBIT) project.…”

Practice and attitudes toward alcohol-based hand disinfection among German infection control teams

“…The reported preference of 30 seconds but with an expectation of higher adherence with shorter times might be a sign of reluctance to change long-standing formal rules, which is a barrier in the conceptual frame of change management and implementation science. 5 This theory is underscored by the fact that two-thirds of the respondents agreed with the statement that you need a buffer between the formal requirement in a standard operating procedure SOP and scientifically sound minimum to generate an additional safety corridor. Although this concept is often used to define technical safety limits, it can be deleterious in behavioral psychology because it undermines trust in the scientific base of infection control recommendations.…”

Implementierungsstrategien für Hygienemaßnahmen

“…Kontext ist die Konstellation (Zusammensetzung) von aktiv (untereinander und mit der Implementierung) interagierenden Variablen [20], nicht einfach nur die passive Bühne des Geschehens. Der Kontext ist auch mehr als nur die bloße Beschreibung von Faktoren, die eine Intervention positiv oder negativ beeinflussen [21,22].…”

“…Kontext ist dynamisch und ändert sich über die Zeit und je nachdem, was man wo implementieren möchte. Die PROHIBIT-InDepth-Studie hatte zum Ziel, den Kontext der oben beschriebenen quantitativen Studie zur Prävention ZVK-assoziierter Blutstrominfektionen zu verstehen und seine Interaktion mit der Implementierung zu beschreiben [22]. Die CFIR-Dimensionen bildeten die Grundlage in der Konzeptualisierung der Methode, um den Kontext außerhalb des "Barrier-versus-Facilitator"-Schemas zu beschreiben [21,22].…”

“…Die PROHIBIT-InDepth-Studie hatte zum Ziel, den Kontext der oben beschriebenen quantitativen Studie zur Prävention ZVK-assoziierter Blutstrominfektionen zu verstehen und seine Interaktion mit der Implementierung zu beschreiben [22]. Die CFIR-Dimensionen bildeten die Grundlage in der Konzeptualisierung der Methode, um den Kontext außerhalb des "Barrier-versus-Facilitator"-Schemas zu beschreiben [21,22]. Menschen "Menschen sind nicht passive Empfänger von Innovationensie suchen sie (Neuesder Mensch ist grundsätzlich neugierig), experimentieren mit ihnen, werten sie aus, finden (oder finden keine) Bedeutung in ihnen, entwickeln (positive oder negative) Gefühle der Innovation gegenüber, fordern sie heraus (testen sie), sorgen sich um sie, beschweren sich über sie, vermeiden sie, machen Erfahrungen mit ihr, versuchen, sie zu verändern und zu verbessernoft im Austausch mit anderen Benutzern/ Kollegen" [24].…”