Barriers and bridges to infection prevention and control: results of a qualitative case study of a Netherlands' surgical unit

Abstract

Objectives

The objectives of the study are to observe the overall work environment including infection prevention and control (IP&C) practices on the target surgical unit; to analyse the policies and procedures in the hospital and unit environments; to analyse the barriers and bridges to IP&C that practitioners identify in visual narratives of their unit environment and to collect monthly specific IP&C-related anonymised data.

Design

In this qualitative case study analysis, a socio-ecological approach on health systems informed the research design and provided a framework to better understand the complexity of implementing effective IP&C.

Setting

The study was conducted on a surgical unit at a Netherlands' hospital that reported successful reductions in the prevalence of targeted multidrug-resistant organisms.

Methods

Research methods included unit observations (n=3), review of relevant policies and procedures, five practitioner-led photo walkabouts of the unit (n=7), three photo elicitation focus groups with practitioners (n=13) and the review of related IP&C data.

Results

The findings indicate some conditions and processes present that may influence the low prevalence of multidrug-resistant organisms, including the ‘search and destroy’ active surveillance strategy, low occupancy rates, a centralised bed cleaning system and the presence of an active grass roots Hygiene in Practice group, which engages practitioners in several ongoing activities to promote IP&C on the units.

Conclusions

Further research on the benefits of practitioner-led community of practices on IP&C practices such as the Hygiene in Practice group is also recommended. Additional case studies to compare theses practices with other acute care hospital around the world would be a valuable way to better understand what IP&C programmes are most effective in which contexts and for what reasons. Further data are available by contacting the primary author directly.

Article summary

Article focus

• To observe the overall work environment including infection prevention and control (IP&C) practices on the target surgical unit;

• To critically review the policies and procedures aimed at the prevention and minimisation of multidrug-resistant organisms in the hospital and unit environments;

• To analyse the barriers and bridges to IP&C that practitioners identify in visual narratives of their unit environment and

• To collect monthly specific IP&C-related anonymised data.

Key messages

The findings indicate some conditions and processes present that may influence the low prevalence of multidrug-resistant organisms, including:

• The ‘search and destroy’ active surveillance strategy, low occupancy rates

• A centralised bed cleaning system and

• The presence of an active grass roots Hygiene in Practice group, which engages practitioners in several ongoing activities to promote IP&C on the units.

Strengths and limitations of this study

• Multiple methods of data collection and a broad socio-ecological system approach to study IP&C on the unit strengthen this research.

• It is possible that staff may have altered their behaviour from normal practices during unit observations.

• The prevalence counts of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococc, Clostridium difficile infections and extended spectrum beta-lactamase; the rates of hand hygiene product usage and antibiotic data were collected by hospital personnel not supervised by the researcher, limiting the ability to assess the rigour of data collection.

• The focus of this study was on a specific clinical unit of the hospital.