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Infectious diseases
Research
Barriers and bridges to infection prevention and control: results of a qualitative case study of a Netherlands' surgical unit
  1. Chantal Backman1,
  2. Patricia B Marck2,
  3. Naomi Krogman3,
  4. Geoff Taylor4,
  5. Anne Sales5,
  6. Marc J M Bonten6,
  7. Ada C M Gigengack-Baars6
  1. 1Faculty of Nursing, University of Alberta, Alberta, Canada
  2. 2Faculty of Health and Social Development, University of British Columbia, Okanagan
  3. 3Department of Rural Economy, University of Alberta, Edmonton, Alberta, Canada
  4. 4Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
  5. 5Veterans Affairs Inpatient Evaluation Center, Ann Arbor Hospital, Ann Arbor, Michigan, USA
  6. 6Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
  1. Correspondence to Dr Chantal Backman; chantal.backman{at}ualberta.ca

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.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

https://doi.org/10.1136/bmjopen-2011-000511

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    Supplementary materials

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    Footnotes

    • To cite: Backman C, Marck PB, Krogman N, et al. Barriers and bridges to infection prevention and control: results of a qualitative case study of a Netherlands' surgical unit. BMJ Open 2012;2:e000511. doi:10.1136/bmjopen-2011-000511

    • Contributors All the authors made substantial contributions to the conception and design of the study and the analysis and interpretation of the data. CB drafted the article; all the authors revised the manuscript critically for important intellectual content and approved the final version submitted for publication. CB had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding The project was funded in part by the Canadian Patient Safety Institute, the University of Alberta Mary Louise Imrie Graduate Award (2008) and the Registered Nurses' Foundation of Ontario Award (Rolling Stones/CPI Award) for the Advancement of Professional Practice in Infection Control (2008).

    • Competing interest None.

    • Ethics approval Ethics approval was provided by University of Alberta Health Ethics Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Supplementary data are available by contacting the primary author.