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


Clack, Lauren; Zingg, Walter; Saint, Sanjay; Casillas, Alejandra; Touveneau, Sylvie; da Liberdade Jantarada, Fabricio; Willi, Ursina; van der Kooi, Tjallie; Damschroder, Laura J; Forman, Jane H; Harrod, Molly; Krein, Sarah; Pittet, Didier; Sax, Hugo; PROHIBIT Consortium (2018). Implementing infection prevention practices across European hospitals: an in-depth qualitative assessment. BMJ Quality and Safety, 27(10):771-780.

Abstract

OBJECTIVE
The 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.

METHODS
Qualitative 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.

RESULTS
Three 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.

CONCLUSION
This 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.

Abstract

OBJECTIVE
The 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.

METHODS
Qualitative 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.

RESULTS
Three 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.

CONCLUSION
This 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.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Infectious Diseases
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:1 October 2018
Deposited On:19 Jul 2018 08:42
Last Modified:20 Oct 2019 05:52
Publisher:BMJ Publishing Group
ISSN:2044-5415
OA Status:Green
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1136/bmjqs-2017-007675
PubMed ID:29950324

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