Barriers and facilitators to infection control at a hospital in northern India: a qualitative study

Anna K Barker,Dawd Siraj,Kelli Brown,Muneeb Ahsan,Sharmila Sengupta,Nasia Safdar

doi:10.1186/s13756-017-0189-9

Abstract

BackgroundHospital acquired infections occur at higher rates in low- and middle-income countries, like India, than in high-income countries. Effective implementation of infection control practices is crucial to reducing the transmission of hospital acquired infections at hospitals worldwide. Yet, no comprehensive assessments of the barriers to sustained, successful implementation of hospital interventions have been performed in Indian healthcare settings to date. The Systems Engineering Initiative for Patient Safety (SEIPS) model examines problems through the lens of interactions between people and systems. It is a natural fit for investigating the behavioral and systematic components of infection control practices.MethodsWe conducted a qualitative study to assess the facilitators and barriers to infection control practices at a 1250 bed tertiary care hospital in Haryana, northern India. Twenty semi-structured interviews of nurses and physicians, selected by convenience sampling, were conducted in English using an interview guide based on the SEIPS model. All interview data was subsequently transcribed and coded for themes.ResultsPerson, task, and organizational level factors were the primary barriers and facilitators to infection control at this hospital. Major barriers included a high rate of nursing staff turnover, time spent training new staff, limitations in language competency, and heavy clinical workloads. A well developed infection control team and an institutional climate that prioritizes infection control were major facilitators.ConclusionsInstitutional support is critical to the effective implementation of infection control practices. Prioritizing resources to recruit and retain trained, experienced nursing staff is also essential.

Highlights

Hospital acquired infections occur at higher rates in low- and middle-income countries, like India, than in high-income countries
Mask use was only required when interacting with patients under droplet or airborne precautions, healthcare workers often put on a mask before entering the Intensive care unit (ICU)
If they are sitting there all the time, the mask makes them very hot.” -Internal medicine resident; “Staff know the importance of personal protective equipment, but they do not always wear the mask. [...] They report that when they wear the mask for a long time, they feel like they are suffocating.” -Infection control head nurse

Summary

Introduction

Hospital acquired infections occur at higher rates in low- and middle-income countries, like India, than in high-income countries. Effective implementation of infection control practices is crucial to reducing the transmission of hospital acquired infections at hospitals worldwide. No comprehensive assessments of the barriers to sustained, successful implementation of hospital interventions have been performed in Indian healthcare settings to date. The Systems Engineering Initiative for Patient Safety (SEIPS) model examines problems through the lens of interactions between people and systems. It is a natural fit for investigating the behavioral and systematic components of infection control practices. Healthcare associated infections (HAIs) affect millions of patients every year and are the most common complication of healthcare delivery globally [1]. Effective implementation of infection control practices is crucial to controlling the transmission of HAIs in settings with high infection rates. Facilitators to intervention implementation must be identified and championed

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Results

Discussion

Conclusion