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Implementing Infection Prevention Practices Across European Hospitals: An In-Depth Qualitative Assessment

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Clack Lauren, Zingg Walter, Saint Sanjay, Casillas Alejandra, Touveneau Sylvie, da Liberdade Jantarada Fabricio, Willi Ursina, van der Kooi Tjallie, Damschroder Laura, Forman Jane, Harrod Molly, Krein Sarah, Pittet Didier, Sax Hugo,
Project Human Factors Analysis of Infectious Risk Moments
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Original article (peer-reviewed)

Journal BMJ Quality and Safety
Page(s) 1 - 10
Title of proceedings BMJ Quality and Safety
DOI 10.1136/bmjqs-2017-007675

Open Access


Purpose: 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 prevention. 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 six 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 one 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 priorities’, and ‘networks and communication’. Hospitals established unique implementation agendas that, while not always aligned with the project goals, shaped subsequent actions. Successful implementation required 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 intra-institutional segregation. Conclusions: 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.