Barriers to implementing infection prevention and control guidelines during crises: Experiences of health care professionals.
Background: Communicable disease crises can endanger the health care system and often require special guidelines. Understanding reasons for nonadherence to crisis guidelines is needed to improve crisis management. We identified and measured barriers and conditions for optimal adherence as perceived by 4 categories of health care professionals. Methods: In-depth interviews were performed (n = 26) to develop a questionnaire for a cross-sectional survey of microbiologists (100% response), infection preventionists (74% response), public health physicians (96% response), and public health nurses (82% response). The groups were asked to appraise barriers encountered during 4 outbreaks (severe acute respiratory syndrome [SARS], Clostridium difficile ribotype 027, rubella, and avian influenza) according to a 5-point Likert scale. When at least 33% of the participants responded strongly agree, agree, or rather agree than disagree,a barrier was defined as often experienced. The common (generic) barriers were included in a univariate and multivariate model. Barriers specific to the various groups were studied as well. Results: Crisis guidelines were found to have 4 generic barriers to adherence: (1) lack of imperative or precise wording, (2) lack of easily identifiable instructions specific to each profession, (3) lack of concrete performance targets, and (4) lack of timely and adequate guidance on personal protective equipment and other safety measures. The cross-sectional study also yielded profession-specific sets of often-experienced barriers. Conclusion: To improve adherence to crisis guidelines, the generic barriers should be addressed when developing guidelines, irrespective of the infectious agent. Profession-specific barriers require profession-specific strategies to change attitudes, ensure organizational facilities, and provide an adequate setting for crisis management.
Data from questionnaires were analyzed using SPSSEach question could be answered with strongly agree/agree/rather/disagree/strongly disagree
Cross-sectional study (questionnaire and in-depth interview)
Barriers that hamper adherence to outbreak control guidelines were identified by 3 categories of professionals.4 were generic to the groups:There are no concrete targets for performance to measure the effectiveness of the measuresControl measures are worded with insufficient urgency or definitionCrucial instructions within control measures (concerning isolation, diagnostics, and treatment) are n.a. or easily identifiable for each professionMeasures regarding the use of personal protective equipment (PPE) are inadequate and not timely
Using the barrier overviews, questionnaires were designed for each profession.
Questionnaires tailored to 4 groups: consultant microbiologists (M), infectionpreventionists (IP), public health physicians (PHP), and public health nurses (PHN)
Identify the generic and profession-specific priorities that need to be addressedto improve adherence to outbreak control guidelines
Because the reported barriers might be different from those observed during outbreaks, they should be regarded as a proxy for reality.
To improve adherence to crisis guidelines, the generic barriers should be addressed when developing guidelines, irrespective of the infectious agent.Crisis guidelines were found to have 4 generic barriers to adherence: (1) lack of imperative or precise wording, (2) lack ofeasily identifiable instructions specific to each profession, (3) lack of concrete performance targets, and (4) lack of timely andadequate guidance on personal protective equipment and other safety measures.
cross-sectional study used questionnaires tailoredto 4 groups: consultant microbiologists (M), infectionpreventionists (IP), public health physicians (PHP),and public health nurses (PHN).Each group’s questionnaire was designed based on in-depth interviews with professionals in that groupAll interviewees had been actively involved in one or more of 4 recent crisis situations due to infectious outbreaks in The Netherlands: severe acute respiratory syndrome (SARS)
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