Barriers and facilitators to infection prevention and control in a neonatal unit in Zimbabwe - a theory-driven qualitative study to inform design of a behaviour change intervention
Barriers and facilitators to infection prevention and control in a neonatal unit in Zimbabwe - a theory-driven qualitative study to inform design of a behaviour change intervention
复制标题
DOI：
10.1016/j.jhin.2020.09.020
复制
发表时间：
2020-12-01
影响因子：
6.9
通讯作者：
Fitzgerald, F. C.
中科院分区：
文献类型：
--
作者：
Herbec, A.;Chimhini, G.;Fitzgerald, F. C.
背景：医院获得性感染 (HAI) 是低收入环境中新生儿发病/死亡的一个日益增加的原因。医院工作人员的行为（例如手部卫生）是导致医院感染的关键因素。了解这些因素的驱动因素可以为改善感染预防和控制 (IPC) 的干预措施提供信息。目的：探索津巴布韦哈拉雷新生儿病房感染预防和控制 (IPC) 的障碍/促进因素。方法：对新生儿和产科病房的 15 名工作人员进行访谈，同时进行人种学观察。访谈指南和数据分析以 COM-B（能力、机会、动机-行为）模型为基础，并探讨了 IPC 的个人、社会文化和组织障碍/促进因素。使用行为改变轮确定了潜在的干预措施。调查结果：能力范围内的推动因素包括对 IPC 的认识，以及认为 IPC 对个人角色至关重要的动机信念，以及对不良 IPC 后果的担忧。工作人员乐观地认为 IPC 可以根据资源可用性（机会）进行改进。障碍包括：对指导方针的了解有限，没有对绩效（能力）的正式反馈，缺乏资源（机会），往往导致即兴发挥和不良习惯的形成。进一步的障碍包括单位的等级制度，例如，清洁工和母亲在 IPC 中的参与度较低，以及工作人员目睹其他团队成员实施不良做法（机会）。潜在的干预措施可能包括树立榜样、让母亲和干部员工参与进来、审计和反馈以及灵活的方案（适应水/洗手液的供应情况）。结论：IPC 的大多数障碍属于机遇，而大多数促成因素属于能力和动机。基于理论的调查为系统地识别和制定干预措施提供了基础，以解决低收入环境中 IPC 的障碍和推动因素。 (C) 2020 医疗保健感染协会。由爱思唯尔有限公司出版。保留所有权利。
Background: Hospital-acquired infection (HAI) is an increasing cause of neonatal morbidity/mortality in low-income settings. Hospital staff behaviours (e.g., hand hygiene) are key contributors to HAI. Understanding the drivers of these can inform interventions to improve infection prevention and control (IPC).Aim: To explore barriers/facilitators to IPC in a neonatal unit in Harare, Zimbabwe.Methods: Interviews were conducted with 15 staff members of neonatal and maternity units alongside ethnographic observations. The interview guide and data analysis were informed by the COM-B (Capability, Opportunity, Motivation-Behaviour) model and explored individual, socio-cultural, and organizational barriers/facilitators to IPC. Potential interventions were identified using the Behaviour-Change Wheel.Findings: Enablers within Capability included awareness of IPC, and within Motivation beliefs that IPC was crucial to one's role, and concerns about consequences of poor IPC. Staff were optimistic that IPC could improve, contingent upon resource availability (Opportunity). Barriers included: limited knowledge of guidelines, no formal feedback on performance (Capability), lack of resources (Opportunity), often leading to improvization and poor habit formation. Further barriers included the unit's hierarchy, e.g., low engagement of cleaners and mothers in IPC, and staff witnessing implementation of poor practices by other team members (Opportunity). Potential interventions could include role-modelling, engaging mothers and staff across cadres, audit and feedback and flexible protocols (adaptable to water/handrub availability).Conclusions: Most barriers to IPC fell within Opportunity, whilst most enablers fell under Capability and Motivation. Theory-based investigation provides the basis for systematically identifying and developing interventions to address barriers and enablers to IPC in low-income settings. (C) 2020 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.