Behavioural determinants of healthcare provider compliance with infection prevention guidelines: systematic review of qualitative literature

Abstract

Introduction: Despite advances in the field of hospital infection prevention, rates of hospital-acquired infection (HAI) remain in the range of 10% and healthcare provider (HCP) compliance with prevention measures remains low. We undertook a systematic review of qualitative published literature to identify HCPs‘ reported barriers and enablers to compliance with infection prevention guidelines. Methods: We searched (August 2017) Medline, Embase, Psychinfo, and the Cochrane Central Register of Controlled Trials. Studies were included that used qualitative methods to explore HCPs‘ reported barriers and enablers to compliance with infection prevention guidelines. Reported barriers and enablers were extracted from included studies as raw data (direct quotations) or author interpretation. Identified barriers/enablers were deductively coded using the Theoretical Domains Framework (TDF). Inductive thematic analyses were conducted to identify relevant themes. Results: We included 30 studies examining compliance with the following guidelines: standard and isolation precautions (e.g. hand hygiene, glove use, isolation precautions, vaccination) and HAI-specific prevention measures. Of the 368 identified barriers/enablers, the most frequent corresponded to the TDF domains: ―Environmental Context and Resources‖ (n=74) [e.g. lack of time, ease of access to materials], ―Beliefs about consequences‖ (n=53) [e.g. self-protection, perceived efficacy of prevention measure] and ―Social Influences‖ (n=53) [e.g. patient influence, role modelling] Discussion: Whereas many infection prevention efforts focus primarily on training and education to increase HCP knowledge and improve practice, our results suggest that other important determinants may be overlooked. Our findings have important implications for guiding the design of future initiatives to address the most prevalent barriers and enablers.