Healthcare Worker Perceptions of the Barriers to Preventing Hospital-Acquired Infections in Greek Neonatal Intensive Care Units
V. Triantafillou, T. Zaoutis, J. Szymczak
35th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID 2017)
Madrid, Spain, May 23-27, 2017
BACKGROUND: Healthcare-associated infections (HAIs) in the neonatal intensive care unit (NICU) result in increased morbidity and mortality, prolonged lengths of stay and increased medical costs. Rates of HAIs in Greek NICUs are among the highest in Europe. An understanding of healthcare worker (HCW) attitudes and cultural perspectives around the barriers to preventing HAI is an important precursor to the development and implementation of preventative strategies.
METHODS: We conducted qualitative interviews with 20 physicians and 17 nurses working in the NICUs of three pediatric hospitals in Athens with high rates of HAI for a total of 37 respondents. Interviews were transcribed and systematically analyzed using a modified grounded theory approach.
RESULTS: Respondents in our sample identified numerous barriers to the prevention of HAIs (Table I). While the majority of barriers to infection prevention were either caused or exacerbated by the economic crisis, in combination they further contributed to HAIs by impacting the ability of HCWs to properly perform hand hygiene. Respondents also identified cultural barriers including entrenched beliefs that limit the ability to change routine and the role of hierarchy. While many respondents perceived HAIs as an “inevitable evil” in the NICU, they located responsibility for transmission within themselves.
| Table I: Barriers to the Prevention of HAIs in Greek NICUs |
| Staffing shortages and workload burden |
| Shortage of medical supplies |
| Lack of continuing education on infection prevention best practices |
| Cluttered and cramped physical space |
| Improper hand hygiene |
| Entrenched beliefs about preventability of HAIs |
CONCLUSIONS: HCWs in Greek NICUs identify numerous barriers to the prevention of HAI. These barriers are largely caused and exacerbated by the country’s economic troubles and a lack of organization in existing stewardship and educational programs. Despite being frustrated with these barriers, HCWs in our sample expressed interest in and optimism about changing practices to prevent HAI, suggesting the opportunity to engage with HCWs in designing infection prevention interventions.