1
|
Houben F, den Heijer CD, van Hensbergen M, Dukers-Muijrers NH, de Bont EG, Hoebe CJ. Behavioural determinants shaping infection prevention and control behaviour among healthcare workers in Dutch general practices: a qualitative study reflecting on pre-, during and post-COVID-19 pandemic. BMC PRIMARY CARE 2024; 25:72. [PMID: 38418938 PMCID: PMC10900587 DOI: 10.1186/s12875-024-02304-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Since the Coronavirus Disease 2019 (COVID-19) pandemic, awareness of infection prevention and control (IPC) has increased in primary care settings. This study aimed to examine behavioural determinants shaping IPC behaviour pre-, during, and post-pandemic among healthcare workers (HCWs) in general practices, to inform optimised IPC in primary care. METHODS For this qualitative study, semi-structured in-depth interviews were conducted during two study periods: (1) pre-COVID-19 pandemic: July 2019-February 2020, with 14 general practitioners (GPs) and medical assistants, and (2) during the COVID-19 pandemic: July 2022-February 2023, with 22 GPs and medical assistants. The design was informed by behaviour change theories. Data were analysed using thematic analysis. RESULTS Main themes were: (1) risk perception and IPC awareness, (2) attitudes towards IPC and professional responsibility, (3) decision-making process and risk considerations for IPC adherence, (4) social norm and social influence in GP practice team, and (5) environmental context and resource availability in GP practice. During the pandemic, risk perception and awareness of the importance of IPC increased compared to the pre-pandemic period. A consistent belief emerged that IPC is part of professional responsibility, while needing to be balanced with other aspects of patient care. Decision-making is dependent on the individual GP and mainly influenced by risk assessments and sustainability considerations. The social context in the practice team can reinforce IPC behaviours. GP practice building and layout, and limited IPC resource and material availability were reported as main barriers. CONCLUSIONS The theory-informed insights of this study can be used for targeted interventions to optimise IPC behaviour in general practices. Adopting multifaceted strategies to target the various determinants is recommended to sustain IPC, by implementing continuous education using tailored communication, integrating IPC in work routines and organisational workflows, refining existing IPC protocols by incorporating decision-making tools for HCWs, fostering a culture of IPC through knowledge-sharing and teamwork, and addressing GP practice physical environment and IPC resource barriers.
Collapse
Affiliation(s)
- Famke Houben
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands.
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health Mosa, South Limburg Public Health Service, P.O. Box 33, Heerlen, 6400 AA, The Netherlands.
| | - Casper Dj den Heijer
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health Mosa, South Limburg Public Health Service, P.O. Box 33, Heerlen, 6400 AA, The Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), P.O. Box 5800, Maastricht, 6202 AZ, The Netherlands
| | - Mitch van Hensbergen
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health Mosa, South Limburg Public Health Service, P.O. Box 33, Heerlen, 6400 AA, The Netherlands
| | - Nicole Htm Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health Mosa, South Limburg Public Health Service, P.O. Box 33, Heerlen, 6400 AA, The Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - Eefje Gpm de Bont
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - Christian Jpa Hoebe
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health Mosa, South Limburg Public Health Service, P.O. Box 33, Heerlen, 6400 AA, The Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), P.O. Box 5800, Maastricht, 6202 AZ, The Netherlands
| |
Collapse
|
2
|
Hilt N, Lokate M, OldeLoohuis A, Hulscher MEJL, Friedrich AW, Voss A. Hand hygiene compliance in Dutch general practice offices. Arch Public Health 2020; 78:79. [PMID: 32939264 PMCID: PMC7486593 DOI: 10.1186/s13690-020-00464-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/02/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hand hygiene (HH) is considered one of the most important measures to prevent healthcare-associated infections (HAI). Most studies focus on HH compliance within the hospital setting, whereas little is known for the outpatient setting. The aim of this study was to evaluate compliance with HH recommendations in general practitioners (GPs) office, based on World Health Organization (WHO) guideline. METHODS An observational study was conducted at five Dutch GPs-practices in September 2017. We measured HH compliance through direct observation using WHO's 'five moments of hand hygiene' observation tool. All observations were done by one trained professional. RESULTS We monitored a total of 285 HH opportunities for 30 health care workers (HCWs). The overall compliance was 37%. Hand hygiene compliance was 34, 51 and 16% for general practitioners, practice assistants, and nurses, respectively. It varies between 63% after body fluid exposure and no HH performance before-, during and after home visit of a patient (defined as moment 5). The preferred method of HH was soap and water (63%) versus 37% for alcohol-based hand rub (ABHR). The median time of disinfecting hands was 8 s (range 6-11 s) for HCWs in our study. CONCLUSIONS HH compliance among HCWs in Dutch GPs was found to be low, especially with regard to home visits. The WHO recommended switch from hand wash to ABHR was not implemented by the majority of HCWs in 5 observed GPs offices.
Collapse
Affiliation(s)
- Nataliya Hilt
- Radboudumc, Department of Medical Microbiology, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Mariëtte Lokate
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Alfons OldeLoohuis
- Radboudumc, Department of Primary and Community Care, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Marlies E. J. L. Hulscher
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Alex W. Friedrich
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Andreas Voss
- Radboudumc, Department of Medical Microbiology, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Clinical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Weg door Jonkerbos 100, 6532 SZ Nijmegen, the Netherlands
- Radboudumc, REshape Center for Innovation, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| |
Collapse
|
3
|
Peytremann A, Senn N, Mueller Y. Infection prevention and control measures in practices of the Swiss sentinel network during seasonal influenza epidemics. J Hosp Infect 2020; 106:786-792. [PMID: 32891687 PMCID: PMC7470729 DOI: 10.1016/j.jhin.2020.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/28/2020] [Indexed: 01/16/2023]
Abstract
Background There are limited data on the transmission of influenza in the context of primary care practices, despite the fact that a significant proportion of the population consult their primary care physician for an influenza-like illness every year. Aim To describe the use of influenza prevention and control methods in private practices of the Swiss sentinel network. Methods This online cross-sectional survey collected data about infection prevention and control measures in the 166 private practices of the Swiss sentinel surveillance network during the 2018–2019 influenza season. Questions pertained to the practice setting, infection prevention and control recommendations, influenza vaccination status of the physicians and their staff, adhesion to hand hygiene, and mask wearing. Findings Among the 122 practices that answered (response rate 73.5%), 90.2% of the responding physicians had been vaccinated themselves, and 46.7% (56/120) estimated that their staff vaccination coverage was >60%, although it was offered to employees in all practices. Most practices (N=68, 55.7%) had no specific recommendations for their staff concerning mask wearing. Most physicians reported washing or disinfecting their hands before examining a patient (N=91, 74.6%), after examination (N=110, 90.2%) and before a medical procedure (N=112, 91.8%). However, this rate was lower for arrival at the practice (N=78, 63.9%) and leaving the practice (N=83, 68.0%). Conclusion Most physicians in the Swiss sentinel surveillance network have been vaccinated themselves. However, the vaccination rates among their staff are low, despite vaccine availability. Hand hygiene measures were also suboptimal. These results warrant further efforts to implement infection prevention and control measures in the ambulatory setting.
Collapse
Affiliation(s)
- A Peytremann
- Faculty of Medicine and Biology, University of Lausanne, Lausanne, Switzerland; Department of Family Medicine, Unisanté - University Centre for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland.
| | - N Senn
- Department of Family Medicine, Unisanté - University Centre for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Y Mueller
- Department of Family Medicine, Unisanté - University Centre for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
4
|
Hilt N, Hulscher M, Antonise-Kamp L, OldeLoohuis A, Voss A. Infection prevention support for general practitioners in the Netherlands. Am J Infect Control 2020; 48:236-237. [PMID: 31822361 DOI: 10.1016/j.ajic.2019.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Nataliya Hilt
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Marlies Hulscher
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Laura Antonise-Kamp
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Alfons OldeLoohuis
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andreas Voss
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Clinical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; REshape Center for Innovation, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|