Barriers and enablers to implementing hospital-acquired urinary tract infection prevention strategies: A qualitative study using the Theoretical Domains Framework
Dr Oyebola Fasugba1, Prof Liz McInnes1, Ms Joyce Baye2, Ms Heilok Cheng1, Ms Rose Gordon2, Prof Sandy Middleton1
1Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Darlinghurst, Australia, 2St Joseph’s Hospital, Auburn, Australia
Introduction: To date, little is known about the factors affecting implementation of hospital-acquired urinary tract infection (UTI) prevention strategies in the high-risk subacute care setting. This study aimed to identify the perceived barriers and enablers of clinicians to implementing hospital-acquired UTI prevention strategies in an Australian subacute hospital.
Methods: Qualitative semi-structured virtual interviews, underpinned by the Theoretical Domains Framework (TDF), were conducted with purposively selected nurses (n=8) and doctors (n=2) at one sub-acute metropolitan hospital. Interview data were content analysed using the TDF as the coding framework.
Results: Eight TDF domains were identified as important in understanding barriers and enablers to implementing hospital-acquired UTI prevention strategies: Knowledge, Skills, Beliefs about capabilities, Emotion, Professional role and identity, Environmental context and resources, Goals and Behavioural regulation. Barriers were poor awareness of clinical practice guidelines for hospital-acquired UTI prevention; lack of training; staff shortages; competing workloads; lack of procedural equipment for urinary catheterisation; difficulty with implementing prevention strategies in cognitively impaired patients; language barriers; and lack of feedback and use of incident reporting data to influence clinical practice. Presence of a proactive staff culture and positive team approach to work emerged as enablers. Audit and feedback, clinical champions, education and patient information resources in languages other than English were identified as potential enablers.
Conclusion: The eight TDF domains should serve as potential target areas in the development of effective behaviour change interventions to improve uptake of and adherence to evidence-based hospital-acquired UTI prevention strategies in the subacute care setting.
Dr Bola Fasugba works as a senior research officer in the Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne and Australian Catholic University. Her background is in medicine and public health research with specific research interests in infection control and implementation science.