Improving outbreak management by understanding barriers faced by professionals in hospitals and public health

Abstract number: P1126

Timen A., Hulscher M., Vos D., van Steenbergen J., Grol R., van der Meer J.

Objectives: The effectiveness of outbreak control depends substantially on the adherence to guidelines. Adherence to guidelines is often not optimal and this has been related, among others, to knowledge, attitudes and behaviour of professionals. Little is known about the factors that influence adherence to authoritative guidance in emergency situations. This study aimed at identifying the most important constraints and facilitators related to professionals in order to improve the quality of outbreak management.

Methods: To qualitatively study and understand barriers to appropriate outbreak control, 26 in-depth interviews with hospital microbiologists and infection control professional and public health physicians and nurseswere carried out in the Netherlands. The conceptual framework of Cabana (JAMA, 1999) was used to discuss recommendations on case finding, infection control, diagnosis, treatment and prophylaxis taking into account recent crisis situations (SARS, outbreaks of C. difficile ribotype 027, rubella outbreak). After classifying the barriers, questionnaires were developed for each group of professionals including: 38 items for public health physicians, 40 items for microbiologists, 26 items for infection control professionals and 40 items for public health nurses. The questionnaires were subsequently administered to hygienists in hospitals (N= 95), physicians and nurses in public health services (N=33) and a representative sample of microbiologists (N=30). A five point, asymmetric Likert scale was used to assess appropriateness of each item.

Results: The response amounts 96% for the public health physicians, 84% for the public health nurses, 63% for the hygienists. The study is still ongoing among microbiologists. Preliminary results show that adherence increases when outbreak control measures are evidence based, do not disturb the daily routine in the hospital/department and take into account the safety of the personnel. Effective communication between microbiologists and clinical specialists increases the adherence to infection control measures and therapy recommendations.

Conclusions: The quality (evidence based development, applicability) and timeliness of scientific guidance during emergency situations are among the most important predictors for the reported adherence by professionals. Further qualitative and quantitative analysis of the data will provide a comprehensive basis for tailored interventions to improve adherence.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Location: Barcelona, Spain
Presentation type:
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