title: Barriers and bridges to infection prevention and control: results of a qualitative case study of a Netherlands' surgical unit.
abstract: OBJECTIVE
  The objectives of the study are to observe the overall work environment including infection prevention and control (IP&C) practices on the target surgical unit; to analyse the policies and procedures in the hospital and unit environments; to analyse the barriers and bridges to IP&C that practitioners identify in visual narratives of their unit environment and to collect monthly specific IP&C-related anonymised data.
  
  
  METHODS
  In this qualitative case study analysis, a socio-ecological approach on health systems informed the research design and provided a framework to better understand the complexity of implementing effective IP&C.
  
  
  METHODS
  The study was conducted on a surgical unit at a Netherlands' hospital that reported successful reductions in the prevalence of targeted multidrug-resistant organisms.
  
  
  METHODS
  Research methods included unit observations (n=3), review of relevant policies and procedures, five practitioner-led photo walkabouts of the unit (n=7), three photo elicitation focus groups with practitioners (n=13) and the review of related IP&C data.
  
  
  RESULTS
  The findings indicate some conditions and processes present that may influence the low prevalence of multidrug-resistant organisms, including the 'search and destroy' active surveillance strategy, low occupancy rates, a centralised bed cleaning system and the presence of an active grass roots Hygiene in Practice group, which engages practitioners in several ongoing activities to promote IP&C on the units.
  
  
  CONCLUSIONS
  Further research on the benefits of practitioner-led community of practices on IP&C practices such as the Hygiene in Practice group is also recommended. Additional case studies to compare theses practices with other acute care hospital around the world would be a valuable way to better understand what IP&C programmes are most effective in which contexts and for what reasons. Further data are available by contacting the primary author directly.
authors.affiliation: Faculty of Nursing, University of Alberta, Alberta, Canada.
authors.forename: Chantal
authors.initials: C
authors.lastname: Backman
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Marck
authors.forename: Naomi
authors.initials: N
authors.lastname: Krogman
authors.forename: Geoff
authors.initials: G
authors.lastname: Taylor
authors.forename: Anne
authors.initials: A
authors.lastname: Sales
authors.forename: Marc J M
authors.initials: MJ
authors.lastname: Bonten
authors.forename: Ada C M
authors.initials: AC
authors.lastname: Gigengack-Baars