title: Barriers to investigating and reporting nosocomial outbreaks to health authorities in São Paulo, Brazil: a mixed methods approach.
abstract: BACKGROUND
  Not all nosocomial outbreaks (NOs) are reported to health authorities (HAs).
  
  
  OBJECTIVE
  To identify barriers to investigating and reporting NOs to HAs.
  
  
  METHODS
  A mixed methods approach was performed with a convergent parallel design. The quantitative and qualitative branches of the study were a statewide (electronic) survey and focus groups (FGs), respectively. Infection control practitioners (ICPs) working in the State of São Paulo, Brazil were recruited.
  
  
  RESULTS
  Eighty-five ICPs were enrolled in the survey and 22 ICPs were enrolled in the FGs. Barriers to investigating and reporting NOs included: (i) difficulty in translating outbreak investigation knowledge into practice; (ii) weak planning in outbreak investigation process; (iii) organizational culture and context; (iv) lack of awareness about reporting; and (v) lack of autonomy of ICPs to report outbreaks to HAs.
  
  
  CONCLUSIONS
  HAs could overcome these barriers by revising their strategies to work with healthcare services, as well as delivering translational educational programmes to support improvement in knowledge and skills for NO investigation.
authors: Department of Collective Health Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil.
authors: A L P
authors: AL
authors: Maciel
authors: Department of Collective Health Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil.
authors: B A
authors: BA
authors: de Carvalho
authors: Nottingham University Business School, Centre for Healthcare Innovation, Leadership and Learning, Nottingham, UK.
authors: S
authors: S
authors: Timmons
authors: Department of Collective Health Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil. Electronic address: padoveze@usp.br.
authors: M C
authors: MC
authors: Padoveze
mesh_terms: D001291:Attitude of Health Personnel; D001938:Brazil; D003428:Cross Infection / Q000453:epidemiology*; D018563:Disease Notification; D004196:Disease Outbreaks; D006801:Humans; D016357:Infection Control Practitioners; D057184:Practice Patterns, Nurses'; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
keywords: Cross-infection; Disease outbreak; Infection control practitioners; Investigation; Mixed methods