title: Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: a multilevel qualitative analysis.
abstract: (1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice.
  
  
  
  A national and local-level analysis of the 27 indicators was conducted. At the national level, documentary review of regulations/policies/guidelines was conducted. At the local level data collection comprised: (a) review of documentary sources from 14 hospitals, to determine the capacity to report performance against these indicators; (b) qualitative interviews with 3 senior managers from 5 hospitals and direct observation of hospital wards to find out if these indicators are used to improve IPC management and practice.
  
  
  
  2 acute English National Health Service (NHS) trusts and 1 NHS foundation trust (14 hospitals).
  
  
  
  3 senior managers from 5 hospitals for qualitative interviews.
  
  
  
  As primary outcome measures, a 'Red-Amber-Green' (RAG) rating was developed reflecting how well the indicators were included in national documents or their availability at the local organisational level. The current use of the indicators to inform IPC management and practice was also assessed. The main secondary outcome measure is any inconsistency between national and local RAG rating results.
  
  
  
  National regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management.
  
  
  
  For effective patient safety and infection prevention in English hospitals, routine and proactive approaches need to be developed. Our approach to evaluation can be extended to other country settings.
authors.affiliation: NIHR Health Protection Research Unit (HPRU) in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK.
authors.forename: Michiyo
authors.initials: M
authors.lastname: Iwami
authors.affiliation: NIHR Health Protection Research Unit (HPRU) in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK.
authors.forename: Raheelah
authors.initials: R
authors.lastname: Ahmad
authors.affiliation: NIHR Health Protection Research Unit (HPRU) in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK.
authors.forename: Enrique
authors.initials: E
authors.lastname: Castro-Sánchez
authors.affiliation: NIHR Health Protection Research Unit (HPRU) in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK.|Antenne Régionale de Lutte contre les Infections Nosocomiales (ARLIN) Pays de la Loire, Nantes, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Birgand
authors.affiliation: Public Health England, London, UK.
authors.forename: Alan P
authors.initials: AP
authors.lastname: Johnson
authors.affiliation: NIHR Health Protection Research Unit (HPRU) in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK.|Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Holmes
mesh_terms: D003428:Cross Infection / Q000517:prevention & control*; D004739:England; D006236:Handwriting; D006291:Health Policy; D006779:Hospitals, Public; D006801:Humans; D006920:Hygiene; D017053:Infection Control / Q000592:standards*; D007588:Job Satisfaction; D008485:Medical Audit; D061214:Patient Safety; D010563:Personnel Turnover / Q000706:statistics & numerical data; D010564:Personnel, Hospital / Q000600:supply & distribution; D019095:Point-of-Care Systems; D019984:Quality Indicators, Health Care; D013222:State Medicine
keywords: Infection prevention and control management; capacity; indicators