title: Barriers and facilitators to infection control at a hospital in northern India: a qualitative study.
abstract: BACKGROUND
  Hospital acquired infections occur at higher rates in low- and middle-income countries, like India, than in high-income countries. Effective implementation of infection control practices is crucial to reducing the transmission of hospital acquired infections at hospitals worldwide. Yet, no comprehensive assessments of the barriers to sustained, successful implementation of hospital interventions have been performed in Indian healthcare settings to date. The Systems Engineering Initiative for Patient Safety (SEIPS) model examines problems through the lens of interactions between people and systems. It is a natural fit for investigating the behavioral and systematic components of infection control practices.
  
  
  METHODS
  We conducted a qualitative study to assess the facilitators and barriers to infection control practices at a 1250 bed tertiary care hospital in Haryana, northern India. Twenty semi-structured interviews of nurses and physicians, selected by convenience sampling, were conducted in English using an interview guide based on the SEIPS model. All interview data was subsequently transcribed and coded for themes.
  
  
  RESULTS
  Person, task, and organizational level factors were the primary barriers and facilitators to infection control at this hospital. Major barriers included a high rate of nursing staff turnover, time spent training new staff, limitations in language competency, and heavy clinical workloads. A well developed infection control team and an institutional climate that prioritizes infection control were major facilitators.
  
  
  CONCLUSIONS
  Institutional support is critical to the effective implementation of infection control practices. Prioritizing resources to recruit and retain trained, experienced nursing staff is also essential.
authors.affiliation: Department of Population Health Sciences, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI USA.
authors.forename: Anna K
authors.identifier: 0000-0003-0719-6838
authors.initials: AK
authors.lastname: Barker
authors.affiliation: Department of Population Health Sciences, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI USA.
authors.forename: Kelli
authors.initials: K
authors.lastname: Brown
authors.affiliation: Department of Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI USA.
authors.forename: Dawd
authors.initials: D
authors.lastname: Siraj
authors.affiliation: Medanta Institute of Eduation and Research, Medanta the Medicity Hospital, Gurgaon, Haryana India.
authors.forename: Muneeb
authors.initials: M
authors.lastname: Ahsan
authors.affiliation: Department of Clinical Microbiology & Infection Control, Medanta the Medicity Hospital, Gurgaon, Haryana India.
authors.forename: Sharmila
authors.initials: S
authors.lastname: Sengupta
authors.affiliation: Department of Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI USA.|William S. Middleton Memorial Veterans Affairs Hospital, Madison, WI USA.
authors.forename: Nasia
authors.initials: N
authors.lastname: Safdar
keywords: Global health; Human factors; India; Infection control; Qualitative methodology