Influence of national culture and context on healthcare workers' perceptions of infection prevention in Greek neonatal intensive care units

V Triantafillou; I Kopsidas; A Kyriakousi; T E Zaoutis; J E Szymczak

doi:10.1016/j.jhin.2019.11.020

Influence of national culture and context on healthcare workers' perceptions of infection prevention in Greek neonatal intensive care units

J Hosp Infect. 2020 Apr;104(4):552-559. doi: 10.1016/j.jhin.2019.11.020. Epub 2019 Nov 29.

Authors

V Triantafillou¹, I Kopsidas², A Kyriakousi³, T E Zaoutis⁴, J E Szymczak⁵

Affiliations

¹ Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Centre for Clinical Epidemiology and Outcomes Research, Non-Profit Civil Partnership, Athens, Greece.
² Centre for Clinical Epidemiology and Outcomes Research, Non-Profit Civil Partnership, Athens, Greece.
³ Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
⁴ Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Centre for Clinical Epidemiology and Outcomes Research, Non-Profit Civil Partnership, Athens, Greece; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁵ Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: jszymcza@pennmedicine.upenn.edu.

PMID: 31790745
DOI: 10.1016/j.jhin.2019.11.020

Abstract

Background: Healthcare-associated infections (HAIs) in neonatal intensive care units (NICUs) result in increased morbidity, mortality and healthcare costs. HAI rates in Greek NICUs are among the highest in Europe. There is a need to identify the factors that influence the transmission of HAIs and implementation of prevention interventions in this setting.

Aim: To understand healthcare workers' perceptions about HAI prevention in Greek NICUs.

Methods: Qualitative interviews were conducted with NICU staff (physicians and nurses) and infection prevention stakeholders (infectious diseases physicians and infection control nurses) working in three hospitals in Athens. Interviews were conducted in Greek, transcribed and translated into English, and analysed using a modified grounded theory approach.

Findings: Interviews were conducted with 37 respondents (20 physicians and 17 nurses). Four main barriers to HAI prevention were identified: (1) resource limitations leading to understaffing and cramped space; (2) poor knowledge about HAI prevention; (3) Greek-specific cultural norms, including hierarchy-driven decisions, a reluctance for public workers to do more than they are paid for, a belief that personal experience trumps evidence-based knowledge, and reactive rather than proactive approaches to societal challenges; and (4) lack of a national infection prevention infrastructure. Respondents believed that these barriers could be overcome through organized initiatives, high-quality HAI performance data, interpersonal interactions to build engagement around HAI prevention, and leveraging the hierarchy to promote change from the 'top down'.

Conclusion: Implementing HAI prevention interventions in Greek NICUs will require consideration of contextual features surrounding the delivery of care, with particular attention paid to national culture.

Keywords: Greece; Infection prevention; Intensive care; Neonatology; Qualitative methods.

MeSH terms

Cross Infection / prevention & control
Cross Infection / psychology*
Greece
Health Knowledge, Attitudes, Practice*
Health Personnel / psychology*
Humans
Infection Control*
Intensive Care Units, Neonatal
Interviews as Topic