Table 2.

Perceived barriers to effective infection prevention and control (IPC) program implementation by IPC personnel (physicians and nurses), and microbiologists

	Barrier and exemplar quotation
Organization	• Limited and/or non-sustainable hospital leadership support towards IPC  “More than a year ago, we developed an IPC plan and presented it to hospital leadership for approval, but we have still not gotten an answer” -IPC physician-  “They [hospital leadership] don’t do anything with the data we share” -IPC physician- • Suboptimal communication with hospital leadership  “We don’t have fluent communication with hospital leadership. For example. We have to mail requests to the hospital director, and wait for weeks or months to get a response” -IPC physician- • Hospital bureaucracy to appoint new personnel, approve purchases, etc. • IPC physicians lack protected time for IPC activities • Inconsistent unit leadership support for IPC activities • Lack of patient safety culture  “This [patient safety culture] is something we have to get better at. Many [HCWs] remember to protect themselves but forget about the patient. Our hand hygiene compliance is always high for moments after interacting with the patients but always low for moments before touching the patient” -IPC nurse- • Suboptimal compensation of HCWs  “Many of us have multiple jobs to make a decent living” -IPC physician- • Suboptimal work climate, low morale • Insufficient human resources and workload across disciplines (including in IPC)  “We are always trying to put out the fire, we don’t have time to really think what are the priorities and how to approach them” -IPC nurse- • Frequent staff turn-over • Power distance  “Our society favors men, and there is a hierarchical structure that does not help us” -IPC nurse- • Lack of unit accountability for low performance
Healthcare personnel	• Limited HCW’s awareness of the importance of IPC programs • Limited HCW’s IPC knowledge • HCW resistance to feedback and/or change • Limited HCW motivation to change • EVC services staffed by external companies (makes communication with IPC a bit more challenging)
Tasks	• Unable to reach all relevant groups/areas (due to inadequate IPC staffing) • Difficulty in translating data into action (majority are familiar with measuring and reporting but less familiar with implementing changes) • Do not measure impact of implemented interventions • IPC teams are responsible for a broad range of issues • Limited testing availability for Clostridioides difficile
Tools and technology	• Limited technical resources  “We have to coordinate who is going to use the computer because we only have one” -IPC nurse-  “Sometimes, a medical student or a resident gives us their old computer. When they die, we have to bring our own” -IPC nurse- • Limited training opportunities for the IPC team  “The [hospital leadership] asked us to do it on weekends because there is less clinical work than on weekdays” -IPC nurse-  “We bought with our own money the supplies we needed for the hand hygiene workshop” -IPC nurse- • Limited training opportunities for HCWs • Limited supplies  “We can’t provide feedback on hand hygiene compliance when we haven’t been able to provide towels to dry their hands” -IPC nurse” • Lack of efficient methods to perform HAI surveillance • Lack of support to process, analyze, or display HAI data • Fragmented electronic health records
Physical environment	• Limited space • The microbiology laboratory has limited operating hours • Hospital infrastructure
External environment	• COVID-19 pandemic  “The pandemic stopped our normal work. We have to go back to measuring hand hygiene compliance and other basic IPC activities” -IPC physician- • Lack of incentives to reduce HAIs • Limited support from public health authorities for IPC implementation  “IPC programs should be a public health priority. We need their support to make IPC programs a hospital standard”

HCW: healthcare worker, HH: hand hygiene, HAIs: healthcare acquired infections