A survey on barriers, cues and needs for Infection Prevention and Control among Healthcare workers

Background

Healthcare-associated infections (HAIs) remain a major patient safety challenge, particularly in tertiary-care hospitals. Despite established infection prevention and control (IPC) measures, adherence is often suboptimal. Understanding healthcare workers’ (HCWs) perceived barriers, cues to action, and needs is essential to inform tailored interventions. This study aimed to assess these factors over time and identify their main determinants.

Methods

We conducted a repeated cross-sectional study over six years (2019–2025, excluding 2020) in a tertiary-care hospital. Each year, IPC referents from hospital wards completed a structured questionnaire assessing perceived barriers, cues to action, and proposed actions for IPC interventions, along with socio-demographic characteristics. Responses were collected using Likert scales. Descriptive analyses and multivariable regression models were performed, with clustering at ward level.

Results

A total of 640 responses were collected (range 85–129/year), including 326 nurses and 314 physicians. Median age was 52 years (IQR 40–58), and 67.8% were female. The most frequently reported barriers were lack of personnel (65.0%) and lack of IPC training (52.0%). Perceived barriers were significantly associated with being a nurse, older age and shorter tenure (p < 0.05). Continuing education (84.1%) and public dissemination of ward-level HAI data (75.2%) were the most endorsed cues to action. Over 85% of responses identified targeted training, behavioural surveillance, and patient and environmental microbiological surveillance as key actions.

Conclusions

Perceived barriers and needs were stable over time, highlighting persistent gaps in staffing and training. HCWs strongly supported education and feedback strategies. Targeted, ward-level interventions integrating workforce strengthening, continuous training, and enhanced surveillance are needed to improve IPC adherence.

Key messages

• Staff shortages and lack of training are the main perceived barriers to IPC adherence, particularly among nurses and less experienced HCWs, highlighting persistent workforce and education gaps.

• HCWs strongly value education and feedback as cues to action and report a high need for training and surveillance, supporting targeted, ward-level IPC strategies to improve adherence and reduce HAIs.