Changes in self-assessed infection prevention and control standards compliance following accreditation in palliative care services: A mixed-methods pre-post evaluation
Tsitsi Theologia, Giannis Polychronis, Monika Nikitara, Elena PapouiAim/Objective
To evaluate changes in self-assessed infection prevention and control (IPC) standards compliance associated with an organizational accreditation process in an independent nonprofit palliative care provider.
Methods and results
A single-site mixed-methods pre-post evaluation was conducted in a 21-bed inpatient hospice. Baseline assessment occurred from May to July 2024, post-implementation assessment in October 2025, and the external survey on 24–27 November 2025. The accreditation intervention included standards review and gap analysis, creation or revision of 64 IPC procedures and criterion-related implementation elements, one comprehensive and one brief staff-training session, a pre-audit, committee oversight, and introduction of healthcare-associated infection surveillance. Six health professionals contributed baseline data and five contributed post-implementation data across 13 IPC dimensions. The overall mean score increased from 3.54 to 4.16 out of 5; the descriptive dimension-level standardized change index was 2.37. External surveyors recorded full IPC compliance. Service-user and loved-one evaluation scores increased from 1.60 to 2.00 out of 2.0. A focus group with six health professionals reported clearer procedures, improved hand hygiene, and increased perceived safety, alongside time and documentation burden. Infection-rate data were reported only as descriptive post-implementation trends because no comparable baseline existed.
Discussion
Accreditation was associated with improved self-assessed IPC standards compliance, supported by external post-implementation findings. Causal inference is limited by the single-site design, small samples, and lack of a control group.
Significance and impact
Accreditation can provide a structured approach to IPC improvement in palliative care, but it sustainability requires reduced documentation burden and workflow integration.