Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: A multilevel qualitative analysis

Michiyo Iwami, Raheelah Ahmad*, Enrique Castro-Sánchez, Gabriel Birgand, Alan Johnson, Alison Holmes

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Objective: (1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice. Design: A national and local-level analysis of the 27 indicators was conducted. At the national level, documentary review of regulations/policies/guidelines was conducted. At the local level data collection comprised: (a) review of documentary sources from 14 hospitals, to determine the capacity to report performance against these indicators; (b) qualitative interviews with 3 senior managers from 5 hospitals and direct observation of hospital wards to find out if these indicators are used to improve IPC management and practice. Setting: 2 acute English National Health Service (NHS) trusts and 1 NHS foundation trust (14 hospitals). Participants: 3 senior managers from 5 hospitals for qualitative interviews. Primary and secondary outcome measures: As primary outcome measures, a 'Red-Amber-Green' (RAG) rating was developed reflecting how well the indicators were included in national documents or their availability at the local organisational level. The current use of the indicators to inform IPC management and practice was also assessed. The main secondary outcome measure is any inconsistency between national and local RAG rating results. Results: National regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management. Conclusions: For effective patient safety and infection prevention in English hospitals, routine and proactive approaches need to be developed. Our approach to evaluation can be extended to other country settings.

Original languageEnglish
Article numbere012520
JournalBMJ Open
Issue number1
Publication statusPublished - 1 Jan 2017

Bibliographical note

Funding Information:
This research was produced by Imperial College London and commissioned by the Health Foundation, an independent charity working to continuously improve the quality of healthcare in the UK. The author(s) were partially funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU (grant number HPRU-2012-10047).

Copyright 2017 Elsevier B.V., All rights reserved.


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