Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
J Hosp Infect. 2024 Nov;153:30-38. doi: 10.1016/j.jhin.2024.08.011. Epub 2024 Aug 28.
Despite evidence that application of infection prevention measures can reduce healthcare-associated infections, compliance with these measures is low, especially among physicians. Intervention effects often do not sustain. An overview of determinants for physicians' infection prevention behaviour and successful behaviour change strategies is lacking. The aim of this review was to identify what determinants influence physicians' infection prevention behaviour, what strategies to improve compliance have been explored, and whether theories, models, and frameworks from implementation science have been used in these studies. A literature search was performed in PubMed, Embase, APA PsycInfo and Web of Science up to June 2, 2023, in collaboration with a medical information specialist. All study types focusing on infection prevention behaviour of physicians in high-income countries were included. Data on determinants and strategies was extracted; determinants were categorized into the Theoretical Domains Framework (TDF). Fifty-six articles were included. The TDF domains 'environmental context and resources', 'social influences', 'beliefs about consequences', 'memory, attention and decision-making', 'knowledge', and 'skills' were found most relevant. The prevailing determinant covers a theme outside the TDF: socio-demographic factors. Sustainable interventions are multimodal approaches that at least include feedback, education, and a champion. Theories, models, and frameworks have rarely been used to guide implementation strategy development. In conclusion, it was found that intervention studies rarely specify the determinants that they aim to address and they lack theoretical underpinning. Future initiatives should combine knowledge about determinants with implementation science to develop theory-based interventions tailored to determinants.
尽管有证据表明应用感染预防措施可以减少医疗保健相关感染，但这些措施的依从性很低，尤其是在医生中。干预效果往往无法持续。缺乏针对医生感染预防行为的决定因素和成功行为改变策略的概述。本综述的目的是确定哪些决定因素影响医生的感染预防行为，已经探索了哪些提高依从性的策略，以及这些研究是否使用了实施科学的理论、模型和框架。在与医学信息专家合作下，于 2023 年 6 月 2 日在 PubMed、Embase、APA PsycInfo 和 Web of Science 上进行了文献检索。纳入了所有关注高收入国家医生感染预防行为的研究类型。提取了关于决定因素和策略的数据；将决定因素分为理论领域框架（TDF）。共纳入 56 篇文章。发现 TDF 领域“环境背景和资源”、“社会影响”、“对后果的信念”、“记忆、注意力和决策”、“知识”和“技能”与决定因素最相关。流行的决定因素涵盖了 TDF 之外的一个主题：社会人口因素。可持续的干预措施是多模式方法，至少包括反馈、教育和拥护者。理论、模型和框架很少用于指导实施策略的制定。总之，研究发现干预研究很少明确他们旨在解决的决定因素，并且缺乏理论基础。未来的举措应将决定因素的知识与实施科学相结合，以针对决定因素制定基于理论的干预措施。
