Table 4

Mixed-methods integration

Theoretical perspectiveQuantitative resultQualitative findingData integration
Innovation Guidelines were perceived as useful (100%), easy to understand (≥90%), easy to navigate (≥68%), logical to use (≥62%), easy to use (≥56%)
Over half of respondents reported either strong or very strong evidence in answer to their personal perception of the strength of the evidence underpinning the guidelines (≥62.%), and how infection prevention and control experts in their organisation would rate the strength of the evidence underpinning the guidelines (≥60%)
Guidelines supported the standardisation of clinical practice
Guidelines as large documents and difficult to locate
Different levels of awareness of guidelines between staff positions
Clinical guidelines support the standardisation of clinical practice
A universal perception that staff lacked the time to read a full guideline
The participants’ level of awareness of the background work that is conducted to support guideline development was variable with those in specialist positions or those in leadership positions perceived to have more awareness than front-line staff
Recipients Respondents were asked their level of agreement with statements which stated that the NCEC HCAI guidelines greatly improved their individual ability and the healthcare teams’ ability to prevent HCAI transmission and HCAI infection. The percentage in agreement for each statement in relation to both guidelines was around 50% (range 37.5%–60%) with slightly higher scores for the perception of teams’ ability compared with individual level abilityGuidelines as Holy Grail and time-consuming implementationThe value of the guidelines to support clinical practice endorsed by participants
The perception that some staff may not see the value of implementing the guidelines or may lack the time was highlighted
Context In terms of the availability of organisational resources to support guideline implementation: the lowest percentage agreement scores were for environmental facilities (≤6.7%), budget/financial resources (≤26.8%) and staffing levels (≤26.7%). The highest scored items were having access to infection control expertise (≥81.3%) and training/education resources (≥56.3%)Importance of governance systems, effective communication loops with audit and timely feedback
Suboptimum infrastructure
Wish for more positive affirmation of things done well
‘World apart concept’—The ideological approach to care which differs from the reality of clinical practice where the resources and time are not always available to fully implement the guideline recommendations
Guidelines may not always be perceived as relevant by practitioners
The negatives related to the frustrations that healthcare teams felt when working with substandard infrastructure and resources which ultimately meant that they were hampered in their ability to provide optimum care and the perception of overly burdensome requirements in terms of audit and administration
Facilitation The strategies perceived as most effective were audit (85.7%), once off educational sessions (85.7%), checklists (80%), having a key nominated person in each department (80%), repeated education sessions (80%), feedback post audit (69.2%), organisational level champions (66.6%) and care bundles (62.5%)Role of infection prevention and control nurse as vital instrumental in ensuring the implementation of the HCAI guidelines
Need for targeted bite size (small information chunks) updates for staff at the front line
Audit, feedback and multipronged educational activates particularly at the front line were generally effective
Information is small bite size chunks is important to ensure translation of evidence into practice
The infection prevention and control specialist nurse, infection prevention and control committee and other specialist infection control roles were instrumental in ensuring implementation of the HCAI guidelines
  • HCAI, Healthcare Associated Infection; NCEC, National Clinical Effectiveness Committee .