Barriers to the prevention and control of healthcare-associated infections in public hospitals: a qualitative study of Sistan and Baluchistan province, Iran

Nasrin Rezaee, Majid Sartipi, Mojdeh Jahantigh, Sally Pezaro, Marjan Mardani- Hamooleh

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Abstract

Background: Healthcare-associated infections (HAIs) are a recognized global concern within the hospital setting, particularly in low-income settings. This study aimed to examine Iranian nurses’ insights into the barriers hindering effective prevention and control of HAIs within the hospital setting. Methods: This qualitative study employed a conventional content analysis approach. Semi-structured and individual interviews with nurses (n = 25) were undertaken. Nurses were recruited from five public hospitals affiliated with Zahedan University of Medical Sciences, located in Sistan and Baluchistan province in southeastern Iran. This region was chosen due to its geographic isolation from other major urban centers or medical hubs within Iran. Participants were recruited using purposive sampling. All interviews were conducted during the final four months of 2024. Data collection continued until data saturation was achieved. Conventional content analysis was used to make sense of the data collected. Results: Barriers in preventing and controlling HAIs were categorized into two primary themes: (1) the provision of substandard and poor-quality care and (2) defective professional and organizational infrastructures. Factors contributing to suboptimal care included heavy workloads caused by staff shortages, fatigue resulting from intensive caregiving demands, the presence of unskilled or negligent nursing staff, and insufficient knowledge of infection prevention and control principles. Moreover, the inadequacy of professional and organizational infrastructures was evident through a lack of effective teamwork and limited support from hospital management. Conclusion: The findings presented in relation to the barriers to the prevention and control of HAIs provides useful evidence for policymakers, healthcare authorities, and hospital administrators to take appropriate action. Addressing staff shortages and promoting leadership engagement in resource-limited provinces along with educational strategies, the enhancement of workplace cultures and the recruitment of effective staff and leaders will be crucial in this pursuit.

Original languageEnglish
Article number972
Number of pages10
JournalBMC Nursing
Volume24
Issue number1
DOIs
Publication statusPublished - 25 Jul 2025

Bibliographical note

This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it.

Funding

The hospital managers referred to by our participants were reportedly facing financial constraints, preventing them from providing necessary support. These problems were perceived to lead to the shortages of quality medical equipment and protective supplies in inpatient units for effective IPC. Indeed, healthcare workers in Iran have reported that the most significant contributors to the spread of infectious diseases which resulted in stress and burnout among staff []. Another notable concern, expressed metaphorically by nurses as \u201Cpatients being treated as tools,\u201D reflected managerial negligence\u2014specifically, the practice of admitting new patients into intensive care units without disinfecting beds. This metaphor captured yet another dimension of the lack of managerial support. Hence, hospital administrators should advocate for increased funding from the Ministry of Health to procure high-quality equipment and allocate additional beds, especially in intensive care units. This is a feasible, long-term, and system-level strategy to ensure effective infection prevention and control.

FundersFunder number
Ministry of Health

    Keywords

    • Healthcare-associated infections
    • Infection control
    • Nursing care
    • Nursing workload
    • Qualitative research

    ASJC Scopus subject areas

    • General Nursing

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