Barriers to investigating and reporting nosocomial outbreaks to health authorities in São Paulo, Brazil: a mixed methods approach

Abstract

Background: Not all nosocomial outbreaks (NOs) are reported to health authorities (HAs).

Aim: To identify barriers to investigating and reporting NOs to HAs.

Methods: A mixed methods approach was performed with a convergent parallel design. The quantitative and qualitative branches of the study were a statewide (electronic) survey and focus groups (FGs), respectively. Infection control practitioners (ICPs) working in the State of São Paulo, Brazil were recruited.

Findings: Eighty-five ICPs were enrolled in the survey and 22 ICPs were enrolled in the FGs. Barriers to investigating and reporting NOs included: (i) difficulty in translating outbreak investigation knowledge into practice; (ii) weak planning in outbreak investigation process; (iii) organizational culture and context; (iv) lack of awareness about reporting; and (v) lack of autonomy of ICPs to report outbreaks to HAs.

Conclusion: HAs could overcome these barriers by revising their strategies to work with healthcare services, as well as delivering translational educational programmes to support improvement in knowledge and skills for NO investigation.

Keywords: Cross-infection; Disease outbreak; Infection control practitioners; Investigation; Mixed methods.