Identifying barriers and enablers to effective infection prevention and control in residential aged care: a qualitative study using the Theoretical Domains Framework.

Abstract

Background: Infection prevention and control (IPC) practices are crucial in residential aged care homes (RACHs), yet gaps between existing evidence-based recommendations and what is done in practice (called 'evidence -practice gaps) continue. Understanding barriers and enablers to implementing evidence-based IPC is essential for improving practice. This study aims to identify barriers and enablers to RACH staff performing evidence-based IPC practices, according to the Theoretical Domains Framework (TDF), and map these domains to associated behaviour change techniques (BCTs) to inform interventions.

Methods: Semi-structured interviews were conducted with 28 staff from nine RACHs in Victoria, Australia. Interviews explored seven prioritised IPC evidence-practice gaps. The TDF guided data collection and analysis. Key domains were identified and mapped to BCTs.

Results: Key enablers included knowledge of IPC importance, access to equipment and resources, skills and experience, self-confidence, visual cues, and beliefs about protecting self and others. Main barriers were related to environmental context and resources, such as limited access to hand hygiene products and personal protective equipment. Social influences and competing priorities also posed challenges. The BCTs mapping suggested focusing on environmental setup, education, and infrastructure to support effective IPC.

Conclusion: Residential aged care staff reported engagement with evidence-based IPC, highlighting its importance. Barriers mainly related to environmental and resource factors. Recommended strategies based on BCTs offer actionable, resource-efficient interventions to improve IPC practice in RACHs.