Health care worker perspectives of their motivation to reduce health care–associated infections


      Health care–associated infections (HAIs) are largely preventable, but are associated with considerable health care burden. Given the significant cost of HAIs, many health care institutions have implemented bundled interventions to reduce HAIs. These complex behavioral interventions require considerable effort; however, individual behaviors and motivations crucial to successful and sustained implementation have not been adequately assessed. We evaluated health care worker motivations to reduce HAIs.


      This was a phenomenologic qualitative study of health care workers in different roles within a university hospital, recruited via a snowball strategy. Using constructs from the Consolidated Framework for Implementation Research model, face-to-face semi-structured interviews were used to explore perceptions of health care worker motivation to follow protocols on HAI prevention.


      Across all types of health care workers interviewed, patient safety and improvement in clinical outcomes were the major motivators to reducing HAIs. Other important motivators included collaborative environment that valued individual input, transparency and feedback at both organizational and individual levels, leadership involvement, and refresher trainings and workshops. We did not find policy, regulatory considerations, or financial penalties to be important motivators.


      Health care workers perceived patient safety and clinical outcomes as the primary motivators to reduce HAI. Leadership engagement and data-driven interventions with frequent performance feedback were also identified as important facilitators of HAI prevention.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Magill S.S.
        • Edwards J.R.
        • Bamberg W.
        • Beldavs Z.G.
        • Dumyati G.
        • Kainer M.A.
        • et al.
        Multistate point-prevalence survey of health care-associated infections.
        N Engl J Med. 2014; 370: 1198-1208
        • Centers for Disease Control and Prevention (CDC)
        Healthcare-associated infections (HAIs), data and statistics page.
        (Available from:) (Accessed November 8, 2016)
        • Quality Net
        Overview: Hospital-Acquired Condition (HAC) Reduction Program.
        (Available from:) (Accessed November 8, 2016)
        • Centers for Medicare & Medicaid Services
        Hospital-Acquired Condition Reduction Program (HACRP).
        (Available from:) (Accessed November 8, 2016)
        • Mauger Rothenberg B.
        • Marbella A.
        • Pines E.
        • Chopra R.
        • Black E.R.
        • Aronson N.
        Closing the quality gap: revisiting the state of the science (vol. 6: prevention of healthcare-associated infections).
        Evid Rep Technol Assess (Full Rep). 2012; 208: 1-578
        • Scott II, R.D.
        The direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention.
        (Publication No. CS200891; Available from:) (Accessed July 7. 2017)
        • Sorensen A.
        • Jarrett N.
        • Tant E.
        • Bernard S.
        • McCall N.
        HAC-POA policy effects on hospitals, other payers, and patients.
        Medicare Medicaid Res Rev. 2014; 4
        • Wald H.
        • Richard A.
        • Dickson V.V.
        • Capezuti E.
        Chief nursing officers' perspectives on Medicare's hospital-acquired conditions non-payment policy: implications for policy design and implementation.
        Implement Sci. 2012; 7: 78
        • Pittet D.
        The Lowbury lecture: behaviour in infection control.
        J Hosp Infect. 2004; 58: 1-13
        • Damschroder L.J.
        • Aron D.C.
        • Keith R.E.
        • Kirsh S.R.
        • Alexander J.A.
        • Lowery J.C.
        Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science.
        Implement Sci. 2009; 4: 50
        • Fox J.
        • Cooney M.
        • Hall C.
        The Seattle virus watch. V. Epidemiologic observations of rhinovirus infections, 1965-1969, in families with young children.
        Am J Epidemiol. 1975; 101: 122-143
        • Shah N.
        • Castro-Sánchez E.
        • Charani E.
        • Drumright L.N.
        • Holmes A.H.
        Towards changing healthcare workers' behaviour: a qualitative study exploring non-compliance through appraisals of infection prevention and control practices.
        J Hosp Infect. 2015; 90: 126-134
        • Seto W.H.
        Staff compliance with infection control practices: application of behavioural sciences.
        J Hosp Infect. 1995; 30: 107-115
        • Stein A.D.
        • Makarawo T.P.
        • Ahmad M.F.
        A survey of doctors' and nurses' knowledge, attitudes and compliance with infection control guidelines in Birmingham teaching hospitals.
        J Hosp Infect. 2003; 54: 68-73
        • Saint S.
        • Kowalski C.P.
        • Banaszak-Holl J.
        • Forman J.
        • Damschroder L.
        • Krein S.L.
        The importance of leadership in preventing healthcare-associated infection: results of a multisite qualitative study.
        Infect Control Hosp Epidemiol. 2010; 31: 901-907
        • Touveneau S.C.L.
        • Ginet C.
        • Stewardson A.
        • Schindler M.B.M.
        • Pittet D.
        • Sax H.
        P168: Leadership styles of ward head nurses and implementation success–a qualitative inquiry in the framework of a mixed-method study on hand hygiene promotion through patient involvement.
        Antimicrob Resist Infect Control. 2013; 2: 168
        • Gifford W.A.
        • Davies B.L.
        • Graham I.D.
        • Tourangeau A.
        • Woodend A.K.
        • Lefebre N.
        Developing leadership capacity for guideline use: a pilot cluster randomized control trial.
        Worldviews Evid Based Nurs. 2013; 10: 51-65
        • Aarons G.A.
        • Ehrhart M.G.
        • Farahnak L.R.
        • Hurlburt M.S.
        Leadership and organizational change for implementation (LOCI): a randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation.
        Implement Sci. 2015; 10: 11