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Background <p>Healthcare-associated infections (HAIs) are a threat to public health, however, infection prevention and control (IPC) interventions have been shown to prevent a substantial portion of HAIs. Due to the interrelatedness of IPC intervention components, multifaceted implementation strategies, and contextual factors, IPC implementation is intricate. Organizational readiness for change (ORC) has been labelled as critical to ensure successful implementation, yet it is unclear under which conditions this is the case. We aim to examine if ORC is a necessary and/or sufficient condition for IPC implementation in REVERSE, a study aimed at decreasing multidrug-resistant HAIs in Europe.</p> Methods <p>We conducted a crisp-set Coincidence Analysis on data from the 24 hospitals enrolled in REVERSE to examine necessary and sufficient conditions for IPC implementation. We collected quantitative data on change complexity, implementation leadership, ORC, and sustainability. Implementation strategies used, as well as both theory-based outcomes of initiation and cooperative behavior, were assessed qualitatively. Models were selected based on theoretical grounds, fit indices, and case knowledge.</p> Results <p>Twelve hospitals (50%) had high IPC implementation initiation. We found two alternative pathways explaining this outcome. When hospitals implemented highly complex IPC practices, they needed high ORC levels to initiate change. When complexity was low, ORC did not shape initiation, but sites rather had to show clearly matched implementation barriers and strategies to initiate IPC. Results for cooperative behavior were inconclusive.</p> Conclusions <p>Using a novel cross-case configurational approach, we uncovered the role of ORC for IPC implementation. We found that ORC is of importance under the condition of highly complex change. When change complexity is low, solidifying ORC is dispensable, and efforts should instead be directed towards a thoughtful and targeted selection of implementation strategies based on identified barriers. These findings have implications for implementers and decision-makers, who may allocate resources based on whether IPC implementation is anticipated to be of high complexity or not, to ensure proper IPC implementation to address HAIs.</p> Trial registration <p>REVERSE was registered with the “International Standard Randomised Controlled Trial Number” (ISRCTN) register under Nr. 12956554 on 11.11.2021, <a href="https://www.isrctn.com/ISRCTN12956554">https://www.isrctn.com/ISRCTN12956554</a>.</p>

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Organizational readiness for implementing infection control in European hospitals: insights from Coincidence Analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月25日

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  • Laura Caci,
  • Kathrin Blum,
  • Clara Johnson,
  • Bianca Albers,
  • Lauren Clack,
  • Anna Rosa Andritsos,
  • Ana-Maria Anghel,
  • Alberto Antonelli,
  • Athanasios Antoniou,
  • Eirini Apostolidi,
  • Alejandro Araujo Ameijeiras,
  • Alessandra Bandera,
  • Lorenzo Biasoli,
  • Teresa Bini,
  • Victoria Bîrluțiu,
  • Greet Boland,
  • Eva Cappelli,
  • Yehuda Carmeli,
  • Elena Carrara,
  • Anna Celotti,
  • Eirini Christaki,
  • Marco Coppi,
  • George Daikos,
  • Anca Damalan,
  • Daniele Fasan,
  • Maurizio Moreno Fattori,
  • María Fernández-Billón Castrillo,
  • Anca Georgescua,
  • Valeriu Gheorghita,
  • Valérie Goldstein,
  • Sotiria Grigoropoulou,
  • Cosmina Gringaras,
  • Silvia Guerriero,
  • Silvia Guillen Climent,
  • Stephan Harbarth,
  • Carlota Hidalgo López,
  • Juan Pablo Horcajada Gallego,
  • Raluca-Maria Hrișcă,
  • Adriana Hristea,
  • Diana-Gabriela Iacob,
  • Mariana Iacobescu,
  • Magda Ialonardi,
  • Bogdan-Daniel Jerdea,
  • Anastasia Kiousi,
  • Jan Kluytmans,
  • Flora V. Kontopidou,
  • Elena Kovlakidi,
  • Malvina Lada,
  • Salvador López Cárdenas,
  • Davide Mangioni,
  • Giulia Marchetti,
  • Symeon Metallidis,
  • Esperanza Merino,
  • Lacramioara Andreea Mohorea,
  • María del Dulce Nombre Montaner Quiroga,
  • Maria Milagro Montero,
  • Marina Murillo Pineda,
  • Rita Murri,
  • Mihai Negrea,
  • Cristina Negulescu,
  • Aude Nguyen,
  • Cristian-Mihail Niculae,
  • Tudor Rareș Olariu,
  • María Teresa Pérez Rodríguez,
  • Maria Pirounaki,
  • Jack Pollard,
  • Corina Pop,
  • Koen Pouwels,
  • Pilar Retamar Gentil,
  • Francesco Rizzolo,
  • Julie Robotham,
  • Jesús Rodríguez Baño,
  • Friederike Roeder,
  • Estrella Rojo Molinero,
  • Gian Maria Rossolini,
  • Rafael Ruiz Montero,
  • Natasha Salant,
  • Inmaculada Salcedo,
  • María Sánchez Valero,
  • Vered Schechner,
  • Elisa Sicuri,
  • Nikolaos Sipsas,
  • Anna Skiada,
  • Ashlesha Sonpar,
  • Giacomo Stroffolini,
  • Manuel Suárez Vázquez,
  • Evelina Tacconelli,
  • Labros Tampakas,
  • Maela Tebon,
  • Sara Tedeschi,
  • Andrea Tedesco,
  • Carlo Torti,
  • Maria Tsakona,
  • Stavroula Tsiara,
  • Sotirios Tsiodras,
  • Ourania Tsompikou,
  • Eline Verhagen,
  • Pierluigi Viale,
  • Daisy Vries,
  • Kristina Zefi,
  • Sofia Zerva,
  • Zheng Jessie Zhang,
  • Walter Zingg,
  • Panagiotis Zisimopoulos,
  • Nadia Zuabi García

摘要

Background

Healthcare-associated infections (HAIs) are a threat to public health, however, infection prevention and control (IPC) interventions have been shown to prevent a substantial portion of HAIs. Due to the interrelatedness of IPC intervention components, multifaceted implementation strategies, and contextual factors, IPC implementation is intricate. Organizational readiness for change (ORC) has been labelled as critical to ensure successful implementation, yet it is unclear under which conditions this is the case. We aim to examine if ORC is a necessary and/or sufficient condition for IPC implementation in REVERSE, a study aimed at decreasing multidrug-resistant HAIs in Europe.

Methods

We conducted a crisp-set Coincidence Analysis on data from the 24 hospitals enrolled in REVERSE to examine necessary and sufficient conditions for IPC implementation. We collected quantitative data on change complexity, implementation leadership, ORC, and sustainability. Implementation strategies used, as well as both theory-based outcomes of initiation and cooperative behavior, were assessed qualitatively. Models were selected based on theoretical grounds, fit indices, and case knowledge.

Results

Twelve hospitals (50%) had high IPC implementation initiation. We found two alternative pathways explaining this outcome. When hospitals implemented highly complex IPC practices, they needed high ORC levels to initiate change. When complexity was low, ORC did not shape initiation, but sites rather had to show clearly matched implementation barriers and strategies to initiate IPC. Results for cooperative behavior were inconclusive.

Conclusions

Using a novel cross-case configurational approach, we uncovered the role of ORC for IPC implementation. We found that ORC is of importance under the condition of highly complex change. When change complexity is low, solidifying ORC is dispensable, and efforts should instead be directed towards a thoughtful and targeted selection of implementation strategies based on identified barriers. These findings have implications for implementers and decision-makers, who may allocate resources based on whether IPC implementation is anticipated to be of high complexity or not, to ensure proper IPC implementation to address HAIs.

Trial registration

REVERSE was registered with the “International Standard Randomised Controlled Trial Number” (ISRCTN) register under Nr. 12956554 on 11.11.2021, https://www.isrctn.com/ISRCTN12956554.