Patient education on transmission based precautions: a context assessment in a university hospital.

Abstract Background: Special precautions are intended to prevent pathogen transmission within the healthcare settings and may require patient isolation. Inpatients in such situation are under risk of isolation-related adverse events. Previously, we developed a guideline to support patient engagement aiming at to minimize their vulnerability to these events. We seek to understand the context in the pre-implementation phase. Aim: to identify barriers and enablers to implement a guidance for effective communication among healthcare workers and inpatients under special precautions. Methods: qualitative study using non-participant observation on two wards of a university hospital. We performed twenty hours of observation, focusing on interactions of healthcare workers, visitors and patients. The Consolidated Framework for Implementation Research (CFIR) was used for data analysis. Results: Inner-setting : The environment showed proper physical structure for infection prevention, including infection prevention protocols. The organizational culture was favorable to the acceptance of innovative approaches. We found several spaces for interaction among healthcare workers, patients, and visitors. However, effective com­­­munication occurred poorly between individuals. There was no standard operational procedures for patient education; therefore, this process leaned on individual initiatives. Individuals : there were several players in the context: doctors, nurses, technicians, physiotherapists, students, teachers, researchers, caregivers, visitors, and police officers. Healthcare workers showed partial adherence to infection prevention measures. Discussion: context assessment identified relevant enablers such as proper physical structure and institutional culture. As the main barriers, we identified a lack of systematic planning for patient education and gaps in infection prevention measures, which can undermine the patients’ confidence in the healthcare personnel. Key words: universal precautions, health education, nursing, patient participation, communication.