The COVID-19 pandemic presented unprecedented challenges to health systems, including preventing transmission within healthcare settings. Infection Prevention and Control (IPC) guidelines aim to reduce nosocomial spread through recommendations on personal protective equipment (PPE) use, patient separation, and enhanced cleaning. Understanding which factors help or hinder healthcare workers' (HCWs') adherence to IPC guidance during a pandemic is essential to improve future responses.
The review's primary objective was to identify factors that impact HCWs' adherence to IPC guidelines for COVID-19. A secondary objective was to update an earlier 2020 rapid review to determine similarities, differences, and novel insights specific to COVID-19 compared with other respiratory infectious diseases.
The authors searched MEDLINE (Ovid), CINAHL (EBSCO), Scopus, Ovid PsycINFO (EBSCO), and Epistemonikos. No language limits were applied. Searches were restricted to studies published from 2020 onward, with the last search conducted on 5 April 2024, to capture evidence produced since the COVID-19 pandemic declaration.
Included studies were qualitative or mixed-methods designs that explored HCWs' experiences and perceptions about factors affecting their ability to adhere to IPC guidelines for COVID-19. Studies of any type of HCW involved in patient care were eligible, and any healthcare setting (local, national, or international IPC guidance) was acceptable. Studies that collected qualitative data but analysed responses only with descriptive statistics were excluded.
From 170 eligible studies, the review team purposively sampled 26 data-rich studies for detailed analysis to ensure variation across HCW cadres, healthcare settings, and geographic contexts. Sample composition reported in the source:
The review used a purposive sampling frame to select studies judged to be rich in relevant data. Methodological strengths and limitations of included studies were appraised using an adapted Critical Appraisal Skills Programme (CASP) tool suitable for qualitative research. For synthesis, the authors applied a 'best-fit framework approach' to analyse themes and generate review findings. They assessed confidence in each finding using GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research).
The authors identified 27 review findings that describe factors influencing HCWs' adherence to IPC guidance for COVID-19. They reported confidence ratings for these findings as follows: high confidence for 12 findings, moderate confidence for 12 findings, and low confidence for 3 findings. The abstract highlights at least one clear pattern: HCWs reported it was easier to follow IPC guidance when there was managerial support and when guidance was communicated in a clear, structured, and accessible manner.
Reported summary details in the available source text include:
The full content of the 27 findings, their individual descriptions, and which specific findings received high, moderate, or low confidence ratings are not presented in the truncated source text provided for this task.
From the abstract-level information, practical implications include reinforcing managerial support mechanisms and ensuring IPC guidelines are communicated clearly and accessibly to frontline staff. The review methodology (purposive sampling, adapted CASP appraisal, best-fit framework synthesis, and GRADE-CERQual) indicates that the authors sought to produce actionable, confidence-graded findings to guide policy and implementation. Detailed implications derived from each specific finding are not available in the provided source excerpt.
This Cochrane qualitative evidence synthesis updates a 2020 review and focuses on HCWs' adherence to IPC guidance during COVID-19, sampling 26 studies from diverse global settings and reporting 27 review findings with graded confidence using GRADE-CERQual. The abstract indicates managerial support and clear, structured communication of guidance facilitate adherence. The source text provided here is incomplete and truncated; the full review contains the detailed 27 findings, supporting data, and comprehensive implications for practice that are not reported in the available excerpt.
Note: The supplied source text was truncated in the middle of the abstract’s sentence; specific details of the 27 findings and the remainder of the authors' synthesis and recommendations were not reported in the provided source and therefore are not included here.