---
title: "Factors Affecting Healthcare Workers' Adherence to IPC Guidelines for COVID-19: Qualitative Synthe"
id: "pubmed-42677895"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42677895"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42677895/"
doi: "10.1002/14651858.CD016384"
published_at: "2026-09-01T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Factors Affecting Healthcare Workers' Adherence to IPC Guidelines for COVID-19: Qualitative Synthe
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42677895
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42677895/)
- **DOI:** [10.1002/14651858.CD016384](https://doi.org/10.1002%2F14651858.CD016384)
- **Published At:** 2026-09-01T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This Cochrane qualitative evidence synthesis examined factors that influence healthcare workers' adherence to **infection prevention and control (IPC)** guidelines during the COVID-19 pandemic. - The review updated an earlier 2020 rapid synthesis and focused on studies published from 2020 to 5 April 2024, capturing evidence specific to COVID-19. - The authors screened qualitative and mixed-methods studies reporting healthcare workers' experiences and perceptions about following IPC guidance, including use of **personal protective equipment (PPE)**, patient separation, and cleaning routines. - A total of 170 studies met inclusion criteria; 26 data-rich studies were purposively sampled for in-depth analysis to ensure variation by cadre, setting, and geography. - Sampled studies came from a range of income settings: high (7), upper-middle (7), lower-middle (8), and low (4) income countries; geographically they included Asia (10), Africa (8), North America (3), South America (1), Oceania (1), and Europe (3). - Most sampled studies included nurses (15) and doctors (11); other clinical staff and support staff were also represented. Settings included hospitals, long-term care, community care, and specific units such as maternity, emergency, intensive/critical care, and operating rooms. - The synthesis identified 27 review findings on factors influencing adherence; confidence in these findings (using **GRADE-CERQual**) was reported as high for 12, moderate for 12, and low for 3 findings. - Preliminary high-level patterns reported in the abstract: managerial support and clear, structured, accessible IPC communication made it easier for HCWs to follow guidance. - The abstract and available text are truncated in the source; detailed descriptions of the 27 findings, their content, and the full implications for practice are not reported in the provided source text. - Methods used included a purposive sampling frame, an adapted CASP tool for quality appraisal, a best-fit framework approach for synthesis, and **GRADE-CERQual** to assess confidence in review findings.
## Clinical Analysis & Structured Key Points
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Factors that impact on healthcare workers' adherence with infection prevention and control (IPC) guidelines for COVID-19: a qualitative evidence synthesis [Catherine Houghton](https://pubmed.ncbi.nlm.nih.gov/?term=Houghton+C&cauthor_id=42677895)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#full-view-affiliation-1 "School of Nursing and Midwifery, University of Galway, Galway, Ireland."), [Pauline Meskell](https://pubmed.ncbi.nlm.nih.gov/?term=Meskell+P&cauthor_id=42677895)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#full-view-affiliation-2 "School of Nursing and Midwifery, University of Limerick, Limerick, Ireland."), [Hannah Delaney](https://pubmed.ncbi.nlm.nih.gov/?term=Delaney+H&cauthor_id=42677895)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#full-view-affiliation-3 "Independent Researcher, Galway, Ireland."), [Sarah Sheehan](https://pubmed.ncbi.nlm.nih.gov/?term=Sheehan+S&cauthor_id=42677895)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#full-view-affiliation-1 "School of Nursing and Midwifery, University of Galway, Galway, Ireland."), [Cian O Donoghue](https://pubmed.ncbi.nlm.nih.gov/?term=O+Donoghue+C&cauthor_id=42677895)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#full-view-affiliation-1 "School of Nursing and Midwifery, University of Galway, Galway, Ireland."), [Claire Glenton](https://pubmed.ncbi.nlm.nih.gov/?term=Glenton+C&cauthor_id=42677895)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#full-view-affiliation-4 "Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway."), [Andrew Booth](https://pubmed.ncbi.nlm.nih.gov/?term=Booth+A&cauthor_id=42677895)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#full-view-affiliation-5 "Sheffield Centre for Health and Related Research \(SCHARR\), University of Sheffield, Sheffield, UK."), [Gøril Jorem](https://pubmed.ncbi.nlm.nih.gov/?term=Jorem+G&cauthor_id=42677895)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#full-view-affiliation-6 "Library, Western Norway University of Applied Sciences, Bergen, Norway."), [Xin Hui S Chan](https://pubmed.ncbi.nlm.nih.gov/?term=Chan+XHS&cauthor_id=42677895)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#full-view-affiliation-7 "Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK."), [Declan Devane](https://pubmed.ncbi.nlm.nih.gov/?term=Devane+D&cauthor_id=42677895)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#full-view-affiliation-1 "School of Nursing and Midwifery, University of Galway, Galway, Ireland.")[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#full-view-affiliation-8 "Evidence Synthesis Ireland, University of Galway, Galway, Ireland.")[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#full-view-affiliation-9 "Health Research Board-Trials Methodology Research Network, University of Galway, Galway, Ireland."), [Linda M Biesty](https://pubmed.ncbi.nlm.nih.gov/?term=Biesty+LM&cauthor_id=42677895)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#full-view-affiliation-1 "School of Nursing and Midwifery, University of Galway, Galway, Ireland.")[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#full-view-affiliation-8 "Evidence Synthesis Ireland, University of Galway, Galway, Ireland.") Affiliations Expand ### Affiliations * 1 School of Nursing and Midwifery, University of Galway, Galway, Ireland. * 2 School of Nursing and Midwifery, University of Limerick, Limerick, Ireland. * 3 Independent Researcher, Galway, Ireland. * 4 Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway. * 5 Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK. * 6 Library, Western Norway University of Applied Sciences, Bergen, Norway. * 7 Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK. * 8 Evidence Synthesis Ireland, University of Galway, Galway, Ireland. * 9 Health Research Board-Trials Methodology Research Network, University of Galway, Galway, Ireland. * PMID: **42677895** * DOI: [ 10.1002/14651858.CD016384 ](https://doi.org/10.1002/14651858.cd016384) Item in Clipboard Review # Factors that impact on healthcare workers' adherence with infection prevention and control (IPC) guidelines for COVID-19: a qualitative evidence synthesis Catherine Houghton et al. Cochrane Database Syst Rev. 2026. Show details Display options Display options Format Abstract PubMed PMID Cochrane Database Syst Rev Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Cochrane+Database+Syst+Rev%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Cochrane+Database+Syst+Rev%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42677895/) . 2026 Sep 1:9:CD016384. doi: 10.1002/14651858.CD016384. ### Authors [Catherine Houghton](https://pubmed.ncbi.nlm.nih.gov/?term=Houghton+C&cauthor_id=42677895)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#short-view-affiliation-1 "School of Nursing and Midwifery, University of Galway, Galway, Ireland."), [Pauline Meskell](https://pubmed.ncbi.nlm.nih.gov/?term=Meskell+P&cauthor_id=42677895)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#short-view-affiliation-2 "School of Nursing and Midwifery, University of Limerick, Limerick, Ireland."), [Hannah Delaney](https://pubmed.ncbi.nlm.nih.gov/?term=Delaney+H&cauthor_id=42677895)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#short-view-affiliation-3 "Independent Researcher, Galway, Ireland."), [Sarah Sheehan](https://pubmed.ncbi.nlm.nih.gov/?term=Sheehan+S&cauthor_id=42677895)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#short-view-affiliation-1 "School of Nursing and Midwifery, University of Galway, Galway, Ireland."), [Cian O Donoghue](https://pubmed.ncbi.nlm.nih.gov/?term=O+Donoghue+C&cauthor_id=42677895)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#short-view-affiliation-1 "School of Nursing and Midwifery, University of Galway, Galway, Ireland."), [Claire Glenton](https://pubmed.ncbi.nlm.nih.gov/?term=Glenton+C&cauthor_id=42677895)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#short-view-affiliation-4 "Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway."), [Andrew Booth](https://pubmed.ncbi.nlm.nih.gov/?term=Booth+A&cauthor_id=42677895)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#short-view-affiliation-5 "Sheffield Centre for Health and Related Research \(SCHARR\), University of Sheffield, Sheffield, UK."), [Gøril Jorem](https://pubmed.ncbi.nlm.nih.gov/?term=Jorem+G&cauthor_id=42677895)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#short-view-affiliation-6 "Library, Western Norway University of Applied Sciences, Bergen, Norway."), [Xin Hui S Chan](https://pubmed.ncbi.nlm.nih.gov/?term=Chan+XHS&cauthor_id=42677895)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#short-view-affiliation-7 "Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK."), [Declan Devane](https://pubmed.ncbi.nlm.nih.gov/?term=Devane+D&cauthor_id=42677895)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#short-view-affiliation-1 "School of Nursing and Midwifery, University of Galway, Galway, Ireland.")[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#short-view-affiliation-8 "Evidence Synthesis Ireland, University of Galway, Galway, Ireland.")[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#short-view-affiliation-9 "Health Research Board-Trials Methodology Research Network, University of Galway, Galway, Ireland."), [Linda M Biesty](https://pubmed.ncbi.nlm.nih.gov/?term=Biesty+LM&cauthor_id=42677895)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#short-view-affiliation-1 "School of Nursing and Midwifery, University of Galway, Galway, Ireland.")[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42677895/#short-view-affiliation-8 "Evidence Synthesis Ireland, University of Galway, Galway, Ireland.") ### Affiliations * 1 School of Nursing and Midwifery, University of Galway, Galway, Ireland. * 2 School of Nursing and Midwifery, University of Limerick, Limerick, Ireland. * 3 Independent Researcher, Galway, Ireland. * 4 Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway. * 5 Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK. * 6 Library, Western Norway University of Applied Sciences, Bergen, Norway. * 7 Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK. * 8 Evidence Synthesis Ireland, University of Galway, Galway, Ireland. * 9 Health Research Board-Trials Methodology Research Network, University of Galway, Galway, Ireland. * PMID: **42677895** * DOI: [ 10.1002/14651858.CD016384 ](https://doi.org/10.1002/14651858.cd016384) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** The COVID-19 pandemic, declared in 2020, brought unprecedented challenges to our healthcare services in relation to the prevention and treatment of the disease. Additionally, preventing transmission within healthcare settings was critical. Infection Prevention and Control (IPC) guidelines are important for providing strategies on the use of personal protective equipment (PPE), the separation of patients with respiratory infections from others, and stricter cleaning routines. It is important to examine how the context of the pandemic impacts healthcare workers' (HCW) ability to adhere to IPC guidance in pandemic situations in the future. This is an update of an earlier review version, published in 2020, titled 'Barriers and facilitators to healthcare workers' adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: a rapid qualitative evidence synthesis'. We built on available evidence for infectious respiratory diseases, but also importantly, given the unprecedented global scale of COVID-19 and its unique challenges for healthcare systems, explored additional factors influencing IPC adherence specific to respiratory diseases with pandemic potential, i.e. infectious respiratory pathogens (such as novel influenza subtypes or coronaviruses) judged capable of causing a pandemic. **Objectives:** Our primary objective is to identify the factors that impact on HCWs' adherence to IPC guidelines for COVID-19. A second objective is to update an existing rapid review, published in 2020, to identify similarities, differences, and novel insights specific to COVID-19 compared with other respiratory infectious diseases. **Search methods:** We searched MEDLINE (Ovid), CINAHL (EBSCO), Scopus, Ovid PsycINFO (EBSCO), and Epistemonikos. We did not apply any language limits but only searched from 2020 to the present (last search 5 April 2024). In the interest of timeliness and relevance, we only included studies published from 2020. We chose this as it marks the year when the COVID-19 pandemic was declared. **Selection criteria:** We included qualitative and mixed methods studies that focused on the experiences and perceptions of HCWs towards factors that impact on their ability to adhere to IPC guidelines for COVID-19. We included studies of any type of healthcare worker with responsibility for patient care. We included studies that focused on IPC guidelines (local, national, or international) for COVID-19 in any healthcare setting. We excluded studies that collected data using qualitative methods (e.g. open-ended survey questions) in which the response data were analysed only with descriptive statistics. **Data collection and analysis:** We used a purposive sampling frame to identify data-rich studies that represented a range of HCWs, healthcare settings, and geographical spread. We assessed methodological strengths and limitations in the same studies using an adapted version of the Critical Skills Appraisal Programme (CASP) tool for qualitative studies. We used the 'best-fit framework approach' to analyse and synthesise the evidence from our included studies. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We examined each review finding to identify factors that may influence guideline adherence and developed implications for practice. **Main results:** We found 170 studies eligible for inclusion; of these, 26 were sampled for analysis using a purposive sampling frame for a balance of variation and richness of data. Seven of the 26 sampled studies were from high-income countries. Of the 15 middle-income countries, seven were upper middle-income countries, and eight were lower middle-income countries. There were four low-income countries included in the sample. In terms of geographical spread, ten were from Asia, eight from Africa, three were from North America, one from South America, one from Oceania, and three from Europe. Most of the studies included nurses (15 studies) or doctors (11 studies). Other types of healthcare workers included in the studies were other clinical staff (11 studies), such as midwives, allied health professionals, medical and radiologic technologists, dental professionals, neonatologists, radiographers, pharmacists, and support staff (7 studies), such as hospital cleaners, clerical staff, technicians, and hospital attendants. Healthcare settings ranged across and within studies, including hospitals, long-term care settings, and community healthcare settings. Specific units such as maternity, intensive care, emergency care, critical care, and operating rooms were identified in five of the sampled studies. We identified 27 findings that outline the factors that impact on HCWs' adherence to IPC guidelines. We have low (n = 3), moderate (n = 12), and high (n = 12) confidence in these findings. HCWs found it easier to follow IPC guidelines with managerial support, and when IPC
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