Strategies and Challenges in Hospital Infection Control: A Qualitative Study in Iran

Subject Areas : Health Management

Zohreh Alinasab Alinasab ¹ , Mohammad-Ali jahani ^{2 *} , Ghahraman Mahmoudi ³ , jamshid yazdanicharati ⁴

1 - Ph.D Candidate of health services administration, Sari.C., Islamic Azad University, Sari, Iran
2 - Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
3 - Department of health services administration, Sari.C.,Islamic Azad University, Sari, Iran
4 - Department of Health Care Managemet, Islamic Azad University, Sari Branch, Sari, Iran

Received: 2025-08-22 Accepted : 2025-09-06 Published : 2025-09-24

Keywords:

Abstract :

Background and Aim: hospital infections (HAIs) remain a major global health concern, especially in low and middle income countries such as Iran. Despite the presence of infection prevention guidelines, there are significant gaps in their implementation. Understanding the challenges and identifying practical strategies from the perspective of infection control professionals is essential to improve hospital safety and quality of care. Materials and Methods: this qualitative study was carried out in 2025. Semi-structured interviews with infection control specialists, hospital managers and frontline health care workers were conducted in various hospitals in Iran. The data were analyzed using thematic analysis with an inductive approach to identify emerging patterns and themes. Results: three inclusive themes were identified: system-level barriers, including limited financial and human resources, inadequate infrastructure and inadequate policies; challenges related to the service provider, such as lack of motivation, inadequate training and resistance to adherence to protocols; and contextual and environmental factors, including busy sectors, cultural attitudes and inadequate management support. In parallel, participants emphasized effective strategies such as continuing education, leadership participation, strengthening regulatory systems, and fostering a safety-oriented culture. Conclusion: infection control in Iranian hospitals faces a combination of systemic, organizational and behavioral barriers. Addressing these challenges requires a multifaceted approach that includes managerial commitment, employee empowerment, and resource allocation. Insights from the study could help policy makers and hospital administrators design more effective infection control programs tailored to the local health care field

References:

1. Yates S, Regan PJJoNt, Practice. Effective methods of promoting hand hygiene to reduce hospital acquired infections: A literature review. 2025;1(1):53-60.
2. Ye F, Ma LJIJoPH. Assessing global nursing interventions in reducing hospital-acquired infections: A meta-analysis. 2025;54(5):915-27.
3. El Arab RA, Almoosa Z, Alkhunaizi M, Abuadas FH, Somerville JJFiPH. Artificial intelligence in hospital infection prevention: an integrative review. 2025;13:1547450.
4. Su X, Niu J, Wang F, Sun LJAJoIC. Comparative analysis of hospital-acquired and community-acquired infections at a tertiary hospital in China before and during COVID-19: A 7-year longitudinal study (2017-2023). 2025;53(3):330-9.
5. Hino C, Ozaki M, Kitahara T, Kouda K, Shikichi K, Nakamura I, et al. Peripheral parenteral nutrition solutions and bed bath towels as risk factors for nosocomial peripheral venous catheter-related bloodstream infection by Bacillus cereus. 2023;20(5):566.
6. Mongardon N, Vincent J-LJICM. Outcome of hospital-acquired bloodstream infection: interplay between bacteria, host, and healthcare system organization. 2024;50(6):925-7.
7. Reid A, Karsten J, Barker K, Zervas M, Gissen A, Palazzo MJPT. A Novel Role for Physical Therapists in Infection Prevention and Control in Response to the COVID-19 Pandemic: An Administrative Case Report. 2024;104(1): 144.

8. Dalton KR, Rock C, Carroll KC, Davis MFJAR, Control I. One Health in hospitals: how understanding the dynamics of people, animals, and the hospital built-environment can be used to better inform interventions for antimicrobial-resistant gram-positive infections. 2020;9(1):78.
9. Oni O, Orok E, Lawal Z, Ojo T, Oluwadare T, Bamitale T, et al. Knowledge and perception of nosocomial infections among patients in a Nigerian hospital. 2023;13(1):20204.
10. Kalın G, Alp E, Chouaikhi A, Roger CJM. Antimicrobial multidrug resistance: clinical implications for infection management in critically ill patients. 2023;11(10):2575.
11. Dubberke ER, Reske KA, Seiler S, Hink T, Kwon JH, Burnham C-ADJAa, et al. Risk factors for acquisition and loss of Clostridium difficile colonization in hospitalized patients. 2015;59(8):4533-4.
12. Aiesh BM, Qashou R, Shemmessian G, Swaileh MW, Abutaha SA, Sabateen A, et al. Nosocomial infections in the surgical intensive care unit: an observational retrospective study from a large tertiary hospital in Palestine. 2023;23(1):686.
13. Bagheri S, Asl NAJQJoMSiHS. Investigating Causes and Factors Affecting the Increase in Rehospitalization Costs in Imam Khomeini Hospital of Ahvaz (2023-2024). 2024.
14. Menzel J, Kuehn A, Beck D, Schock B, Chaberny IFJU. Hand hygiene in the operating room (OR)-(not) an issue? 2022;126(7):563-8.
15. Odoom A, Donkor ESJHSR. Prevalence of Healthcare‐Acquired Infections Among Adults in Intensive Care Units: A Systematic Review and Meta‐Analysis. 2025;8(7):e70939.
16. Liu Y, Jiang Y, Shi Q-F, He C-Y, Shan L-Y, Zheng Y-H, et al. A nosocomial outbreak of Mycobacterium Abscessus infection in a private hospital of Shanghai, China, 2021.
17. Boncea EE, Expert P, Honeyford K, Kinderlerer A, Mitchell C, Cooke GS, et al. Association between intrahospital transfer and hospital-acquired infection in the elderly: a retrospective case–control study in a UK hospital network. 2021;30(6):457-66.
18. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan EJBAIJoO, et al. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. 2012;119(11):1324-33.
19. Behar L, Chadwick D, Dunne A, Jones CI, Proctor C, Rajkumar C, et al. Toxigenic Clostridium difficile colonization among hospitalised adults; risk factors and impact on survival. 2017;75(1):20-5.
20. Álvarez-Villalobos NA, Ruiz-Hernandez FG, Méndez-Arellano AC, Azamar-Márquez JM, Camacho-Ortiz AJE, Infection. Epidemiologic profile of community-acquired Clostridioides difficile infections: a systematic review and meta-analysis. 2025;153:e46.
21. Whitacre TJICT. SHEA/IDSA/APIC Answer to Diekema, et al, Study on Prevention of MRSA Infection and Transmission. 2024:NA-NA.
22. Najjar-Debbiny R, Chazan B, Lobl R, Greene MT, Ratz D, Saint S, et al. Healthcare-associated infection prevention and control practices in Israel: results of a national survey. 2022;22(1):739.
23. Nomoto H, Saito H, Ishikane M, Gu Y, Ohmagari N, Pittet D, et al. First nationwide survey of infection prevention and control among healthcare facilities in Japan: impact of the national regulatory system. 2022;11(1):135.
24. Harun MGD, Anwar MMU, Sumon SA, Hassan MZ, Haque T, Mah-E-Muneer S, et al. Infection prevention and control in tertiary care hospitals of Bangladesh: results from WHO infection prevention and control assessment framework (IPCAF). 2022;11(1):125.
25. Mohamad N, Pahrol MA, Shaharudin R, Md Yazin NKR, Osman Y, Toha HR, et al. Compliance to infection prevention and control practices among healthcare workers during COVID-19 pandemic in Malaysia. 2022;10:878396.
26. Taye ZW, Abebil YA, Akalu TY, Tessema GM, Taye EBJFiPH. Incidence and determinants of nosocomial infection among hospital admitted adult chronic disease patients in University of Gondar Comprehensive Specialized Hospital, North–West Ethiopia, 2016–2020. 2023;11:1087407.
27. Gulia S, Kaur K, Devi S, Singh S, Rohilla KKJJoe, promotion h. Nurses in NICUs’ views on nosocomial infection prevention. 2022;11(1):158.
28. Isigi SS, Parsa AD, Alasqah I, Mahmud I, Kabir RJJph, surveillance. Predisposing factors of nosocomial infections in hospitalized patients in the United Kingdom: systematic review. 2023;9:e43743.
29. Tozzo P, Delicati A, Caenazzo LJFiPH. Human microbiome and microbiota identification for preventing and controlling healthcare-associated infections: A systematic review. 2022;10:989496.
30. Issa M, Dunne SS, Dunne CPJIJoMS. Hand hygiene practices for prevention of health care-associated infections associated with admitted infectious patients in the emergency department: a systematic review. 2023;192(2):871-99.
31. Shin J, Nakano K, Asai Y, Yatomi C, Yaguchi T, Fujimoto M, et al. Experience in Prevention of Nosocomial and Horizontal Transmission of SARS-CoV-2 in the NICU. 2023;42(11):e423-e4.
32. Wen R, Li X, Liu T, Lin GJBid. Effect of a real-time automatic nosocomial infection surveillance system on hospital-acquired infection prevention and control. 2022;22(1):857.
33. Mungoma D. Evaluation of infection control at Butiru Chrisco Hospital in Manafwa District, Eastern Uganda. 2023.
34. Darko DO, Opoku DA, Ayisi-Boateng NK, Mohammed A, Ashilevi J, Amponsah OK, Mate-Kole A, Egblewogbe D, Darko BA, Agyemang E, Okyere P. Health and safety of health workers in the Suame Municipality of Ghana–Lessons learnt from the COVID-19 outbreak in infection prevention and control for future pandemics. SAGE Open Medicine. 2024 Jan;12:20503121231225924.