The NOSO-COVID study: a large-scale survey assessing stakeholder perspectives on patient and family engagement in infection prevention, informed by Q-methodology findings.

BACKGROUND: Healthcare-associated infections are common in hospitalized patients, exacerbated by COVID-19. Engaging patients and families in infection prevention and control may enhance adherence, but optimal strategies remain unclear. OBJECTIVE: This study developed a large-scale survey, informed by previous Q-methodology research, to assess stakeholder perspectives on patient and family engagement in infection prevention, identify consensus and disagreement, and explore socio-demographic and work-related influences. METHODS: A cross-sectional survey was conducted in surgical and family medicine units at two Canadian university hospitals in 2023. The NOSO-COVID survey included 17 Likert-scale items derived from identified infection prevention engagement viewpoints. Data were analyzed using univariate, bivariate, and multivariable logistic regression. RESULTS: Among 212 participants (patients, family members, and staff), responses varied on infection prevention engagement strategies. Common suggestions included bedside disinfectants and monitoring staff compliance. Older participants, particularly in family medicine units, were more supportive of educational and behavioral measures. Comfort with advocating for infection prevention differed across units, with surgical unit participants expressing less confidence. Institutional culture influenced perceptions, with staff at one hospital reporting greater ease in engaging patients and families in infection prevention. Four consensus items were identified, emphasizing staff reminders for hand hygiene, availability of disinfectants, and providing accessible infection prevention information. CONCLUSIONS: Our findings suggest that tailoring IPC engagement strategies to hospital unit cultures and stakeholder needs is essential. Strategies to enhance communication, address power dynamics, and promote shared responsibilities to improve IPC should be identified and their effectiveness evaluated.