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Table 1 Representative quotations of themes identified using the SEIPS framework

From: Infection control at an urban hospital in Manila, Philippines: a systems engineering assessment of barriers and facilitators

SEIPS factor


Subject position and department



Role of Infection Control Staff

1: Staff Nurse, Infection Control

1: “We’re doing surveillance for infection control… like gathering data for patients who have risk devices. We’re also checking the environment… to make sure that infection control policies are implemented properly.”

2: Staff Nurse, Oncology

2: “The infection control people visit us… they monitor us… they check everything on a daily basis.”

3: Head Nurse, Internal Medicine

3: “[Healthcare workers are] amenable with the infection control rules… because they’re for the patients.”

Communication to improve hand hygiene

4: Resident, Emergency Medicine

4: “It’s the nurses who do the hand hygiene more than the doctors”

5: Resident, Pediatrics

5: “When [the consultants] go in and we follow, we forget to wash too.”

6: Resident, Pediatrics

6: “I think it needs to be a team effort, like a constant reminder… the head nurses talk to you: ‘Doctor, you need to wash your hands’. I think it’s very helpful, you need to do that… But there are some doctors here who don’t really become too friendly with the nurses. They really set the barrier between them.”


Infection Control Policies

7: Staff Nurse, Infection Control

7: “HICEC is divided into committees… the executive committee makes the policies… we also have the nurses and staff from all different departments. Whenever we make a policy we make sure that all of [the representatives] approve.”

8: Resident, first year

8: “It’s part of the infection control committee responsibilities to do regular lectures on hand hygiene.”

9: Head Nurse, Internal Medicine

9: “We can coordinate with HICEC if we have a misunderstanding with the doctors… because we have a set of admitting guidelines for what is allowed in our ward, so sometimes we just have to tell the doctors that. You can also ask HICEC [to do that].”

Laboratory Facilities

10: Attending Physician, Gastroenterology

10: “[The lab] immediately informs us… so that we can treat right away.”

11: Resident, Pediatrics

11: “We try our best to prevent [resistant infections] here… but other doctors in other places, and the lay people, don’t have any idea what antibiotic resistance means.”


High Patient Volumes

12: Resident, Emergency Medicine

12: “There are times we have to see one patient, just remove the gloves, and move onto the next patient, so there’s no [time for] alcohol in between.”

Training of New Nursing Staff

13: Resident, first year

13: “[Nurses] get their training and then leave after about two to three years.”

14: Head Nurse, Emergency Medicine

14: “We teach them all the standard precautions and diseases that any nurse could encounter.”

Physical Environment

Layout and Access to Hand Hygiene Supplies

15: Head Nurse, Internal Medicine

15: “The baby-friendly [obstetrics/gynecology ward] is much better with the hand hygiene because they have their own station there.”

16: Resident, Emergency Medicine

16: “The alcohol rub is more in the station, where the medications are prepared [by the nurses]… so it’s not really that accessible to us.”

17: Resident, Pediatrics

17: “I see some patients get the alcohol and place it in their room… one of the patients actually got the whole alcohol container.”

18: Resident, Emergency Medicine

18: “There are some doctors who bring their own, or at least have it hooked on to them. And then that’s the time when they can do hand rubbing.”

Technology and Tools

CCTV Data Reporting

19: Head Nurse, Emergency Medicine

19: “[Each person] is not being reported, the whole emergency department is being reported. It’s not working I think, because when we look at the results they’re not specific.”

20: Resident, Pediatrics

20: “They should call out those who don’t really hand wash, and talk to them directly. Because [the providers] don’t know they’re being monitored, so they think they can get away with it.”

RFID Badges

21: Staff Nurse, Infection Control

21: “Every time the healthcare worker will enter the patient’s room, the ID will alarm if you don’t do hand hygiene.”

Medical Trolleys

22: Head Nurse, Oncology

22: “The problem here is sometimes the nurses have too many things in their arms… [they need somewhere to] place things first while they’re rubbing their hands.”

  1. HICEC hospital infection control executive committee, CCTV closed circuit television, RFID radio frequency identification