Omissions in nurses’ infection prevention and control practices and their contributing factors: a CFIR-based sequential explanatory mixed-methods study

BACKGROUND: Omissions in infection prevention and control (IPC) practices may increase the risk of healthcare-associated infections, yet their underlying determinants remain insufficiently understood. This study aimed to examine the extent of IPC omissions among nurses and identify contributing factors using the Consolidated Framework for Implementation Research (CFIR). METHODS: An explanatory sequential mixed-methods study was conducted at a tertiary hospital in China from October to December 2023. Quantitatively, 397 nurses completed a survey assessing IPC omissions using the Missed Nursing Care in Infection Prevention and Control (MNCIPC) scale. Qualitatively, semi-structured interviews were performed to further explored the causes and mechanisms of IPC omissions, and the data were analyzed using the CFIR framework. RESULTS: IPC omissions were common among nurses and varied substantially across practices, with omission rates ranging from 10.8% to 72.8%. A bipolar pattern in hand hygiene emerged: most nurses reported performing hand hygiene after gown removal or body fluid exposure, whereas omissions were frequently reported before patient contact and after touching patient surroundings. Agreement on the proposed contributing factors was low to moderate. The qualitative findings corroborated most of the quantitative factors and further expanded determinants across CFIR domains, including unequal nurse-physician accountability, risk perception bias, evidence-practice gaps, and limited authority of infection control personnel. CONCLUSION: IPC omissions among nurses were common and were shaped by interacting individual, contextual, and implementation-related factors, indicating a system-sensitive subtype of missed care. Improving IPC adherence requires shifting from individual blame to systems-based strategies that strengthen leadership, accountability, adaptive implementation, and context-sensitive training.