Abstract
Balancing Safety and Therapy in Psychiatric Wards: A CFIR-Based Framework for Implementing Infection Prevention
Hafedh Ghazouani1, Elmukhtar Habas2, Ahmed Assar3, Ala Habas4, Mohammed Hassan5, Majid Alabdulla6, Jameela Alajmi7
Keywords: Infection prevention and control, psychiatric hospitals, therapeutic environment, patient safety, implementation science, MentalHealth Services
DOI: 10.63475/yjm.v5i1.0261
DOI URL: https://doi.org/10.63475/yjm.v5i1.0261
Publish Date: 25-03-2026
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Author Affiliation:
1 Quality and Patient Reviewer, Corporate Quality Improvement and Patient Safety Department, Hamad Medical Corporation, Doha, Qatar
2 Professor of Internal Medicine, Qatar University, Hamad Medical Corporation, Hamad General Hospital, Doha, Qatar
3 Consultant, Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
4 Specialist, Tripoli Central Hospital, University of Tripoli, Tripoli, Libya
5 Research Manager, Corporate Quality Improvement and Patient Safety Department, Hamad Medical Corporation, Doha, Qatar
6 Senior Consultant, Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
7 Senior Consultant, Corporate Quality Improvement and Patient Safety Department, Hamad Medical Corporation, Doha, Qatar
Abstract
Background: Implementation of infection prevention and control (IPC) in psychiatric inpatient settings poses particular challenges compared with general medical settings. The therapeutic context highlights the importance of openness, sociability, and interpersonal connection, which can conflict with conventional IPC practices like physical distancing and mask-wearing. This tension may create persistent barriers to successful IPC delivery, thereby affecting patient safety and organizational risk-control goals. In this systematic review, we aimed to (1) identify and classify barriers to IPC implementation in adult psychiatric inpatient settings; (2) synthesize the evidence on practical adaptations and interventions of IPC; and (3) develop an integrated framework for the implementation of IPC practices based on an integrated approach to strike a balance between infection prevention and recovery-focused mental health care.
Methods: Consistent with the PRISMA 2020 guidelines, we searched PubMed/MEDLINE, Scopus, PsycINFO, and CINAHL for studies published from January 2000 to December 2024. Two reviewers independently screened 1345 records, removed 312 duplicates, and assessed 1033 unique titles and abstracts. After a full-text examination of 189 potentially eligible articles, 143 met eligibility criteria and were included. We conducted a narrative synthesis using the Popay framework and analyzed the data thematically at the patient, staff, and system levels.
Results: The review identified three main categories of barriers to IPC implementation. At the patient level, cognitive impairments affecting an estimated 45% to 70% of psychiatric inpatients, active psychiatric symptoms, and trauma history are significant barriers to adherence to IPC practices. Morally distressing tensions between IPC requirements and patient-centered care principles, as well as a lack of specialist training to inform IPC policy, were identified as the primary issues at the staff level. System-level barriers were the outdated nature of the infrastructure, such as inadequate ventilation and single-patient rooms; chronic resource limitations; and a lack of IPC specific to the psychiatric environment, in addition to evidence-based adaptations for these factors. Adaptations like visual cueing for cognitive impairment and trauma-informed Personal protective equipment (PPE) protocols showed promise, including implementing trauma-informed care-oriented protective gear, and redefining IPC as a collaborative rather than punitive endeavor.
Conclusions: To implement IPC effectively in psychiatric settings, there must be substantial change from standardized protocols to therapeutically driven, person-centered approaches. This requires facility improvements, staff training on ethical concerns, and the development of psychiatricspecific IPC strategies. The proposed Consolidated Framework for Implementation Research (CFIR)-informed, multi-tiered framework provides actionable guidance for achieving this balance, underscoring the strong need for the development and dissemination of formal, psychiatryspecific IPC guidelines.