Une passionnante enquête scientifique et humaine Épidémiologiste, infectiologue, spécialiste en santé globale et ambassadeur de l'hygiène des mains pour l'OMS, Didier Pittet a participé à la gestion de la crise Covid-19 en Suisse, notamment aux stratégies de confinement et de déconfinement. Dans ce journal de bord, il revient sur six mois mémorables dans l'histoire de l'humanité. Le « docteur Mains propres » nous raconte comment il a combattu aussi bien le coronavirus que la désinformation au jour le jour et à la lumière du peu d'éléments dont les spécialistes disposaient, se lançant dans une véritable enquête scientifique à la recherche du moindre indice susceptible de sauver des vies. Il revient sur les mesures prises dans son hôpital de Genève comme ailleurs dans le monde, incluant celles qui ont été imposées en France : confinement strict, port du masque obligatoire... En comparant les gestions de crise de plusieurs pays, le professeur Didier Pittet dresse un bilan inédit. Au programme, (in)décisions et contradictions politiques.

Abstract: Objective The Prevention of Hospital Infections by Intervention and Training (PROHIBIT) project included a cluster-randomised, stepped wedge, controlled study to evaluate multiple strategies to prevent catheter-related bloodstream infection. We report an in-depth investigation of the main barriers, facilitators and contextual factors relevant to successfully implementing these strategies in European acute care hospitals. Methods Qualitative comparative case study in 6 of the 14 European PROHIBIT hospitals. Data were collected through interviews with key stakeholders and ethnographic observations conducted during 2-day site visits, before and 1 year into the PROHIBIT intervention. Qualitative measures of implementation success included intervention fidelity, adaptation to local context and satisfaction with the intervention programme. Results Three meta-themes emerged related to implementation success: 'implementation agendas', 'resources' and 'boundary-spanning'. Hospitals established unique implementation agendas that, while not always aligned with the project goals, shaped subsequent actions. Successful implementation required having sufficient human and material resources and dedicated change agents who helped make the intervention an institutional priority. The salary provided for a dedicated study nurse was a key facilitator. Personal commitment of influential individuals and boundary spanners helped overcome resource restrictions and intrainstitutional segregation. Conclusion This qualitative study revealed patterns across cases that were associated with successful implementation. Consideration of the intervention-context relation was indispensable to understanding the observed outcomes