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Table S2. Fidelity assessment. (DOCX 47 kb)

ST1. Sensitivity analysis results: frequencies of MRSA, MSSA, and Total SA colonization at the endpoint of the trial at each body site, stratified by re-assigned GI or extra-GI colonization group based on PCR and culture screening results at baseline, and probiotic or placebo treatment group. (DOCX 110Â kb)

ST1. Sensitivity analysis results: frequencies of MRSA, MSSA, and Total SA colonization at the endpoint of the trial at each body site, stratified by re-assigned GI or extra-GI colonization group based on PCR and culture screening results at baseline, and probiotic or placebo treatment group. (DOCX 110Â kb)

Illustrative quotations from the interviews arranged within the five bathing steps and the order set intervention. (DOCX 49 kb)

Table S3. Meta-regression analysis showed that the stratified estimates did not significantly differ between subgroups. (DOCX 14 kb)

Figure S1. Effect of chlorhexidine gluconate bathing comparing Randomized vs. non-randomized studies. Figure S2. Effect of chlorhexidine gluconate bathing comparing bundled vs. non-bundled interventions. Figure S3. Effect of chlorhexidine gluconate bathing comparing 2% chlorhexidine impregnated wipes vs. 4% CHG solution. Figure S4. Effect of chlorhexidine gluconate bathing comparing intensive care unit (ICU) vs. non-ICU settings. (PDF 164 kb)

Table S1. Characteristics of included studies. (DOCX 57 kb)

Table S2. Fidelity assessment. (DOCX 47 kb)

Figure S1. Effect of chlorhexidine gluconate bathing comparing Randomized vs. non-randomized studies. Figure S2. Effect of chlorhexidine gluconate bathing comparing bundled vs. non-bundled interventions. Figure S3. Effect of chlorhexidine gluconate bathing comparing 2% chlorhexidine impregnated wipes vs. 4% CHG solution. Figure S4. Effect of chlorhexidine gluconate bathing comparing intensive care unit (ICU) vs. non-ICU settings. (PDF 164 kb)

Table S1. Characteristics of included studies. (DOCX 57 kb)

Background Hospital acquired infections occur at higher rates in low- and middle-income countries, like India, than in high-income countries. Effective implementation of infection control practices is crucial to reducing the transmission of hospital acquired infections at hospitals worldwide. Yet, no comprehensive assessments of the barriers to sustained, successful implementation of hospital interventions have been performed in Indian healthcare settings to date. The Systems Engineering Initiative for Patient Safety (SEIPS) model examines problems through the lens of interactions between people and systems. It is a natural fit for investigating the behavioral and systematic components of infection control practices. Methods We conducted a qualitative study to assess the facilitators and barriers to infection control practices at a 1250 bed tertiary care hospital in Haryana, northern India. Twenty semi-structured interviews of nurses and physicians, selected by convenience sampling, were conducted in English using an interview guide based on the SEIPS model. All interview data was subsequently transcribed and coded for themes. Results Person, task, and organizational level factors were the primary barriers and facilitators to infection control at this hospital. Major barriers included a high rate of nursing staff turnover, time spent training new staff, limitations in language competency, and heavy clinical workloads. A well developed infection control team and an institutional climate that prioritizes infection control were major facilitators. Conclusions Institutional support is critical to the effective implementation of infection control practices. Prioritizing resources to recruit and retain trained, experienced nursing staff is also essential. Electronic supplementary material The online version of this article (doi:10.1186/s13756-017-0189-9) contains supplementary material, which is available to authorized users.

Table S3. Meta-regression analysis showed that the stratified estimates did not significantly differ between subgroups. (DOCX 14 kb)