Discussion

This study evaluated the perceptions of IPC specialists and HCWs in clinics regarding the use of effective communication practices in IPC programs implemented in healthcare institutions in Türkiye. The main finding was that there are significant differences between IPC teams’ perceptions of their own practices and HCWs’ experiences in the field. According to survey reports, IPC experts reported that training and effective communication methods were widely used, but HCWs indicated that the practices were used at lower rates. This situation shows that training and communication are not effectively reflected in the field. This difference in perception is most prominent in the communication of hand hygiene indications and bundle training. There is a lack of visibility or implementation in the areas of education, reminders, feedback, and cultural change emphasized in the WHO’s multimodal strategy. ^{4,Reference Moghnieh, Al-Maani and Berro14} The literature highlights that the effectiveness of IPC training is determined by its content, presentation method, continuity, and feedback mechanisms, and it is emphasized that the participation and motivation of HCWs are closely related to the communication style of IPC. ^{Reference Sussenbach, Graveland, Voss and Versteeg15–Reference Alhumaid, Al Mutair and Al Alawi17}

Differences in perceptions of organizational motivation are also notable. HCWs believe that their institutions are more motivating in terms of IPC, and a higher rate of uncertainty has been observed among IPC specialists. This could be a result of IPC teams having increased responsibilities, workloads, and expectations leading to more critical perspectives. Factors defined by the WHO regarding workload, staff numbers, and bed occupancy rates are known to be key variables affecting IPC practices. ⁷ In this study, the very low percentage of institutions that were able to achieve the recommended number of IPC nurses indicates that IPC teams face limitations in terms of organizational capacity and human resources for effective communication and training activities.

Differences observed between IPCPs and HCWs have significant implications for clinical practice. The fact that there are significant differences between IPC specialists’ self-reported use of effective communication techniques and HCWs’ perceptions, particularly in hand hygiene training, suggests that IPC programs may be overestimating the effectiveness of communication strategies at the point of care. From a practical perspective, IPC programs should complement traditional training methods with structured mechanisms that actively assess how messages are perceived by frontline staff. Incorporating HCWs’ feedback, using interactive communication approaches such as scenario-based training or feedback methods, and evaluating understanding as well as compliance may help bridge this perception gap. Additionally, IPC committees should consider routinely integrating communication effectiveness monitoring and auditing processes, rather than focusing solely on compliance outcomes. Treating communication as a measurable component of IPC implementation can increase participation, improve compliance with infection-control measures, and support more sustainable behavior change in clinical settings.

The high percentage of HCWs who reported being “undecided” about the use of effective communication during bundle training may reflect several key issues, such as limited exposure to bundle-based training, a lack of clear understanding of what bundle training entails, or insufficient interactive communication during such activities. Regardless of the underlying cause, this finding suggests that bundle training may not be sufficiently visible or clearly distinguishable from other frontline training activities. Therefore, IPC programs should ensure that bundle training is clearly labeled, delivered consistently, and supported by clear communication regarding its objectives and relevance to daily clinical practice.

Perceptions regarding the COVID-19 pandemic also differed significantly between groups. While a high rate of IPC specialists believed that the pandemic has increased IPC compliance, the rate was significantly lower among HCWs. However, there was strong consensus between both groups that compliance decreased in the post-pandemic period. The literature also indicates that awareness and motivation regarding IPC practices increased at the onset of the pandemic, but this interest did not continue in the post-pandemic period. The lack of structural and behavioral strategies to ensure the sustainability of IPC compliance may be a reason for this decline observed in the post-pandemic period. ^{Reference Storr, Twyman and Zingg18–Reference Madran, Demir and Yalcin20}

Both groups found that posters and reminder materials were mostly adequate. This indicates that there is no lack of visibility of these physical reminders. However, the perceived gap in education and communication suggests that a fundamental problem may stem not from a lack of knowledge, but from the way that knowledge is communicated. The need for communication supported by cultural change, teamwork, and personalized methods as emphasized by the WHO is consistent with these findings.

This study has some limitations. First, its cross-sectional design and use of a voluntary, online survey may create selection bias and limit causal inferences. Second, the survey was a theory-based tool developed for the specific purposes of this study and was not a pre-validated scale, which may affect the generalizability of the findings. Finally, the results are based on self-reported perceptions and may be subject to response and social desirability bias. Another limitation is that the definition of “effective communication” in some items contains multiple components (e.g., empathy, openness, respect, verbal and nonverbal communication) that may be interpreted differently by participants and could affect construct validity. Furthermore, some items that are conceptually clear in the original Turkish version may appear complex or ambiguous in the English translation. These limitations should be considered when interpreting the findings. The data have a nested structure, with HCWs and IPCPs clustered within the same hospitals. Although group comparisons were made using χ² tests assuming the independence of observations, responses from the same institution may share organizational characteristics, which could violate this assumption and affect variance estimates. The total number of HCWs and IPC professionals who received the survey invitation was not recorded; therefore, a formal response rate could not be calculated. This may introduce selection bias, as participants with greater interest or engagement in infection prevention and control activities may have been more likely to respond.

This study is important in terms of revealing the current status of IPC programs in Türkiye in terms of their education and communication components. The findings indicate that there is a need for more structured and interaction-focused strategies supported by feedback mechanisms to reduce differences in communication, perception, and implementation between IPC specialists and HCWs. Furthermore, strengthening IPC teams, increasing staffing levels, and integrating training more firmly into corporate policy appear to be critical for sustainable implementation.