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Methods A case study was conducted using a mixed deductive and inductive approach based on the grounded theory (Glaser & Strauss, 1967). During the active implementation phase we interviewed head nurses of the 19 study wards quarterly regarding their attitude towards PP, their promotional engagement, their knowledge of the ward’s implementation progress, and their account of facilitators and barriers. Results The head nurses’ intrinsic leadership characteristics and their ‘perception of PP’ emerged as key elements for successful implementation. Plotted as a matrix, they formed winning or losing combinations in regards to implementation success. ‘Promotional activity’ types ‘refusing’ and ‘pretending’ were unsuccessful, while ‘proactive managing’ and ‘innovation’ were winning combinations. Additionally, we saw ‘perception of PP’ evolve over the course of the study as a function of prior implementation experience and the hierarchical and team support they received. Patients very rarely reminded healthcare workers (HCW) to do hand hygiene, but awareness of the importance of hand hygiene rose amongst both patients and HCW.

antimicrobial resistance and infection control

P168: Leadership styles of ward head nurses and implementation success – a qualitative inquiry in the framework of a mixed-method study on hand hygiene promotion through patient involvement