Insights into the implementation of a whole genome sequencing report form (SRF) to reduce nosocomial SARS-CoV-2 in UK hospitals within an unfolding pandemic: a qualitative process evaluation using normalisation process theory

Background
Here we report on a process evaluation conducted as part of a large multisite non-randomised trial of the effectiveness of a novel whole genome sequence report form (SRF) to reduce nosocomial SARS-CoV-2 through changing infection prevention and control (IPC) behaviours during the COVID –19 pandemic. We detail how the SRF was implemented across a heterogeneous purposive sub-sample of hospital trial sites (n=5/14).

Methods
We conducted in-depth interviews from diverse professional staff (N=39). Deductive and inductive thematic analysis initially explored participants’ accounts of implementing the SRF. The resulting themes, concerning the way the SRF was used within sites, were then coded in relation to the key tenets of normalisation process theory (NPT).

Results
Factors that enabled the implementation of the SRF included: elements of the context such as health care professional passion; the existence of whole genome sequencing (WGS) infrastructure; effective communication channels, the creation of new connections across professionals and teams; the integration of SRF-led discussions within pre-existing meetings and the ability of a site to achieve a rapid turnaround time. In contrast, we found factors that constrained the use of the SRF included elements of the context such as the impact of the Alpha-variant overwhelming hospitals. In turn, dealing with COVID-19 breached the limited capacity of infection prevention and control (IPC) to respond to the SRF and ensure its routinisation.

Conclusion
We show preliminary support for this SRF being an acceptable, useable and potentially scalable way of enhancing existing IPC activities for viral respiratory infections. However, the context of both the trial and the alpha wave of COVID-19 limit confidence in these insights.