Table 2 Overview of the guideline-specific barriers obtained during the in-depth interviews

1. Justification of addressing measles

It was unclear why measles should be addressed in the hospital setting and why it poses a risk (n = 1)

2. Distinguishing immune from non-immune HCWs

It was not clear where to draw a line concerning immune or non-immune HCWs; the cut-off point at 1975 lead to discussion. Two participants mentioned that among the HCWs not protected according to the RIVM guideline, 65/72 HCWs who had their antibody levels tested actually were immune to measles (n = 4)

3. Visitors of high-risk departments

Four participants indicated to have had some discussion about how to deal with visitors of high-risk departments. The guideline does not discuss this aspect of infection prevention. (n = 4)

4. External personnel

The guideline was not clear on how to deal with external personnel, such as midwives. Since external personnel are not included in the hospital database in many cases, there is a risk of accidentally excluding them from the new policy (n = 2)

5. Risk estimation departments

The guideline should be more specific about making estimations of the risks different departments face, thereby enabling hospital professionals to better target their HCW vaccination policies (n = 2)

6. Immunocompromised HCW

In the guideline, immunocompromised HCWs are indicated to be at increased risk of severe course of disease after measles infection. However, it was unclear when one actually is immunocompromised (n = 2)

7. Isolation type

It was not clear why the RIVM guideline proposed strict isolation for measles cases as opposed to aerogenic, which is the standard form of isolation for measles. When it is not clear to the professionals, they indicate that they cannot convince their HCWs to follow protocol. Furthermore, since strict isolation is more expensive than aerogenic it was indicated that it should really be clarified (n = 4)