Beyond hand hygiene: A qualitative study of the everyday work of preventing cross-contamination on Hospital wards

Hor, SY; Hooker, C; Iedema, R; Wyer, M; Gilbert, GL; Jorm, C; O'Sullivan, MVN

Beyond hand hygiene: A qualitative study of the everyday work of preventing cross-contamination on Hospital wards

Hor, SY

Hooker, C Iedema, R Wyer, M

Gilbert, GL Jorm, C O'Sullivan, MVN

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Publication Type:: Journal Article
Citation:: BMJ Quality and Safety, 2017, 26 (7), pp. 552 - 558
Issue Date:: 2017-01-01

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Field	Value	Language
dc.contributor.author	Hor, SY https://orcid.org/0000-0002-6498-9722	en_US
dc.contributor.author	Hooker, C	en_US
dc.contributor.author	Iedema, R	en_US
dc.contributor.author	Wyer, M https://orcid.org/0000-0002-1215-8089	en_US
dc.contributor.author	Gilbert, GL	en_US
dc.contributor.author	Jorm, C	en_US
dc.contributor.author	O'Sullivan, MVN	en_US
dc.date.available	2016-11-05	en_US
dc.date.issued	2017-01-01	en_US
dc.identifier.citation	BMJ Quality and Safety, 2017, 26 (7), pp. 552 - 558	en_US
dc.identifier.issn	2044-5415	en_US
dc.identifier.uri	http://hdl.handle.net/10453/123639
dc.description.abstract	© 2017 BMJ Publishing Group. All rights reserved. Background: Hospital-acquired infections are the most common adverse event for inpatients worldwide. Efforts to prevent microbial crosscontamination currently focus on hand hygiene and use of personal protective equipment (PPE), with variable success. Better understanding is needed of infection prevention and control (IPC) in routine clinical practice. Methods: We report on an interventionist videoreflexive ethnography study that explored how healthcare workers performed IPC in three wards in two hospitals in New South Wales, Australia: an intensive care unit and two general surgical wards. We conducted 46 semistructured interviews, 24 weeks of fieldwork (observation and videoing) and 22 reflexive sessions with a total of 177 participants (medical, nursing, allied health, clerical and cleaning staff, and medical and nursing students). We performed a postintervention analysis, using a modified grounded theory approach, to account for the range of IPC practices identified by participants. Results: We found that healthcare workers' routine IPC work goes beyond hand hygiene and PPE. It also involves, for instance, the distribution of team members during rounds, the choreography of performing aseptic procedures and moving 'from clean to dirty' when examining patients. We account for these practices as the logistical work of moving bodies and objects across boundaries, especially from contaminated to clean/vulnerable spaces, while restricting the movement of micro-organisms through cleaning, applying barriers and buffers, and trajectory planning. Conclusions: Attention to the logistics of moving people and objects around healthcare spaces, especially into vulnerable areas, allows for a more comprehensive approach to IPC through better contextualisation of hand hygiene and PPE protocols, better identification of transmission risks, and the design and promotion of a wider range of preventive strategies and solutions.	en_US
dc.relation.ispartof	BMJ Quality and Safety	en_US
dc.relation.isbasedon	10.1136/bmjqs-2016-005878	en_US
dc.subject.classification	Health Policy & Services	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Cross Infection	en_US
dc.subject.mesh	Equipment Contamination	en_US
dc.subject.mesh	Infection Control	en_US
dc.subject.mesh	Qualitative Research	en_US
dc.subject.mesh	Anthropology, Cultural	en_US
dc.subject.mesh	Audiovisual Aids	en_US
dc.subject.mesh	Patients' Rooms	en_US
dc.subject.mesh	Surgery Department, Hospital	en_US
dc.subject.mesh	Intensive Care Units	en_US
dc.subject.mesh	Hospitals	en_US
dc.subject.mesh	New South Wales	en_US
dc.subject.mesh	Interviews as Topic	en_US
dc.subject.mesh	Moving and Lifting Patients	en_US
dc.subject.mesh	Hand Hygiene	en_US
dc.title	Beyond hand hygiene: A qualitative study of the everyday work of preventing cross-contamination on Hospital wards	en_US
dc.type	Journal Article
utslib.citation.volume	7	en_US
utslib.citation.volume	26	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1302 Curriculum and Pedagogy	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	open_access
pubs.issue	7	en_US
pubs.publication-status	Published	en_US
pubs.volume	26	en_US

Abstract:

© 2017 BMJ Publishing Group. All rights reserved. Background: Hospital-acquired infections are the most common adverse event for inpatients worldwide. Efforts to prevent microbial crosscontamination currently focus on hand hygiene and use of personal protective equipment (PPE), with variable success. Better understanding is needed of infection prevention and control (IPC) in routine clinical practice. Methods: We report on an interventionist videoreflexive ethnography study that explored how healthcare workers performed IPC in three wards in two hospitals in New South Wales, Australia: an intensive care unit and two general surgical wards. We conducted 46 semistructured interviews, 24 weeks of fieldwork (observation and videoing) and 22 reflexive sessions with a total of 177 participants (medical, nursing, allied health, clerical and cleaning staff, and medical and nursing students). We performed a postintervention analysis, using a modified grounded theory approach, to account for the range of IPC practices identified by participants. Results: We found that healthcare workers' routine IPC work goes beyond hand hygiene and PPE. It also involves, for instance, the distribution of team members during rounds, the choreography of performing aseptic procedures and moving 'from clean to dirty' when examining patients. We account for these practices as the logistical work of moving bodies and objects across boundaries, especially from contaminated to clean/vulnerable spaces, while restricting the movement of micro-organisms through cleaning, applying barriers and buffers, and trajectory planning. Conclusions: Attention to the logistics of moving people and objects around healthcare spaces, especially into vulnerable areas, allows for a more comprehensive approach to IPC through better contextualisation of hand hygiene and PPE protocols, better identification of transmission risks, and the design and promotion of a wider range of preventive strategies and solutions.

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http://hdl.handle.net/10453/123639