Hospital infection control: old problem – evolving challenges

Abstract

Hospital infection prevention and control (IPC) is often regarded by doctors as mundane and unnecessarily rigid, but the continued occurrence of preventable healthcareassociated infections, increasing antimicrobial resistance (to which hospitals are major contributors) and rare, but potentially devastating hospital outbreaks of emerging infectious diseases, suggest that IPC must be taken seriously. Healthcare professionals often fail to comply with effective, evidence-based IPC practices and there is ample evidence that doctors, generally, do so less consistently than nurses. However, doctors' practices are highly variable, apparently because of a perceived entitlement to clinical autonomy. In practice, most doctors observe safe IPC practices, most of the time. However, some are ignorant or dismissive of IPC policies and some respond angrily, when reminded. Among a small proportion of senior consultants, negative attitudes to IPC are perceived by their peers to correlate with a more general failure to meet their public hospital commitments, apparently because of conflicting demands, including private practice. The fact that breaches of IPC practice have significant, although often hidden, consequences indicates a need for continued improvement based on new strategies that might include: better surveillance, to identify and inform doctors of the true burdens of healthcare-associated infections; professional self-reflection on falsely dichotomous claims of medical professionalism namely: clinical autonomy versus regard for patient welfare by complying with 'rules' designed to protect them; and review of the consequences of recent changes in healthcare delivery, including proliferation of multiple, part-time consultant contracts at the expense of public hospital culture and status.

Factors associated with patient safety in neonatal intensive care units: A multicenter study using ordinal logistic regression

“…A study that explored ICU nurses' experiences of infection control guidelines in emergency situations (Donati et al, 2019) found that nurses only partially implemented infection control guidelines, and debated whether they should follow strict infection control guidelines or respond to the emergency when they did not have enough time. According to a study on the infection prevention guidelines performance of physicians (Gilbert & Kerridge, 2020), lack of adherence to infection control was widespread and consistent across all healthcare professionals including physicians; the study presented various reasons including lack of role models, excessive workload, focusing on immediate patient treatment, inconvenience of using personal protective equipment, uncertainties with policy application, and unclear penalties for non‐compliance. Such a poor infection control performance ultimately threatens patient safety and even healthcare professionals themselves (Donati et al, 2019); it is critical to follow guidelines and accurately implement infection control despite its time‐consuming nature and healthcare workers' busy schedules.…”

“…However, some inconsistent results have been reported, for example, nurses' education, clinical experience, and safety education did not influence patient safety (Yang, 2019), and nurse‐to‐patient ratio and patient outcomes were not related (Verbeek‐Van Noord, Wagner, Van Dyck, Twisk, & De Bruijne, 2014). Moreover, even physicians and nurses do not implement infection control measures despite knowing about them in emergency situations in the emergency room and ICU (Donati et al, 2019; Gilbert & Kerridge, 2020). In summary, it is important to consider how patient safety can be influenced by organizational staffing levels, as well as nurses' individual knowledge, practice, and experience despite the organization's infection control discipline and culture.…”

27. The ethics of contact precautions in hospital care: An interpretive description

“…As Winton(D) astutely observed, and has been recognised elsewhere (Cabana et al, 1999), the ability to overcome the inertia of previous practice is a common reason for noncompliance. Doctors may demonstrate outright hostility towards guidance that they see as an imposed device of managerial control rather than an intrinsic part of patient care (Gilbert & Kerridge, 2020).…”

Positive deviance in infection prevention and control: A systematic literature review

“…The reviewers (M.A.A. 1 , A.R.M., and M.A.A. 2 ) retrieved data on study design, population and setting, and the positive deviance intervention definition using paperbased forms.…”

“…Healthcare-associated infections (HAIs) remain a major challenge 1,2 ; they are associated with increased morbidity and mortality. 3 The total annual cost for the major HAIs is ~$10 billion in the United States.…”