Infection control, ethics and accountability

Abstract

Health care‐associated infections (HAIs) are a major clinical and economic problem in Australian hospitals, and a significant proportion are preventable. HAIs are the result of complex environmental, microbiological, pathological, behavioural and organisational factors, and prevention requires a multifaceted (“bundled”) approach, including appropriate policies, educational programs for health care workers, and adequate resources to implement them effectively. Failure to protect patients from avoidable harm, including HAIs, has significant ethical implications; it often reflects both organisational systems failure and non‐compliance of health care workers with evidence‐based policies, including hand hygiene. If implemented with appropriate safeguards, infection control “bundles” that include sanctions for poor compliance with hand hygiene and other infection control policies, will achieve sustained improvements where previous approaches have failed.

Suboptimal infection prevention and control in the healthcare culture

“…When battling cancer, heart disease and other similar diseases, HCWs resent being pestered about what they see as a minor matter. 57 Infection is regarded as an inferior order of medical problem and an unavoidable complication of life-saving highly interventionist medical practice, 58 being referred to by McAlearney 59 as the "cost of doing business". Studies show doctors generally are less likely to think HAIs are preventable, 60 are more negative about guidelines 11 and consider strategies for improving infection control practices have significantly less impact on their practice.…”

Hospital infection control: old problem – evolving challenges

“…2,6,7 However, none adequately explains doctors' relatively poor IPC compliance. However, a plethora of new antimicrobials was available to cure them, so strict IPC measures seemed less importantat least until the excessive use of these drugs started to be reflected in increasing antimicrobial resistance (AMR) in the 1960s, and later, when fewer new ones meant that successful treatment was no longer guaranteed.…”

“…The reasons why this is so are broadly consistent, to varying degrees, across all healthcare professionals; they include: lack of role models; heavy workloads; focus on immediate patient care; inconvenience; uncertainty about how to apply policies; scepticism about their efficacy; the absence of obvious consequences of breaches; and the number and complexity of policies and guidelines. 2,6,7 However, none adequately explains doctors' relatively poor IPC compliance.…”

Patient safety era: time to think about accountability

“…In complex health systems, individuals play a critical role in protecting patient and reducing harm, requiring health care professionals to be accountable for their practice and comply with their moral obligation to ‘do no harm’(Gilbert et al , ).…”