The Lowbury lecture: behaviour in infection control

Pittet, Didier

doi:10.1016/j.jhin.2004.06.002

Cited by 228 publications

(169 citation statements)

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“…While there is a body of work that examines factors affecting compliance with guidelines and is aimed at predicting infection prevention behaviours, some behaviour that occurs in everyday practice remains unexplained (Pittet 2004). Examining such behaviours may provide a key insight into the challenges of behaviour change and may ultimately inform new initiatives aimed at improving practice, increasing quality of patient care and enhancing infection prevention.…”

Section: Introductionmentioning

confidence: 99%

“…Repeated UK government initiatives (DH 2001a(DH , 2001b(DH , 2003(DH , 2004(DH , 2005(DH , 2007(DH , 2008 led to some reported improvements in control (NAO 2009); however evidence suggests that infection spread continues to be poorly understood by healthcare workers and the general population, with practices not underpinned by sound knowledge and evidence (Easton et al 2007, Nichols and Badger 2008, Morrow et al 2011. Furthermore, although the need to understand infection prevention behaviour has been identified as a key factor in improving practice and a significant step towards modifying behaviour (Pittet 2004), little research has been undertaken regarding the motivation behind specific behaviours. Some studies have identified why certain procedures and practices are not carried out, for example handwashing, but few have considered workers' behaviours as a whole or investigated the key determinants to behaviour and infection prevention practices (Pittet 2004, Whitby et al 2006.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, although the need to understand infection prevention behaviour has been identified as a key factor in improving practice and a significant step towards modifying behaviour (Pittet 2004), little research has been undertaken regarding the motivation behind specific behaviours. Some studies have identified why certain procedures and practices are not carried out, for example handwashing, but few have considered workers' behaviours as a whole or investigated the key determinants to behaviour and infection prevention practices (Pittet 2004, Whitby et al 2006.…”

Section: Introductionmentioning

confidence: 99%

“…Evidence suggests this is affected by many factors, including perception of one's own practice and intention, motivation, perception of threat and social or peer pressure (Chan et al 2002, Stein et al 2003, Pittet 2004, Akyol et al 2006. Additionally, knowledge does not necessarily correlate with good practice; low compliance with standard precautions has been noted in those who reported a high level of conflict between providing patient care and the need to protect themselves (Gould 2004).…”

Section: Introductionmentioning

confidence: 99%

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Infection prevention as “a show”: A qualitative study of nurses’ infection prevention behaviours

Jackson

Lowton

Griffiths

2014

International Journal of Nursing Studies

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This is a pre-print version of a paper published as:Jackson, C., Lowton, K., Griffiths, P., 2013. Infection prevention as "a show": A qualitative study of nurses' infection prevention behaviours. International Journal of Nursing Studies online early http://dx.doi.org/10.1016/j.ijnurstu.2013.07.002.Copyright is vested in the publisher of the paper. You may not copy or redistribute this work in any way without their permission. Infection prevention as "a show": A qualitative study of nurses' infection prevention behavioursBackground; Control of infection and prevention of healthcare associated infections is an ongoing issue worldwide. Yet despite initiatives and strategies to reduce the burden that these infections cause, healthcare workers' practice is still reported as suboptimal and these infections persist. Much of the research to date has primarily focused on predicting infection prevention behaviours and factors associated with guideline compliance. While this has given valuable insight, an investigation aiming to understand and explain behaviours that occur in everyday practice from the perspective of the actors themselves may hold the key to the challenges of effecting behaviour change. This study questioned "How can nurses' infection prevention behaviour be explained?" This paper presents one of three identified themes 'Rationalizing dirt-related behaviour'.Design; This interpretative qualitative study uses vignettes, developed from nurses' accounts of practice, to explore nurses' reported infection prevention behavioursParticipants; Registered nurses working in an acute hospital setting and had been qualified for over a year. They were recruited while studying part-time at a London University.Methods; Twenty semi-structured interviews were undertaken using a topic guide and vignettes. Interviews were transcribed verbatim and analysed using the framework method.Results; The findings demonstrate that participants were keen to give a good impression and present themselves as knowledgeable practitioners, although it was evident that they did not always follow procedure and policy. They rationalized their own behaviour and logically justified any deviations from policy. Deviations in others were criticised as irrational and explained as superficial and part of a 'show' or display. However, participants also gave a presentation of themselves: a show or display that was influenced by the desire to protect self and satisfy patient scrutiny.Conclusions; this study contributes to the identification and explanation of nurses' infection prevention behaviours which are considered inappropriate or harmful. Behaviour is multifaceted and complex, stemming from a response to factors that are outside a purely 'scientific' understanding of infection and not simply understood as a deficit in knowledge. This calls for educational interventions that consider beliefs, values and social understanding of dirt and infection.Key words-infection prevention, healthcare associated infection, qualitative research, compliance, nurse, G...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Infection prevention as “a show”: A qualitative study of nurses’ infection prevention behaviours

Jackson

Lowton

Griffiths

2014

International Journal of Nursing Studies

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“…6 Infection control professionals need to identify barriers to guideline implementation and find strategies based on behavioral theories to improve staff adherence to guidelines. 11,12 These results justify future studies, such as observation of contact precaution practices, in-depth evaluation of knowledge in different types of HCW, and dissemination of information on MRSA rates and infection control institutional guidelines for prevention of multidrug-resistant organisms.…”

Section: Discussionmentioning

confidence: 75%

Endemic methicillin-resistant Staphylococcus aureus: Nurses' risk perceptions and attitudes

Pedro

Uva²,

Pina³

2014

American Journal of Infection Control

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Dissemination of methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most difficult challenges for prevention, control, and treatment of health careeassociated infections. A survey and interviews were conducted on nurses from a hospital center. We found that most nurses' perceived risk of acquiring MRSA related to themselves (72%), other nurses (88.5%), and patients (97.8%). This perception influences attitudes, leading to compliance with the existing recommendations.Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.In Portugal, methicillin-resistant Staphylococcus aureus (MRSA) is endemic in most hospitals, with resistance rates >49% in cerebrospinal fluid and blood samples. 1 Several international organizations have developed guidelines for prevention and control of MRSA, 2-4 namely patient isolation or cohorting, contact precautions, active patient screening at admission, decolonization, and environmental decontamination.Full adoption of guidelines for prevention of cross infection depends on the awareness of the guidelines and risk perception related to the presence of MRSA by health care workers (HCWs). Behavioral theories suggest that a high-risk perception encourages individuals to adopt actions to reduce risk. 5,6 METHODS We conducted a cross-sectional study to determine perception and attitudes in relation with risk of exposure to MRSA. The study included nurses from 10 clinical units in a teaching medical center in Lisbon, which is composed of 4 hospital sites, though only 2 were used to conduct the study, in old buildings with wards of 4 beds and very limited isolation facilities. Wards with patients with more risk factors for acquiring MRSA and where surveillance of MRSA has been in place longer were selected.We intended to identify nurses' knowledge about the MRSA chain of transmission and nurses' perception of risks related to acquisition and transmission of MRSA for themselves, other nurses, and patients. We also identified how knowledge and perception are reflected in practices described by HCWs.The study protocol was submitted for approval by the hospital board and ethics committee. Internal consistency was evaluated with the Kaiser-Meyer-Olkin test. 7 After factorial analysis the sentence about "MRSA isolation report in discharge and transfer forms" was categorized as "risk perception" for purposes of analysis. Following expert review, the questionnaire and semistructured interview guide were subjected to pilot testing on a sample of the study population and were modified accordingly.The self-assessed anonymous questionnaire was distributed to a sample of nurses from 3 intensive care units and 7 medical wards (MWs). Additionally, an interview was conducted with 1 nurse per unit, selected on a voluntary basis.The questionnaire was composed of 21 items: 6 assessed knowledge, 8 addressed risk perception, and 7 addressed attitudes. Knowledge questions were multiple choice, and risk perce...

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