Mary Wyer1, Debra Jackson2, Rick Iedema1,3, Su-Yin Hor4, Gwendolyn L Gilbert5,6, Christine Jorm7, Claire Hooker8, Matthew Vincent Neil O'Sullivan6,9, Katherine Carroll10. 1. Faculty of Health, School of Health Sciences, University of Tasmania (Sydney Campus), Darlinghurst, NSW, Australia. 2. Oxford Brookes University, Faculty of Health and Life Sciences, Oxford and University of New England, School of Health, Darlinghurst, NSW, Australia. 3. Agency for Clinical Innovation, NSW Ministry of Health, Chatswood, NSW, Australia. 4. Faculty of Arts and Social Sciences, University of Technology, Sydney, NSW, Australia. 5. Marie Bashir Institute for Infectious Diseases and Biosecurity, Faculty of Medicine, University of Sydney, Westmead, NSW, Australia. 6. Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW, Australia. 7. Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia. 8. Medical Humanities, Centre for Values, Ethics and the Law in Medicine, Faculty of Medicine, The University Of Sydney, Camperdown, NSW, Australia. 9. Marie Bashir Institution for Infectious Diseases and Biosecurity, University of Sydney, Westmead, NSW, Australia. 10. Faculty of Health Sciences, Mayo Clinic, Rochester, MN, USA.
Abstract
AIMS AND OBJECTIVES: This paper explores patients' perspectives on infection prevention and control. BACKGROUND: Healthcare-associated infections are the most frequent adverse event experienced by patients. Reduction strategies have predominantly addressed front-line clinicians' practices; patients' roles have been less explored. DESIGN: Video-reflexive ethnography. METHODS: Fieldwork undertaken at a large metropolitan hospital in Australia involved 300 hours of ethnographic observations, including 11 hours of video footage. This paper focuses on eight occasions, where video footage was shown back to patients in one-on-one reflexive sessions. FINDINGS: Viewing and discussing video footage of clinical care enabled patients to become articulate about infection risks, and to identify their own roles in reducing transmission. Barriers to detailed understandings of preventative practices and their roles included lack of conversation between patients and clinicians about infection prevention and control, and being ignored or contradicted when challenging perceived suboptimal practice. It became evident that to compensate for clinicians' lack of engagement around infection control, participants had developed a range of strategies, of variable effectiveness, to protect themselves and others. Finally, the reflexive process engendered closer scrutiny and a more critical attitude to infection control that increased patients' sense of agency. CONCLUSION: This study found that patients actively contribute to their own safety. Their success, however, depends on the quality of patient-provider relationships and conversations. Rather than treating patients as passive recipients of infection control practices, clinicians can support and engage with patients' contributions towards achieving safer care. RELEVANCE TO CLINICAL PRACTICE: This study suggests that if clinicians seek to reduce infection rates, they must start to consider patients as active contributors to infection control. Clinicians can engage patients in conversations about practices and pay attention to patient feedback about infection risk. This will broaden clinicians' understandings of infection control risks and behaviours, and assist them to support appropriate patient self-care behaviour.
AIMS AND OBJECTIVES: This paper explores patients' perspectives on infection prevention and control. BACKGROUND: Healthcare-associated infections are the most frequent adverse event experienced by patients. Reduction strategies have predominantly addressed front-line clinicians' practices; patients' roles have been less explored. DESIGN: Video-reflexive ethnography. METHODS: Fieldwork undertaken at a large metropolitan hospital in Australia involved 300 hours of ethnographic observations, including 11 hours of video footage. This paper focuses on eight occasions, where video footage was shown back to patients in one-on-one reflexive sessions. FINDINGS: Viewing and discussing video footage of clinical care enabled patients to become articulate about infection risks, and to identify their own roles in reducing transmission. Barriers to detailed understandings of preventative practices and their roles included lack of conversation between patients and clinicians about infection prevention and control, and being ignored or contradicted when challenging perceived suboptimal practice. It became evident that to compensate for clinicians' lack of engagement around infection control, participants had developed a range of strategies, of variable effectiveness, to protect themselves and others. Finally, the reflexive process engendered closer scrutiny and a more critical attitude to infection control that increased patients' sense of agency. CONCLUSION: This study found that patients actively contribute to their own safety. Their success, however, depends on the quality of patient-provider relationships and conversations. Rather than treating patients as passive recipients of infection control practices, clinicians can support and engage with patients' contributions towards achieving safer care. RELEVANCE TO CLINICAL PRACTICE: This study suggests that if clinicians seek to reduce infection rates, they must start to consider patients as active contributors to infection control. Clinicians can engage patients in conversations about practices and pay attention to patient feedback about infection risk. This will broaden clinicians' understandings of infection control risks and behaviours, and assist them to support appropriate patient self-care behaviour.