TY - JOUR
T1 - Trajectories of hospital infection control
T2 - Using non-representational theory to understand and improve infection prevention and control
AU - Hooker, Claire
AU - Hor, Suyin
AU - Wyer, Mary
AU - Gilbert, Gwendolyn L.
AU - Jorm, Christine
AU - Iedema, Rick
PY - 2020/7
Y1 - 2020/7
N2 - In this paper we undertake an innovative analysis of infection prevention and control (IPC) activities in hospitals, using non-representational theory of space (2005). We deployed video-reflexive ethnography in three wards in two metropolitan teaching hospitals involving 252 healthcare workers as participants. We analysed our data iteratively using non-representational theory, which showed hospital space being constantly produced from varied, intersecting, and sometimes competing trajectories of hospital work, objects and people. The approach enabled multiple material factors impinging on routine IPC (including objects such as rolls of surgical tape), and habitual or prioritised actions (such as safeguarding patient privacy) to be included in analysis. The analysis also included the role of time which has been absent from other discussions of IPC, highlighting the transience of spaces produced through IPC practices and the need to continually re-make them. We found many situations in which the complexity of practice, rather than failures of compliance, contributed to potential microbial transmission. We show how inconsistency and confusion about IPC practice often can only be resolved through action. Our findings suggest that further reduction in preventable hospital infection rates will require better integration of IPC with other work trajectories; a shift in emphasis from compliance monitoring to collaborative practice; and greater use of in situ risk assessment and judgment.
AB - In this paper we undertake an innovative analysis of infection prevention and control (IPC) activities in hospitals, using non-representational theory of space (2005). We deployed video-reflexive ethnography in three wards in two metropolitan teaching hospitals involving 252 healthcare workers as participants. We analysed our data iteratively using non-representational theory, which showed hospital space being constantly produced from varied, intersecting, and sometimes competing trajectories of hospital work, objects and people. The approach enabled multiple material factors impinging on routine IPC (including objects such as rolls of surgical tape), and habitual or prioritised actions (such as safeguarding patient privacy) to be included in analysis. The analysis also included the role of time which has been absent from other discussions of IPC, highlighting the transience of spaces produced through IPC practices and the need to continually re-make them. We found many situations in which the complexity of practice, rather than failures of compliance, contributed to potential microbial transmission. We show how inconsistency and confusion about IPC practice often can only be resolved through action. Our findings suggest that further reduction in preventable hospital infection rates will require better integration of IPC with other work trajectories; a shift in emphasis from compliance monitoring to collaborative practice; and greater use of in situ risk assessment and judgment.
KW - Hand hygiene
KW - Health geography
KW - Hospital acquired infection
KW - Infection prevention and control
KW - new materialism
KW - Non-representational theory
KW - Situated responsiveness
KW - Spatial analysis
KW - Video-reflexive ethnography
UR - http://www.scopus.com/inward/record.url?scp=85084809189&partnerID=8YFLogxK
U2 - 10.1016/j.socscimed.2020.113023
DO - 10.1016/j.socscimed.2020.113023
M3 - Article
C2 - 32446154
AN - SCOPUS:85084809189
SN - 0277-9536
VL - 256
JO - Social Science and Medicine
JF - Social Science and Medicine
M1 - 113023
ER -