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Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Nosocomial Infection | Study protocol

Infection prevention control and organisational patient safety culture within the context of isolation: study protocol

Authors: John Gammon, Julian Hunt, Sharon Williams, Sharon Daniel, Sue Rees, Sian Matthewson

Published in: BMC Health Services Research | Issue 1/2019

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Abstract

Background

Healthcare associated infection (HCAI) is a major cause of morbidity and mortality. In recent years, there have been high profile successes in infection prevention control (IPC), such as the dramatic reductions in methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (which is viewed as one proxy indicator of overall harm) and Clostridium difficile in the UK. Nevertheless, HCAI remains a costly burden to health services, a source of concern to patients and the public and at present, is receiving priority from policy makers as it contributes to the global threat of antimicrobial resistance.

Methods

The study involves qualitative case studies within isolation settings at two National Health Service (NHS) district general hospitals (DGHs) in Wales, in the UK. The 18-month study incorporates Manchester Patient Safety Framework (MaPSaF) workshops with health workers and other hospital staff, in depth interviews with patients and their relative / informal carer, health workers and hospital staff, and periods of hospital ward observation.

Discussion

The present study aims to investigate the ways in which engagement of health workers with IPC strategies and principles, shape and inform organisational patient safety culture within the context of isolation in surgical, medical and admission hospital settings; and vice-versa. We want to understand the meaning of IPC ‘ownership’ for health workers; the ways in which IPC is promoted, how IPC teams operate as new challenges arise, how their effectiveness is assessed and the positioning of IPC within the broader context of organisational patient safety culture, within hospital isolation settings.
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Literature
1.
go back to reference Department of Health. The Health Act. Code of practice for the prevention and control of healthcare associated infections. London: Department of Health; 2006. Department of Health. The Health Act. Code of practice for the prevention and control of healthcare associated infections. London: Department of Health; 2006.
2.
go back to reference Harbarth S, Sax H, Gastmeier P. The preventable proportion of nosocomial infections: an overview of published reports. J Hosp Infect. 2003;54:258–66.CrossRef Harbarth S, Sax H, Gastmeier P. The preventable proportion of nosocomial infections: an overview of published reports. J Hosp Infect. 2003;54:258–66.CrossRef
3.
go back to reference Burke JP. Infection control – a problem for patient safety. N Engl J Med. 2003;348:651–6.CrossRef Burke JP. Infection control – a problem for patient safety. N Engl J Med. 2003;348:651–6.CrossRef
4.
go back to reference Gerberding JL. Hospital-onset infections: a patient safety issue. Ann Intern Med. 2003;137:665–70.CrossRef Gerberding JL. Hospital-onset infections: a patient safety issue. Ann Intern Med. 2003;137:665–70.CrossRef
5.
go back to reference Jeeva RR, Wright D. Healthcare-associated infection: a national patient safety problem and the coordinated response. Med Care. 2014;52:S4–8.CrossRef Jeeva RR, Wright D. Healthcare-associated infection: a national patient safety problem and the coordinated response. Med Care. 2014;52:S4–8.CrossRef
6.
go back to reference Krein SL, Olmsted RN, Hofer TP, Kowalski C, Forman J, Banaszak-Holl J, Saint S. Translating infection prevention evidence into practice using quantitative and qualitative research. Am J Infect Control. 2006;34:507–12.CrossRef Krein SL, Olmsted RN, Hofer TP, Kowalski C, Forman J, Banaszak-Holl J, Saint S. Translating infection prevention evidence into practice using quantitative and qualitative research. Am J Infect Control. 2006;34:507–12.CrossRef
7.
go back to reference Saint S, Kowalski CP, Banaszak-Holl J, Forman J, Damschroder L, Krein SL. How active resistors and organizational conspirators affect healthcare-acquired infection prevention efforts. Jt Comm J Qual Patient Saf. 2009;35:239–46.CrossRef Saint S, Kowalski CP, Banaszak-Holl J, Forman J, Damschroder L, Krein SL. How active resistors and organizational conspirators affect healthcare-acquired infection prevention efforts. Jt Comm J Qual Patient Saf. 2009;35:239–46.CrossRef
8.
go back to reference Health Protection Agency (Now Public Health England). Quarterly Epidemiological Commentary: Mandatory MRSA, MSSA and E. Coli bacteraemia and C. difficile infection data. 2013. Health Protection Agency (Now Public Health England). Quarterly Epidemiological Commentary: Mandatory MRSA, MSSA and E. Coli bacteraemia and C. difficile infection data. 2013.
9.
go back to reference Health Protection Scotland. Quarterly report on the surveillance of Clostridium difficile infection (CDI) in Scotland. 2012. Health Protection Scotland. Quarterly report on the surveillance of Clostridium difficile infection (CDI) in Scotland. 2012.
10.
go back to reference HSC Northern Ireland, Public Health Agency. C. difficile Surveillance quarterly report. 2012. HSC Northern Ireland, Public Health Agency. C. difficile Surveillance quarterly report. 2012.
11.
go back to reference Public Health Wales. Clostridium difficile mandatory surveillance report: All Wales. 2012. Public Health Wales. Clostridium difficile mandatory surveillance report: All Wales. 2012.
12.
go back to reference Department of Health. UK Five Year Antimicrobial Resistance Strategy 2013 to 2018. London: Department of Health; 2013. Department of Health. UK Five Year Antimicrobial Resistance Strategy 2013 to 2018. London: Department of Health; 2013.
13.
go back to reference Welsh Government. Together for Health: Tackling antimicrobial resistance and improving antibiotic prescribing. A Delivery Plan for Wales NHS and its partners. Cardiff: Welsh Government; 2016. Welsh Government. Together for Health: Tackling antimicrobial resistance and improving antibiotic prescribing. A Delivery Plan for Wales NHS and its partners. Cardiff: Welsh Government; 2016.
14.
go back to reference Welsh Government. Code of practice for the prevention and control of healthcare associated infections. 2014. Welsh Government. Code of practice for the prevention and control of healthcare associated infections. 2014.
15.
go back to reference Welsh Government. Commitment to purpose: eliminating preventable healthcare associated infections (HCAIs). 2011. Welsh Government. Commitment to purpose: eliminating preventable healthcare associated infections (HCAIs). 2011.
16.
go back to reference Dodds A, Kodate N. Accountability, organisational learning and risks to patient safety in England: conflict or compromise. Health Risk Soc. 2011;13:327–46.CrossRef Dodds A, Kodate N. Accountability, organisational learning and risks to patient safety in England: conflict or compromise. Health Risk Soc. 2011;13:327–46.CrossRef
17.
go back to reference Department of Health. An organisation with a memory. London: Department of Health; 2000. Department of Health. An organisation with a memory. London: Department of Health; 2000.
18.
go back to reference Leape LL, Berwick DM. Safe health care: are we up to it? BMJ. 2000;320:725–6.CrossRef Leape LL, Berwick DM. Safe health care: are we up to it? BMJ. 2000;320:725–6.CrossRef
19.
go back to reference Vincent C, Taylor-Adams S, Chapman EJ, Hewett D, Prior S, Strange P, Tizzard A. How to investigate and analyse clinical incidents: clinical risk management unit and association of litigation and risk management protocol. BMJ. 2000;320:777–81.CrossRef Vincent C, Taylor-Adams S, Chapman EJ, Hewett D, Prior S, Strange P, Tizzard A. How to investigate and analyse clinical incidents: clinical risk management unit and association of litigation and risk management protocol. BMJ. 2000;320:777–81.CrossRef
20.
go back to reference Clarke S. Perceptions of organisational safety: implications for the development of safety culture. J Organ Behav. 1999;20:185–98.CrossRef Clarke S. Perceptions of organisational safety: implications for the development of safety culture. J Organ Behav. 1999;20:185–98.CrossRef
21.
go back to reference De Bono S, Heling G, Borg MA. Organisational culture and its implications for infection prevention and control in healthcare institutions. J Hosp Infect. 2014;86:1–6.CrossRef De Bono S, Heling G, Borg MA. Organisational culture and its implications for infection prevention and control in healthcare institutions. J Hosp Infect. 2014;86:1–6.CrossRef
22.
go back to reference Charani S, Holmes AH. Antimicrobial stewardship programmes: the need for wider engagement’. BMJ Qual Saf. 2013;22:885–7.CrossRef Charani S, Holmes AH. Antimicrobial stewardship programmes: the need for wider engagement’. BMJ Qual Saf. 2013;22:885–7.CrossRef
23.
go back to reference Conroy LJ, Raveis VH, Pogorzelska-Maziarz M, Uchida M, Stone PW, Larson EL. Tensions inherent in the evolving role of the infection preventionist. Am J Infect Control. 2013;41:959–64.CrossRef Conroy LJ, Raveis VH, Pogorzelska-Maziarz M, Uchida M, Stone PW, Larson EL. Tensions inherent in the evolving role of the infection preventionist. Am J Infect Control. 2013;41:959–64.CrossRef
24.
go back to reference Brewster L, Tarrant C, Dixon-Woods M. Qualitative study of views and experiences of performance management for healthcare associated infections. J Hosp Infect. 2016;94:41–7.CrossRef Brewster L, Tarrant C, Dixon-Woods M. Qualitative study of views and experiences of performance management for healthcare associated infections. J Hosp Infect. 2016;94:41–7.CrossRef
25.
go back to reference Gould DJ, Hale R, Waters E, Allen D. Promoting health workers’ ownership of infection prevention and control: using normalization process theory as an interpretive framework. J Hosp Infect. 2016;94:373–80.CrossRef Gould DJ, Hale R, Waters E, Allen D. Promoting health workers’ ownership of infection prevention and control: using normalization process theory as an interpretive framework. J Hosp Infect. 2016;94:373–80.CrossRef
26.
go back to reference Lo E, Nicolle LE, Coffin SE, Gould C, Maragakis LL, Meddings J, Pegues DA, Pettis AM, Saint S, Yokoe DS. Strategies to prevent catheter associated urinary tract infections in acute hospitals. Infect Control Hosp Epidemiol. 2014;35 Suppl:32–S47.CrossRef Lo E, Nicolle LE, Coffin SE, Gould C, Maragakis LL, Meddings J, Pegues DA, Pettis AM, Saint S, Yokoe DS. Strategies to prevent catheter associated urinary tract infections in acute hospitals. Infect Control Hosp Epidemiol. 2014;35 Suppl:32–S47.CrossRef
27.
go back to reference Hale R, Powell T, Drey NS, Gould DJ. Working practices and success of infection prevention and control teams: a scoping study. J Hosp Infect. 2015;89:77–88.CrossRef Hale R, Powell T, Drey NS, Gould DJ. Working practices and success of infection prevention and control teams: a scoping study. J Hosp Infect. 2015;89:77–88.CrossRef
28.
go back to reference Zimmerman B, Reason P, Rykert L, Gitterman L, Christian J, Gardam M. Frontline ownership: generating a cure mindset for patient safety. Healthcare Papers. 2013;13:7–22. Zimmerman B, Reason P, Rykert L, Gitterman L, Christian J, Gardam M. Frontline ownership: generating a cure mindset for patient safety. Healthcare Papers. 2013;13:7–22.
29.
go back to reference Masterton RG, Mifsud AJ, Rao GG. Review of hospital isolation and infection control precautions. J Hosp Infect. 2003;54(3):171–3.CrossRef Masterton RG, Mifsud AJ, Rao GG. Review of hospital isolation and infection control precautions. J Hosp Infect. 2003;54(3):171–3.CrossRef
30.
go back to reference Coia JE, Duckworth GJ, Edwards DI, Farrington M, Fry C, Humphreys H, Mallaghan C, Tucker DR. Hospital infection society and Infection Control Nurses Association guidelines for the control of prevention of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect. 2006;63 Suppl:1–44.CrossRef Coia JE, Duckworth GJ, Edwards DI, Farrington M, Fry C, Humphreys H, Mallaghan C, Tucker DR. Hospital infection society and Infection Control Nurses Association guidelines for the control of prevention of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect. 2006;63 Suppl:1–44.CrossRef
31.
go back to reference Cookson BD, Macrae MB, Barrett SP, Brown DF, Chadwick C, French GL, Hateley P, Hosein IK, Wade JJ. Guidelines for the control of glycopeptides-resistant enterococci in hospitals. J Hosp Infect. 2006;62(1):6–21.CrossRef Cookson BD, Macrae MB, Barrett SP, Brown DF, Chadwick C, French GL, Hateley P, Hosein IK, Wade JJ. Guidelines for the control of glycopeptides-resistant enterococci in hospitals. J Hosp Infect. 2006;62(1):6–21.CrossRef
32.
go back to reference Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, Farr BM. SHEA guideline for preventing nosocomial transmission of multi-drug resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol. 2003;24(5):362–86.CrossRef Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, Farr BM. SHEA guideline for preventing nosocomial transmission of multi-drug resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol. 2003;24(5):362–86.CrossRef
33.
go back to reference Siegel JD, Rhinehart E, Jackson M, Chiarello L. Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Am J Infect Control. 2007;35(10):S65–164.CrossRef Siegel JD, Rhinehart E, Jackson M, Chiarello L. Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Am J Infect Control. 2007;35(10):S65–164.CrossRef
34.
go back to reference Jackson MM, Lynch P. Invited commentary: guideline for isolation precautions in hospitals. Am J Infect Control. 1996;24(3):203–6.CrossRef Jackson MM, Lynch P. Invited commentary: guideline for isolation precautions in hospitals. Am J Infect Control. 1996;24(3):203–6.CrossRef
35.
go back to reference Prieto J, Macleod Clark J. Contact precautions for Clostridium difficile and methicillin-resistant Staphylococcus aureus: assessing the impact of a supportive intervention to improve practice. J Res Nurs. 2005;10(5):511–26.CrossRef Prieto J, Macleod Clark J. Contact precautions for Clostridium difficile and methicillin-resistant Staphylococcus aureus: assessing the impact of a supportive intervention to improve practice. J Res Nurs. 2005;10(5):511–26.CrossRef
36.
go back to reference Cooper BS, Stone SP, Kibbler CC, Cookson BD, Roberts JA, Medley GF, Duckworth GJ, Lai R, Ebrahim S. Systematic review of isolation policies in the hospital management of methicillin-resistant Staphylococcus aureus: a review of the literature with epidemiological and economic modelling. Health Technol Assess. 2003;7(39):1–194.CrossRef Cooper BS, Stone SP, Kibbler CC, Cookson BD, Roberts JA, Medley GF, Duckworth GJ, Lai R, Ebrahim S. Systematic review of isolation policies in the hospital management of methicillin-resistant Staphylococcus aureus: a review of the literature with epidemiological and economic modelling. Health Technol Assess. 2003;7(39):1–194.CrossRef
37.
go back to reference Aboelela SW, Saiman L, Stone P, Lowy FD, Quiros D, Larson E. Effectiveness of barrier precautions and surveillance cultures to control transmission of multidrug-resistant organisms: a systematic review of the literature. Am J Infect Control. 2006;30(7):40–3. Aboelela SW, Saiman L, Stone P, Lowy FD, Quiros D, Larson E. Effectiveness of barrier precautions and surveillance cultures to control transmission of multidrug-resistant organisms: a systematic review of the literature. Am J Infect Control. 2006;30(7):40–3.
38.
go back to reference Davies H, Rees J. Psychological effects of isolation nursing (1): mood disturbance. Nurs Stand. 2000;14:35–8.CrossRef Davies H, Rees J. Psychological effects of isolation nursing (1): mood disturbance. Nurs Stand. 2000;14:35–8.CrossRef
39.
go back to reference Gammon, J. & Hunt, J. The stigmatisation of source isolation: a literature review. J Res Nurs In Press. Gammon, J. & Hunt, J. The stigmatisation of source isolation: a literature review. J Res Nurs In Press.
40.
go back to reference Gammon J, Hunt J. Source isolation and patient wellbeing in healthcare settings: a literature review. Br J Nurs. 2018;27(2):88–91.CrossRef Gammon J, Hunt J. Source isolation and patient wellbeing in healthcare settings: a literature review. Br J Nurs. 2018;27(2):88–91.CrossRef
41.
go back to reference Gammon J, Hunt J. A review of isolation practices and procedures in healthcare settings. Br J Nurs. 2018;27(3):137–40.CrossRef Gammon J, Hunt J. A review of isolation practices and procedures in healthcare settings. Br J Nurs. 2018;27(3):137–40.CrossRef
42.
go back to reference Knowles H. The experience of infectious patients in isolation. Nurs Times. 1993;89:53–6.PubMed Knowles H. The experience of infectious patients in isolation. Nurs Times. 1993;89:53–6.PubMed
43.
go back to reference Rees J, Davies H, Birchall C. Psychological effects of source isolation (2): patient satisfaction. Nurs Stand. 2000;14:32–6.CrossRef Rees J, Davies H, Birchall C. Psychological effects of source isolation (2): patient satisfaction. Nurs Stand. 2000;14:32–6.CrossRef
44.
go back to reference Allaire Y, Firsirotu ME. Theories of organizational culture. Organ Stud. 1984;5:193–226.CrossRef Allaire Y, Firsirotu ME. Theories of organizational culture. Organ Stud. 1984;5:193–226.CrossRef
45.
go back to reference Ashkanasy NM, Jackson CRA. Organizational culture and climate. In: Anderson N, Ones DS, Sinangil HK, Viswesvaran C, editors. Handbook of industrial work and organizational psychology. Volume 2: organizational psychology. Thousand Oaks: Sage Publications; 2001. Ashkanasy NM, Jackson CRA. Organizational culture and climate. In: Anderson N, Ones DS, Sinangil HK, Viswesvaran C, editors. Handbook of industrial work and organizational psychology. Volume 2: organizational psychology. Thousand Oaks: Sage Publications; 2001.
46.
go back to reference Alvesson M. Cultural perspectives on Organisations. Cambridge: Cambridge University Press; 1995. Alvesson M. Cultural perspectives on Organisations. Cambridge: Cambridge University Press; 1995.
47.
go back to reference Ott JS. The organizational culture perspective. Chicago: Dorsey; 1989. Ott JS. The organizational culture perspective. Chicago: Dorsey; 1989.
48.
go back to reference Brown A. Organizational Culture. London: Pitman; 1995. Brown A. Organizational Culture. London: Pitman; 1995.
49.
go back to reference Hunt J, Sanchez A, Tadd W, O’Mahony S. Organizational culture and performance in health care for older people: a systematic review. Rev Clin Gerontol. 2012;22(3):218–34.CrossRef Hunt J, Sanchez A, Tadd W, O’Mahony S. Organizational culture and performance in health care for older people: a systematic review. Rev Clin Gerontol. 2012;22(3):218–34.CrossRef
50.
go back to reference Schein EH. Organisational culture and leadership. San Francisco: Jossey-Bass; 1985. Schein EH. Organisational culture and leadership. San Francisco: Jossey-Bass; 1985.
51.
go back to reference Mannion R, Davies HTO, Marshall MN. Cultures for performance in health care. Berkshire: Open University Press; 2005. Mannion R, Davies HTO, Marshall MN. Cultures for performance in health care. Berkshire: Open University Press; 2005.
52.
go back to reference Scott JT, Mannion R, Davies HTO, Marshall MN. Organisational culture and performance in the NHS: a review of the theory, instruments and evidence. York: Centre for Health Economics; 2001. Scott JT, Mannion R, Davies HTO, Marshall MN. Organisational culture and performance in the NHS: a review of the theory, instruments and evidence. York: Centre for Health Economics; 2001.
53.
go back to reference Scott JT, Mannion R, Davies HTO, Marshall MN. Health care performance and Organisational culture. Oxford: Radcliffe Medical Press; 2003. Scott JT, Mannion R, Davies HTO, Marshall MN. Health care performance and Organisational culture. Oxford: Radcliffe Medical Press; 2003.
54.
go back to reference Scott JT, Mannion R, Davies HTO, Marshall MN. Does organisational culture influence health care performance? A review of the evidence. J Health Serv Res Policy. 2003;8(2):105–17.CrossRef Scott JT, Mannion R, Davies HTO, Marshall MN. Does organisational culture influence health care performance? A review of the evidence. J Health Serv Res Policy. 2003;8(2):105–17.CrossRef
55.
go back to reference Scott JT, Mannion R, Davies HTO, Marshall MN. Implementing culture change in health care: theory and practice. Int J Qual Health Care. 2003;15(2):111–8.CrossRef Scott JT, Mannion R, Davies HTO, Marshall MN. Implementing culture change in health care: theory and practice. Int J Qual Health Care. 2003;15(2):111–8.CrossRef
56.
go back to reference May C. Agency and implementation: understanding the embedding of healthcare innovations in practice. Soc Sci Med. 2013;78:26–33.CrossRef May C. Agency and implementation: understanding the embedding of healthcare innovations in practice. Soc Sci Med. 2013;78:26–33.CrossRef
57.
go back to reference Colyvas JA, Jonsson S. Ubiquity and legitimacy: disentangling confusion and institutionalization. Sociol Theor. 2011;29:27–53.CrossRef Colyvas JA, Jonsson S. Ubiquity and legitimacy: disentangling confusion and institutionalization. Sociol Theor. 2011;29:27–53.CrossRef
58.
go back to reference May C. A rational model for assessing and evaluating complex interventions in health care. BMC Health Serv Res. 2006;6:1–11.CrossRef May C. A rational model for assessing and evaluating complex interventions in health care. BMC Health Serv Res. 2006;6:1–11.CrossRef
59.
go back to reference May C. Towards a general theory of implementation. Implement Sci. 2013;8(18):1–14. May C. Towards a general theory of implementation. Implement Sci. 2013;8(18):1–14.
60.
go back to reference Coffey A, Atkinson P. Making sense of qualitative data: complementary research strategies. London: Sage; 1996. Coffey A, Atkinson P. Making sense of qualitative data: complementary research strategies. London: Sage; 1996.
61.
go back to reference Ayres L, Kavanaugh K, Knafl KA. Within-case and across-case approaches to qualitative data analysis. Qual Health Res. 2003;13(6):871–83.CrossRef Ayres L, Kavanaugh K, Knafl KA. Within-case and across-case approaches to qualitative data analysis. Qual Health Res. 2003;13(6):871–83.CrossRef
Metadata
Title
Infection prevention control and organisational patient safety culture within the context of isolation: study protocol
Authors
John Gammon
Julian Hunt
Sharon Williams
Sharon Daniel
Sue Rees
Sian Matthewson
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4126-x

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