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Beyond hand hygiene: a qualitative study of the everyday work of preventing cross-contamination on hospital wards


Hor, S-Y and Hooker, C and Iedema, R and Wyer, M and Gilbert, GL and Jorm, C and O'Sullivan, MVN, Beyond hand hygiene: a qualitative study of the everyday work of preventing cross-contamination on hospital wards, BMJ quality & safety, 26, (7) pp. 552-558. ISSN 2044-5415 (2017) [Refereed Article]

Copyright Statement

Copyright 2016 Hor S-yin, et al.

DOI: doi:10.1136/bmjqs-2016-005878


BACKGROUND: Hospital-acquired infections are the most common adverse event for inpatients worldwide. Efforts to prevent microbial cross-contamination currently focus on hand hygiene and use of personal protective equipment (PPE), with variable success. Better understanding is needed of infection prevention and control (IPC) in routine clinical practice.

METHODS: We report on an interventionist video-reflexive ethnography study that explored how healthcare workers performed IPC in three wards in two hospitals in New South Wales, Australia: an intensive care unit and two general surgical wards. We conducted 46 semistructured interviews, 24 weeks of fieldwork (observation and videoing) and 22 reflexive sessions with a total of 177 participants (medical, nursing, allied health, clerical and cleaning staff, and medical and nursing students). We performed a postintervention analysis, using a modified grounded theory approach, to account for the range of IPC practices identified by participants.

RESULTS: We found that healthcare workers' routine IPC work goes beyond hand hygiene and PPE. It also involves, for instance, the distribution of team members during rounds, the choreography of performing aseptic procedures and moving 'from clean to dirty' when examining patients. We account for these practices as the logistical work of moving bodies and objects across boundaries, especially from contaminated to clean/vulnerable spaces, while restricting the movement of micro-organisms through cleaning, applying barriers and buffers, and trajectory planning.

CONCLUSIONS: Attention to the logistics of moving people and objects around healthcare spaces, especially into vulnerable areas, allows for a more comprehensive approach to IPC through better contextualisation of hand hygiene and PPE protocols, better identification of transmission risks, and the design and promotion of a wider range of preventive strategies and solutions.

Item Details

Item Type:Refereed Article
Research Division:Health Sciences
Research Group:Health services and systems
Research Field:Health services and systems not elsewhere classified
Objective Division:Health
Objective Group:Public health (excl. specific population health)
Objective Field:Public health (excl. specific population health) not elsewhere classified
UTAS Author:Hor, S-Y (Dr Su-Yin Hor)
UTAS Author:Iedema, R (Professor Rick Iedema)
UTAS Author:Wyer, M (Ms Mary Wyer)
ID Code:115233
Year Published:2017 (online first 2016)
Web of Science® Times Cited:21
Deposited By:Health Sciences
Deposited On:2017-03-10
Last Modified:2017-11-17

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