Infection Prevention and the Patient’s Voice Using video research methods for collaborative research with patients and clinicians
Involving patients in understanding hospital infection prevention and control using video-reflexive methods Mary Wyer 1,2 , Su-yin Hor 1,5 , Ruth Barratt 1,2 , Lyn Gilbert 1,2 1 Westmead Institute for Medical Research, Westmead, Australia 2 Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Australia 3 University of Technology, Sydney, Australia
A3� .2� How� does� patient-centred� care� relate� to� infection� prevention� and� control?� Putting� patients� at� the� centre� of� infection� prevention� and� control� and� enabling� them� to� participate� in� the� care� process� is� not� just� about� explaining� the� risks� of� treatments,� but� involves� considering� patients ’ � needs� at� every� level.� This� ranges� from� designing� the� facility� to� maximise� patient� comfort� and� safety� to� having� a� range� of� processes� to� engage� patients� in� their� care� and� listen� and� act� on� their� feedback� as� well� as� providing� the� patient� with� education� and� support� so� that� they� can� be� involved� in� looking� after� themselves.�
Patient involvement in IPC Davis, R., Parand, A., Pinto, A., & Buetow, S. (2015). Systematic review of the effectiveness of strategies to encourage patients to remind healthcare professionals about their hand hygiene. Journal of Hospital Infection , 89 (3), 141-162. Seale, H., Chughtai, A. A., Kaur, R., Crowe, P., Phillipson, L., Novytska, Y., & Travaglia, J. (2015). Ask, speak up, and be proactive: Empowering patient infection control to prevent health care- -acquired infections. American Journal of Infection Control , 43 (5), 447-453 5
Strengthening frontline clinicians' infection Talking with Patients: Improving clinician- control: A multi-method study to reduce patient communication around healthcare- MRSA infection and transmission (NHMRC associated infections using video-reflexive # 1009178) ethnography
Working with participants to video practices of interest, and then showing back the footage to them in reflexive sessions Engages with the expertise of frontline staff/patients/visitors Makes explicit the complex reality of clinical work Raises awareness of taken-for-granted practices & relationships Results in learning and change (practice optimization)
Research Project 1
Strengthening frontline clinicians' infection control: A multi-method study to reduce MRSA infection and transmission
Video-reflexive ethnography with patients Patients view & reflect Film care episodes Patients’ insights fed back to nurses Reproduced /Sage publishing: Wyer, M., Iedema, R., Hor, S. et al. (2017)
Video 1 • Video removed for confidentiality
Notes about Video 1 • James is watching back some footage of a staff member taking his blood,. • By watching footage James became aware of risks he previously hadn’t noticed . • He notices that she starts touching things with her gloved hands, contaminating them before coming to him • He devises some solutions to deal with them. But interestingly rather than confronting her directly, he decides that if it happens again, he will grab her hands and contaminate her gloves so she has to change them • He thinks it would be better to make himself look silly – to help the HCW save face but also be able to feel safe.
Research Project 2
Talking with patients • Collaboration between researchers, renal unit staff & patients, infection control professionals, infectious diseases physicians and laboratory staff • Aim: To improve clinician-patient communication around HAIs and IPC, with the broader aim of reducing HAIs by increasing patient involvement in IPC
Working party Researcher analysis Research dissemination
Reflexive discussion points 1. Which sites do we swab? 2. Communicating with patients about screening 3. Patients taking their own swabs 4. Informing patients about how they can protect themselves and others from infections while in hospital
Resources created
Spreading the word Workshops to support clinician-led projects
Clinician-led VRE projects • VRE workshop – to empower clinical staff to undertake their own VRE projects – 6 nurses – loaned equipment and researcher support • Project 1: Interdisciplinary Cath lab project looking at hand hygiene during angiography • Project 2: Improvement in clinical handover involving isolation rooms
References • Alzyood, M., Jackson, D., Brooke, J., & Aveyard, H. (2018). An integrative review exploring the perceptions of patients and healthcare professionals towards patient involvement in promoting hand hygiene compliance in the hospital setting. Journal of clinical nursing, 27(7-8), 1329-1345. • Australian Commission on Safety and Quality in Health Care (ACSQHC). (2011). National safety and quality health service standards. Sydney: ACSQHC • Bevan, H., & Fairman, S. (2014). The new era of thinking and practice in change and transformation: A call to action for leaders of health and care. NHSIQ (NHS Improving Quality). Available At:http://media.nhsiq.nhs.uk/whitepaper/html5/index.html. • Biesta, G.(2005). Against learning: Reclaiming a language for education in an age of learning. Nordisk Pedagogik, 25 , 54-66 • Brett, J., Staniszewska, S., Mockford, C., Herron-Marx, S., Hughes, J., Tysall, C., & Suleman, R. (2014). Mapping the impact of patient and public involvement on health and social care research: A systematic review. Health Expectations , 17 (5), 637-65 • Burnett, E., Johnston, B., Kearney, N., Corlett, J., & MacGillivray, S. (2013). Understanding factors that impact on public and patient's risk perceptions and responses toward Clostridium difficile and other health care-associated infections: a structured literature review. American Journal of Infection Control, 41(6), 542-548. doi:10.1016/j.ajic.2012.05.026 • Dadich, A., & Wyer, M. (2018). Patient Involvement in Healthcare-Associated Infection Research: A Lexical Review. Infection Control & Hospital Epidemiology , 1-8. doi: 10.1017/ice.2018.62 • Davis, R. E., Parand, A., Pinto, A., & Buetow, S. (2015). Systematic review of the effectiveness of strategies to encourage patients to remind healthcare professionals about their hand hygiene. Journal of Hospital Infection, 89(3), 141-162. doi:10.1016/j.jhin.2014.11.010 • Davis, R. E., Pinto, A., Sevdalis, N., Vincent, C., Massey, R., & Darzi, A. (2012). Patients' and health care professionals' attitudes towards the PINK patient safety video. Journal of Evaluation in Clinical Practice, 18(4), 848-853. • Davis, R., Briggs, M., Arora, S., Moss, R., & Schwappach, D. (2014). Predictors of health care professionals' attitudes towards involvement in safety-relevant behaviours. Journal of Evaluation in Clinical Practice, 20(1), 12-19. • Dewey, J. (1922). Human nature and conduct: An introduction to social psychology . New York: H. Holt & Company. • Ferguson, J. K. (2009). Preventing healthcare associated infection: Risks, healthcare systems and behaviour. Internal Medicine Journal, 39 (9), 574-581. • Fox, N. J. (2015). Emotions, affects and the production of social life. The British Journal of Sociology, 66 (2), 301-318.
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