Ethnographic study using Normalization Process Theory to understand the implementation process of infection...

Area of Science:

• Healthcare quality and safety
• Clinical practice research
• Sociology of health

Background:

• Infection prevention and control (IPC) guidelines are crucial for patient safety.
• Understanding the gap between IPC guidelines and clinical practice is essential.
• Previous research has not fully explored the practical implementation of IPC guidelines.

Purpose of the Study:

• To explore the use and understanding of IPC guidelines by healthcare professionals, patients, and families.
• To identify factors influencing the implementation of IPC guidelines in clinical settings.

Main Methods:

• Ethnographic study involving 59 hours of non-participant observation.
• 57 conversational interviews were conducted with healthcare professionals, patients, and families.
• Analysis was guided by Normalization Process Theory (NPT).

Main Results:

• A dissonance exists between IPC guidelines and the reality of clinical practice.
• Challenges in legitimizing guideline recommendations were observed.
• Symbolic implementation of IPC guidelines was prevalent, alongside a lack of shared reflection.
• Workforce fragmentation, time pressure, and low IPC prioritization impacted implementation.

Conclusions:

• IPC guideline implementation is often symbolic, focusing on symbols rather than evidence-based recommendations.
• Successful IPC requires aligning guidelines with clinical work and fostering shared reflection.
• Addressing systemic issues like workforce fragmentation and time pressure is crucial for effective IPC.