Trajectories of hospital infection control: Using non-representational theory to understand and improve infection prevention and control

Claire Hooker, Suyin Hor, Mary Wyer, Gwendolyn L. Gilbert, Christine Jorm and Rick Iedema

Social Science & Medicine, 2020, vol. 256, issue C

Abstract: 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.

Keywords: Video-reflexive ethnography; Hospital acquired infection; Hand hygiene; Non-representational theory; new materialism; Health geography; Spatial analysis; Infection prevention and control; Situated responsiveness (search for similar items in EconPapers)
Date: 2020
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DOI: 10.1016/j.socscimed.2020.113023

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