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 Wyer1,2, Su-yin Hor1,5, Ruth Barratt1,2, Lyn

Gilbert1,2

1 Westmead Institute for Medical Research, Westmead, Australia 2 Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Australia3 University of Technology, Sydney, Australia

A3.2Howdoespatient-centredcarerelatetoinfectionpreventionandcontrol?

Puttingpatientsatthecentreofinfectionpreventionandcontrolandenablingthemtoparticipateinthecareprocessisnotjustaboutexplainingtherisksoftreatments,butinvolvesconsideringpatients’needsateverylevel.Thisrangesfromdesigningthefacilitytomaximisepatientcomfortandsafetytohavingarangeofprocessestoengagepatientsintheircareandlistenandactontheirfeedbackaswellasprovidingthepatientwitheducationandsupportsothattheycanbeinvolvedinlookingafterthemselves.

5

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

Strengthening frontline clinicians' infection

control: A multi-method study to reduce

MRSA infection and transmission (NHMRC

# 1009178)

Talking with Patients: Improving clinician-

patient communication around healthcare-

associated infections using video-reflexive

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

Film care episodes

Video-reflexive ethnography with patients

Patients view & reflect

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

Researcher analysis

Research dissemination

Working party

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

Reflexive discussion points

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.

References• Gould, D. J., Drey, N. S., Millar, M., Wilks, M., & Chamney, M. (2009). Patients and the public:

Knowledge, sources of information and perceptions about healthcare-associated infection. Journal of

Hospital Infection, 72(1), 1-8. doi:10.1016/j.jhin.2009.01.024

• Guttorm, H., Hohti, R., & Paakkari, A. (2015). Do the next thing: An interview with Elizabeth Adams St.

Pierre on post-qualitative methodology Educational Research Methodology, 6(1), 15-22

• Hor, S., Carroll, K., Collier, C., Lenne, B., & Wyer, M. (2016). Analysis on the run: Redefining and

locating analysis in video-reflexive ethnography. Paper presented at the ACSPRI Social Science

Methodology Conference, University of Sydney, Australia.

• Hospital accreditation to end – in Denmark. (2015, April 20). Retrieved April 29, 2016, from

http://gpaccess.uk/news/hospital-accreditation-to-end-in-Denmark/

• Iedema, R. (2011). Creating safety by strengthening clinicians' capacity for reflexivity. BMJ Quality &

Safety, 20(Suppl1), i83-i86.

• Iedema, R., Hor, S., Wyer, M., Gilbert, G. L., Jorm, C., Hooker, C., & O'Sullivan, M. V. N. (2015). An

innovative approach to strengthening health professionals’ infection control and limiting hospital-

acquired infection: video-reflexive ethnography. BMJ Innovations.

• Iedema, R., Mesman, J., & Carroll, K. (2013). Visualising health care practice improvement: Innovation

from within. London: Radcliffe Pub.

• INVOLVE. (2012). Briefing notes for researchers: Public involvement in NHS, public health and social

care research. Eastleigh, Hampshire: INVOLVE.

• Kim, M. K., Nam, E. Y., Na, S. H., Shin, M. J., Lee, H. S., Kim, N. H., . . . Kim, H. B. (2015).

Discrepancy in perceptions regarding patient participation in hand hygiene between patients and

health care workers. American Journal of Infection Control, 43(5), 510-515.

• Levinson, W., Lesser, C. S., & Epstein, R. M. (2010). Developing physician communication skills for

patient-centered care. Health Aff (Millwood), 29(7), 1310-1318. doi:10.1377/hlthaff.2009.0450

• Longtin, Y., Sax, H., Leape, L. L., Sheridan, S. E., Donaldson, L., & Pittet, D. (2010). Patient

participation: Current knowledge and applicability to patient safety. Mayo Clinic Proceedings, 85(1),

53-62.

• Martin, H. M., Navne, L. E., & Lipczak, H. (2013). Involvement of patients with cancer in patient safety:

A qualitative study of current practices, potentials and barriers. BMJ Quality & Safety, 22(10), 836-842

• McGuckin, M., & Govednik, J. (2013). Patient empowerment and hand hygiene, 1997 2012. Journal of

Hospital Infection, 84(3), 191-199.

• Mutsonziwa, G., & Green, J. (2011). Colonised and isolated: A qualitative metasynthesis of patients’

experiences of being infected with multiple drug resistant organisms and subsequent isolation.

Healthcare infection, 16(4), 147-155. doi:10.1071/hi11020

• .

References• NHMRC. (2010). Australian guidelines for the prevention and control of infection in healthcare:

Commonwealth of Australia.

• PCORI. (2014, October). About us. Retrieved fromhttp://www.pcori.org/about-us

• Pittet, D., Hugonnet, S., Harbarth, S., Mourouga, P., Sauvan, V., Touveneau, S., & Perneger, T. V.

(2000). Effectiveness of a hospital wide programme to improve compliance with hand hygiene.

Lancet, 56(9238), 1307-1312

• Schwappach, D. L. (2010). Engaging patients as vigilant partners in safety: A systematic review.

Medical Care Research and Review, 67(2), 119-148.

• 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

• World Health Organization. (2009). WHO guidelines on hand hygiene in health care : First global

patient safety challenge : Clean care is safer care. Geneva, Switzerland: World Health Organization.

Retrieved from http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf

• World Health Organization. (2011). Report on the burden of endemic health care-associated infection

worldwide World Health Organization, Geneva.

• Wyer, M., Jackson, D., Iedema, R., Hor, S., Gilbert, G. L., Jorm, C., . . . Carroll, K. (2015). Involving

patients in understanding hospital infection control using visual methods. Journal of Clinical Nursing,

24(11-12), 1718-1729. doi:10.1111/jocn.12779

• Wyer, M., Iedema, R., Jorm, C., Armstrong, G., Hor, S. Y., Hooker, C., ... & Gilbert, G. L. (2015).

Should I stay or should I go? Patient understandings of and responses to source-isolation

practices. Patient Experience Journal, 2(2), 60-68.

• Wyer, M., Iedema, R., Hor, S., Jorm, C., Hooker, C. & Gilbert, GL. (2017) Patient involvement can

affect clinicians’ perspectives and practices of infection prevention and control. A “post-qualitative”

study using video-reflexive ethnography. International Journal of Qualitative Methods, 16(1), 1-10.

doi:10.1177/1609406917690171