Sydney Health Ethics, University of Sydney, Level 1, Building 1, Medical Foundation Building, 92/94 Parramatta Rd, Camperdown, NSW, 2050, Australia.
Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW, 2145, Australia.
BMC Health Serv Res. 2019 Apr 2;19(1):212. doi: 10.1186/s12913-019-4044-y.
Hospital infection prevention and control (IPC) programs are designed to minimise rates of preventable healthcare-associated infection (HAI) and acquisition of multidrug resistant organisms, which are among the commonest adverse effects of hospitalisation. Failures of hospital IPC in recent years have led to nosocomial and community outbreaks of emerging infections, causing preventable deaths and social disruption. Therefore, effective IPC programs are essential, but can be difficult to sustain in busy clinical environments. Healthcare workers' adherence to routine IPC practices is often suboptimal, but there is evidence that doctors, as a group, are consistently less compliant than nurses. This is significant because doctors' behaviours disproportionately influence those of other staff and their peripatetic practice provides more opportunities for pathogen transmission. A better understanding of what drives doctors' IPC practices will contribute to development of new strategies to improve IPC, overall.
This qualitative case study involved in-depth interviews with senior clinicians and clinician-managers/directors (16 doctors and 10 nurses) from a broad range of specialties, in a large Australian tertiary hospital, to explore their perceptions of professional and cultural factors that influence doctors' IPC practices, using thematic analysis of data.
Professional/clinical autonomy; leadership and role modelling; uncertainty about the importance of HAIs and doctors' responsibilities for preventing them; and lack of clarity about senior consultants' obligations emerged as major themes. Participants described marked variation in practices between individual doctors, influenced by, inter alia, doctors' own assessment of patients' infection risk and their beliefs about the efficacy of IPC policies. Participants believed that most doctors recognise the significance of HAIs and choose to [mostly] observe organisational IPC policies, but a minority show apparent contempt for accepted rules, disrespect for colleagues who adhere to, or are expected to enforce, them and indifference to patients whose care is compromised.
Failure of healthcare and professional organisations to address doctors' poor IPC practices and unprofessional behaviour, more generally, threatens patient safety and staff morale and undermines efforts to minimise the risks of dangerous nosocomial infection.
医院感染预防与控制（IPC）计划旨在降低可预防的医疗相关感染（HAI）和多药耐药菌的发生率，这些都是住院治疗最常见的不良后果之一。近年来，医院 IPC 的失败导致了新出现感染的医院内和社区暴发，造成了可预防的死亡和社会混乱。因此，有效的 IPC 计划至关重要，但在繁忙的临床环境中很难维持。医护人员对常规 IPC 实践的遵守往往并不理想，但有证据表明，医生作为一个群体，一贯不如护士遵守。这很重要，因为医生的行为对其他工作人员的影响不成比例，他们流动的行医方式提供了更多的病原体传播机会。更好地了解是什么驱动医生的 IPC 实践，将有助于制定新的策略来改善整体的 IPC。
这项定性案例研究采用深入访谈的方法，对来自澳大利亚一家大型三级医院的广泛专业领域的资深临床医生和临床医生管理人员/主任（16 名医生和 10 名护士）进行了访谈，以探讨他们对影响医生 IPC 实践的专业和文化因素的看法，使用数据的主题分析。
专业/临床自主权；领导和榜样作用；对 HAI 的重要性和医生预防 HAI 的责任的不确定性；以及对高级顾问义务的不明确性，这些都是主要的主题。参与者描述了个体医生之间的实践差异很大，这主要受到医生对患者感染风险的评估以及他们对 IPC 政策效果的看法等因素的影响。参与者认为，大多数医生都认识到 HAI 的重要性，并选择[主要]遵守组织的 IPC 政策，但少数人明显轻视公认的规则，不尊重遵守或预期执行这些规则的同事，也不关心自己的患者的护理受到影响。
医疗保健和专业组织未能解决医生较差的 IPC 实践和不专业的行为，更普遍地威胁到患者安全和员工士气，并破坏了降低危险的医院感染风险的努力。
