Health Humanities, Sydney Health Ethics, K25 Medical Foundation Building, University of Sydney, NSW, 2777, Australia.
Centre for Health Services Management, Faculty of Health, University of Technology, Sydney, NSW, 2777, Australia.
Soc Sci Med. 2020 Jul;256:113023. doi: 10.1016/j.socscimed.2020.113023. Epub 2020 May 5.
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.
在本文中，我们使用非代表性空间理论（2005 年）对医院感染预防和控制（IPC）活动进行了创新性分析。我们在两家大都市教学医院的三个病房中部署了视频反思民族志研究，涉及 252 名医护人员作为参与者。我们使用非代表性理论对数据进行了迭代分析，该理论表明医院空间是由医院工作、物品和人员的各种、交叉且有时相互竞争的轨迹不断产生的。该方法使影响常规 IPC 的多种物质因素（包括手术胶带卷等物品）以及习惯性或优先采取的行动（如保护患者隐私）纳入了分析。该分析还包括时间的作用，这在其他关于 IPC 的讨论中是缺失的，突出了通过 IPC 实践产生的空间的短暂性以及不断重新构建它们的必要性。我们发现许多情况下，实践的复杂性而不是合规性的失败导致了潜在的微生物传播。我们展示了IPC 实践中的不一致和混乱通常如何只能通过行动来解决。我们的研究结果表明，要进一步降低可预防的医院感染率，就需要将 IPC 更好地与其他工作轨迹相结合；将重点从合规性监测转移到协作实践；并更多地使用现场风险评估和判断。
