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Implementation in the midst of complexity: Using ethnography to study health care–associated infection prevention and control

  • Mary Jo Knobloch
    Correspondence
    Address correspondence to Mary Jo Knobloch, PhD, MPH, University of Wisconsin, School of Medicine and Public Health, Department of Medicine, Infectious Disease, 1685 Highland Ave, Centennial Building, 5th Floor, Madison, WI 53705. (M.J. Knobloch).
    Affiliations
    Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI

    William S. Middleton Memorial Veterans Hospital, Madison, WI
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  • Kevin V. Thomas
    Affiliations
    Washington University, St. Louis, MO
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  • Erin Patterson
    Affiliations
    Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI

    William S. Middleton Memorial Veterans Hospital, Madison, WI
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  • Michele L. Zimbric
    Affiliations
    Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
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  • Jackson Musuuza
    Affiliations
    Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI

    William S. Middleton Memorial Veterans Hospital, Madison, WI
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  • Nasia Safdar
    Affiliations
    Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI

    William S. Middleton Memorial Veterans Hospital, Madison, WI
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      Highlights

      • Moving evidence to practice in complex environments may require methods that highlight context.
      • Ethnography is well-suited to study health care–associated infections (HAIs).
      • Many HAI studies using ethnography have used video-reflexive methods.
      • Ethnography can intersect with complexity science and influence real-time practice change.

      Background

      Contextual factors associated with health care settings make reducing health care–associated infections (HAIs) a complex task. The aim of this article is to highlight how ethnography can assist in understanding contextual factors that support or hinder the implementation of evidence-based practices for reducing HAIs.

      Methods

      We conducted a review of ethnographic studies specifically related to HAI prevention and control in the last 5 years (2012-2017).

      Results

      Twelve studies specific to HAIs and ethnographic methods were found. Researchers used various methods with video-reflexive sessions used in 6 of the 12 studies. Ethnography was used to understand variation in data reporting, identify barriers to adherence, explore patient perceptions of isolation practices and highlight the influence of physical design on infection prevention practices. The term ethnography was used to describe varied research methods. Most studies were conducted outside the United States, and authors indicate insights gained using ethnographic methods (whether observations, interviews, or reflexive video recording) as beneficial to unraveling the complexities of HAI prevention.

      Conclusions

      Ethnography is well-suited for HAI prevention, especially video-reflexive ethnography, for activating patients and clinicians in infection control work. In this era of increasing pressure to reduce HAIs within complex work systems, ethnographic methods can promote understanding of contextual factors and may expedite translation evidence to practice.

      Key Words

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