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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Infection ControlAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Vital signs, stop the spread of healthcare-associated infections.(Available at:) (Accessed July 14, 2017)
- Making health care safer, vital signs, topics covered, healthcare-associated infections.(Available at:) (Accessed July 14, 2017)
- Healthcare-associated infections, preventing HAIs.(Available at:) (Accessed July 14, 2017)
- Healthcare-associated infections prevention toolkits.(Available at:) (Accessed July 14, 2017)
- Healthcare-associated infections.(Available at:) (Accessed July 14, 2017)
- Multistate point-prevalence survey of health care-associated infections.N Engl J Med. 2014; 370: 1198-1208
- Translating infection prevention evidence into practice using quantitative and qualitative research.Am J Infect Control. 2006; 34: 507-512
- Implementation science: how to jump-start infection prevention.Infect Control Hosp Epidemiol. 2010; 31: S14-7
- Mapping the dark matter of context: a conceptual scoping review.Med Educ. 2016; 50: 807-816
- Implementing complex innovations: factors influencing middle manager support.Health Care Manage Rev. 2011; 36: 369-379
- Catheter-associated urinary tract infection: a successful prevention effort employing a multipronged initiative at an academic medical center.J Nurs Care Qual. 2014; 29: 141-148
- Qualitative research methodologies: ethnography.BMJ. 2008; 337: a1020
- Applying ethnography to the study of context in healthcare quality and safety.BMJ Qual Saf. 2014; 23: 99-105
- An overview of ethnography in healthcare and medical education research.J Educ Eval Health Prof. 2011; 8: 4
- Designing & conducting ethnographic research: an introduction.AltaMira Press, Lanham (MD)2010
- What is ethnography? Can it survive? Should it?.Ethnogr Educ. 2017; : 1-17
- Patient safety and the problem of many hands.BMJ Qual Saf. 2016; 25: 485-488
- Nursing older dying patients: findings from an ethnographic study of death and dying in elderly care wards.J Adv Nurs. 2001; 35: 59-68
- Causes of intravenous medication errors: an ethnographic study.Qual Saf Health Care. 2003; 12: 343-347
- Boys in white: a classic of qualitative research turns 50.Hist Cienc Saude Manguinhos. 2014; 21: 1179-1196
- The use of focused ethnography in nursing research.Nurse Res. 2013; 20: 36-43
- Ethnography and health care.BMJ. 2000; 321: 1400-1402
- What counts? An ethnographic study of infection data reported to a patient safety program.Milbank Q. 2012; 90: 548-591
- Implementation of infection control best practice in intensive care units throughout Europe: a mixed-method evaluation study.Implement Sci. 2013; 8: 24
- Explaining matching Michigan: an ethnographic study of a patient safety program.Implement Sci. 2013; 8: 70
Szymczak J.E. How mandatory public reporting undermines infection prevention: an ethnographic study HAI surveillance and public reporting: center for pediatric clinical effectiveness. Abstract presented at: HAI Surveillance and Public Reporting. Philadelphia, PA: Children's Hospital of Philadelphia; October 10, 2014: 12:30 PM.
- Involving patients in understanding hospital infection control using visual methods.J Clin Nurs. 2015; 24: 1718-1729
- Should I stay or should I go? Patient understandings of and responses to source-isolation practices.Patient Exp J. 2015; 2: 8
- Implications of design on infection prevention and control practice in a novel hospital unit: the medical ward of the 21st century.Anthropol Med. 2015; 22: 149-161
- Beyond hand hygiene: a qualitative study of the everyday work of preventing cross-contamination on hospital wards.BMJ Qual Saf. 2017; 26: 552-558
- A complex endeavour: an ethnographic study of the implementation of the Sepsis Six clinical care bundle.Implement Sci. 2016; 11: 149
- Patients' and families' perspectives of patient safety at the end of life: a video-reflexive ethnography study.Int J Qual Health Care. 2016; 28: 66-73
- Patient involvement can affect clinicians' perspectives and practices of infection prevention and control: a “post-qualitative” study using video-reflexive ethnography.Int J Qual Methods. 2017; 16: 1-10
- The constant comparative method of qualitative analysis.Soc Probl. 1965; 12: 436-445
- An innovative approach to strengthening health professionals' infection control and limiting hospital-acquired infection: video-reflexive ethnography.BMJ Innov. 2015; 1: 157-162
- Researching reflexively with patients and families.Qual Health Res. 2015; 26: 979-993
- Creating spaces in intensive care for safe communication: a video-reflexive ethnographic study.BMJ Qual Saf. 2014; 23: 1007-1013
- Going forward through the world: thinking theoretically about first person perspective digital ethnography.Integr Psychol Behav Sci. 2015; 49: 239-252
- Seeing risk and allocating responsibility: talk of culture and its consequences on the work of patient safety.Soc Sci Med. 2014; 120: 252-259
- How complexity science can inform scale-up and spread in health care: understanding the role of self-organization in variation across local contexts.Soc Sci Med. 2013; 93: 194-202
- Manifestations and implications of uncertainty for improving healthcare systems: an analysis of observational and interventional studies grounded in complexity science.Implement Sci. 2014; 9: 165
- Scoping review of complexity theory in health services research.BMC Health Serv Res. 2016; 16: 87
Article Info
Publication History
Published online: July 31, 2017
Footnotes
Conflicts of interest: None to report.
Identification
Copyright
Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.
