title: Involving patients in understanding hospital infection control using visual methods.
abstract: OBJECTIVE
  This paper explores patients' perspectives on infection prevention and control.
  
  
  BACKGROUND
  Healthcare-associated infections are the most frequent adverse event experienced by patients. Reduction strategies have predominantly addressed front-line clinicians' practices; patients' roles have been less explored.
  
  
  METHODS
  Video-reflexive ethnography.
  
  
  METHODS
  Fieldwork undertaken at a large metropolitan hospital in Australia involved 300 hours of ethnographic observations, including 11 hours of video footage. This paper focuses on eight occasions, where video footage was shown back to patients in one-on-one reflexive sessions.
  
  
  RESULTS
  Viewing and discussing video footage of clinical care enabled patients to become articulate about infection risks, and to identify their own roles in reducing transmission. Barriers to detailed understandings of preventative practices and their roles included lack of conversation between patients and clinicians about infection prevention and control, and being ignored or contradicted when challenging perceived suboptimal practice. It became evident that to compensate for clinicians' lack of engagement around infection control, participants had developed a range of strategies, of variable effectiveness, to protect themselves and others. Finally, the reflexive process engendered closer scrutiny and a more critical attitude to infection control that increased patients' sense of agency.
  
  
  CONCLUSIONS
  This study found that patients actively contribute to their own safety. Their success, however, depends on the quality of patient-provider relationships and conversations. Rather than treating patients as passive recipients of infection control practices, clinicians can support and engage with patients' contributions towards achieving safer care.
  
  
  CONCLUSIONS
  This study suggests that if clinicians seek to reduce infection rates, they must start to consider patients as active contributors to infection control. Clinicians can engage patients in conversations about practices and pay attention to patient feedback about infection risk. This will broaden clinicians' understandings of infection control risks and behaviours, and assist them to support appropriate patient self-care behaviour.
authors: Faculty of Health, School of Health Sciences, University of Tasmania (Sydney Campus), Darlinghurst, NSW, Australia.
authors: Mary
authors: http://orcid.org/0000-0002-1215-8089
authors: M
authors: Wyer
authors: Oxford Brookes University, Faculty of Health and Life Sciences, Oxford and University of New England, School of Health, Darlinghurst, NSW, Australia.
authors: Debra
authors: D
authors: Jackson
authors: Faculty of Health, School of Health Sciences, University of Tasmania (Sydney Campus), Darlinghurst, NSW, Australia.|Agency for Clinical Innovation, NSW Ministry of Health, Chatswood, NSW, Australia.
authors: Rick
authors: R
authors: Iedema
authors: Faculty of Arts and Social Sciences, University of Technology, Sydney, NSW, Australia.
authors: Su-Yin
authors: SY
authors: Hor
authors: Marie Bashir Institute for Infectious Diseases and Biosecurity, Faculty of Medicine, University of Sydney, Westmead, NSW, Australia.|Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW, Australia.
authors: Gwendolyn L
authors: GL
authors: Gilbert
authors: Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.
authors: Christine
authors: C
authors: Jorm
authors: Medical Humanities, Centre for Values, Ethics and the Law in Medicine, Faculty of Medicine, The University Of Sydney, Camperdown, NSW, Australia.
authors: Claire
authors: C
authors: Hooker
authors: Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW, Australia.|Marie Bashir Institution for Infectious Diseases and Biosecurity, University of Sydney, Westmead, NSW, Australia.
authors: Matthew Vincent Neil
authors: MV
authors: O'Sullivan
authors: Faculty of Health Sciences, Mayo Clinic, Rochester, MN, USA.
authors: Katherine
authors: K
authors: Carroll
mesh_terms: D000328:Adult; D003428:Cross Infection / Q000451:nursing / Q000517:prevention & control*; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D009517:New South Wales; D010349:Patient Compliance; D010353:Patient Education as Topic; D014741:Video Recording
keywords: healthcare-associated infection; infection prevention and control; methicillin-resistant Staphylococcus aureus; patient involvement; qualitative research; video-reflexive ethnography