Promoting health workers' ownership of infection prevention and control: using Normalization Process Theory as an interpretive framework.
BACKGROUND
All health workers should take responsibility for infection prevention and control (IPC). Recent reduction in key reported healthcare-associated infections in the UK is impressive, but the determinants of success are unknown. It is imperative to understand how IPC strategies operate as new challenges arise and threats of antimicrobial resistance increase.


METHODS
The authors undertook a retrospective, independent evaluation of an action plan to enhance IPC and 'ownership' (individual accountability) for IPC introduced throughout a healthcare organization. Twenty purposively selected informants were interviewed. Data were analysed inductively. Normalization Process Theory (NPT) was applied to interpret the findings and explain how the action plan was operating.


RESULTS
Six themes emerged through inductive analysis. Theme 1: 'Ability to make sense of ownership' provided evidence of the first element of NPT (coherence). Regardless of occupational group or seniority, informants understood the importance of IPC ownership and described what it entailed. They identified three prerequisites: 'Always being vigilant' (Theme 2), 'Importance of access to information' (Theme 3) and 'Being able to learn together in a no-blame culture' (Theme 4). Data relating to each theme provided evidence of the other elements of NPT that are required to embed change: planning implementation (cognitive participation), undertaking the work necessary to achieve change (collective action), and reflection on what else is needed to promote change as part of continuous quality improvement (reflexive monitoring). Informants identified barriers (e.g. workload) and facilitators (clear lines of communication and expectations for IPC).


CONCLUSIONS
Eighteen months after implementing the action plan incorporating IPC ownership, there was evidence of continuous service improvement and significant reduction in infection rates. Applying a theory that identifies factors that promote/inhibit routine incorporation ('normalization') of IPC into everyday health care can help explain the success of IPC initiatives and inform implementation.
Cardiff University, Cardiff, UK. Electronic address: gouldd@cardiff.ac.uk.
D J
DJ
Gould
Cardiff University, Cardiff, UK.
R
R
Hale
Aneurin Bevan University Health Board, Newport, UK.
E
E
Waters
Cardiff University, Cardiff, UK.
D
D
Allen
D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006302:Health Services Research; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000458:organization & administration*; D008297:Male; D012189:Retrospective Studies; D012941:Social Responsibility; D006113:United Kingdom / Q000453:epidemiology
Infection prevention and control; Normalization Process Theory; Ownership/accountability; Qualitative research