title: Beyond hand hygiene: a qualitative study of the everyday work of preventing cross-contamination on hospital wards.
abstract: BACKGROUND
  Hospital-acquired infections are the most common adverse event for inpatients worldwide. Efforts to prevent microbial cross-contamination currently focus on hand hygiene and use of personal protective equipment (PPE), with variable success. Better understanding is needed of infection prevention and control (IPC) in routine clinical practice.
  
  
  METHODS
  We report on an interventionist video-reflexive ethnography study that explored how healthcare workers performed IPC in three wards in two hospitals in New South Wales, Australia: an intensive care unit and two general surgical wards. We conducted 46 semistructured interviews, 24 weeks of fieldwork (observation and videoing) and 22 reflexive sessions with a total of 177 participants (medical, nursing, allied health, clerical and cleaning staff, and medical and nursing students). We performed a postintervention analysis, using a modified grounded theory approach, to account for the range of IPC practices identified by participants.
  
  
  RESULTS
  We found that healthcare workers' routine IPC work goes beyond hand hygiene and PPE. It also involves, for instance, the distribution of team members during rounds, the choreography of performing aseptic procedures and moving 'from clean to dirty' when examining patients. We account for these practices as the logistical work of moving bodies and objects across boundaries, especially from contaminated to clean/vulnerable spaces, while restricting the movement of micro-organisms through cleaning, applying barriers and buffers, and trajectory planning.
  
  
  CONCLUSIONS
  Attention to the logistics of moving people and objects around healthcare spaces, especially into vulnerable areas, allows for a more comprehensive approach to IPC through better contextualisation of hand hygiene and PPE protocols, better identification of transmission risks, and the design and promotion of a wider range of preventive strategies and solutions.
authors.affiliation: School of Health Sciences, Faculty of Health, University of Tasmania, Darlinghurst, New South Wales, Australia.
authors.forename: Su-Yin
authors.identifier: http://orcid.org/0000-0002-6498-9722
authors.initials: SY
authors.lastname: Hor
authors.affiliation: Centre for Values, Ethics and the Law in Medicine, The University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: Claire
authors.initials: C
authors.lastname: Hooker
authors.affiliation: School of Public Health & Preventive Medicine, Monash University,Clayton, Victoria, Australia.
authors.forename: Rick
authors.initials: R
authors.lastname: Iedema
authors.affiliation: School of Health Sciences, Faculty of Health, University of Tasmania, Darlinghurst, New South Wales, Australia.
authors.forename: Mary
authors.identifier: http://orcid.org/0000-0002-1215-8089
authors.initials: M
authors.lastname: Wyer
authors.affiliation: Centre for Values, Ethics and the Law in Medicine, The University of Sydney, Camperdown, New South Wales, Australia.|Marie Bashir Institute for Infectious Diseases & Biosecurity, The University of Sydney, Westmead, New South Wales, Australia.
authors.forename: Gwendolyn L
authors.initials: GL
authors.lastname: Gilbert
authors.affiliation: Sydney Medical School, Sydney University, Sydney, New South Wales, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: Jorm
authors.affiliation: Marie Bashir Institute for Infectious Diseases & Biosecurity, The University of Sydney, Westmead, New South Wales, Australia.|Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, New South Wales, Australia.
authors.forename: Matthew Vincent Neil
authors.initials: MVN
authors.lastname: O'Sullivan
mesh_terms: D000884:Anthropology, Cultural; D001296:Audiovisual Aids; D003428:Cross Infection / Q000517:prevention & control*; D004866:Equipment Contamination / Q000517:prevention & control*; D063373:Hand Hygiene / Q000379:methods; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D007407:Interviews as Topic; D055805:Moving and Lifting Patients / Q000379:methods*; D009517:New South Wales; D010362:Patients' Rooms; D036301:Qualitative Research; D013503:Surgery Department, Hospital
keywords: Clinical practice guidelines; Complexity; Infection control; Patient safety; Qualitative research