title: Exploring the context for effective clinical governance in infection control.
abstract: BACKGROUND
  Effective clinical governance is necessary to support improvements in infection control. Historically, the focus has been on ensuring that infection control practice and policy is based on evidence, and that there is use of surveillance and auditing for self-regulation and performance feedback. There has been less exploration of how contextual and organizational factors mediate an infection preventionists (IP's) ability to engage with evidence-based practice and enact good clinical governance.
  
  
  METHODS
  A cross sectional Web-based survey of IPs in Australia and New Zealand was undertaken. Questions focused on engagement in evidence-based practice and perceptions about the context, culture, and leadership within the infection control team and organization. Responses were mapped against dimensions of Scally and Donaldson's clinical governance framework.
  
  
  RESULTS
  Three hundred surveys were returned. IPs appear well equipped at an individual level to undertake evidence-based practice. The most serious set of perceived challenges to good clinical governance related to a lack of leadership or active resistance to infection control within the organization. Additional challenges included lack of information technology solutions and poor access to specialist expertise and financial resources.
  
  
  CONCLUSIONS
  Focusing on strengthening contextual factors at the organizational level that otherwise undermine capacity to implement evidence-based practice is key to sustaining current infection control successes and promoting further practice improvements.
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia. Electronic address: k.halton@qut.edu.au.
authors.forename: Kate
authors.initials: K
authors.lastname: Halton
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Hall
authors.affiliation: School of Nursing, Midwifery, and Paramedicine, Australian Catholic University, Dickson, Australian Capital Territory, Australia.
authors.forename: Anne
authors.initials: A
authors.lastname: Gardner
authors.affiliation: Infection Prevention and Control Department, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.
authors.forename: Deborough
authors.initials: D
authors.lastname: MacBeth
authors.affiliation: School of Nursing, Midwifery, and Paramedicine, Australian Catholic University, Dickson, Australian Capital Territory, Australia; Faculty of Nursing and Health, Avondale College of Higher Education, Wahroonga, New South Wales, Australia.
authors.forename: Brett G
authors.initials: BG
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D001315:Australia; D054976:Clinical Governance / Q000458:organization & administration*; D003428:Cross Infection / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D016357:Infection Control Practitioners / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009520:New Zealand
keywords: Australia; Evidence-based practice; Healthcare-associated infections; Safety and quality