Letter to the editor

Dear Editor,

I read with interest your editorials published in the January and March 2018 issues of the Journal of Infection Prevention. Your insights into both the use of audit and of root cause analysis (RCA) in assuring the quality and efficacy of infection prevention and control (IPC) practice has resonated significantly with me. I wonder if all of the tools and processes that we use in the practice of IPC require to be interrogated in a similar manner.

Indeed, Storr et al. (2013) advocate a radical rethink of current IPC practice in order to ensure the gains made by embracing the newer techniques drawn from industry, such as RCA and Improvement Science methodology, are sustained and further advanced. For me, there is nothing much wrong with the tools we use, traditional or modern; rather the challenge is in the application of the tools and what the purpose and endpoint are. As an experienced IPC practitioner, the rote production of reports and datasets, that miss the intention of IPC interventions, causes me a significant level of professional frustration. As a nurse my raison d’être is to ensure good, effective patient care, yet much IPC practice ‘wastes valuable resources’, ‘damages efforts to improve quality of care’ and ‘generates a high level of cynicism’ (Wilson, 2018a, 2018b) within the very healthcare workers whose practice we seek to influence.

In an excellent paper by Iwami et al. (2016), the authors contend that the indicators used to measure the efficacy of IPC interventions require regular appraisal and macro influences must be explicitly acknowledged. Griffiths et al. (2009) assert that there is a need for much further investigation of the wider social, organisational and managerial aspects of infection outbreaks and that this needs to be carried out utilising systems-level, organisation-wide approaches, i.e. utilising systems ergonomics or systems analysis. Others (Storr et al., 2013) have recommended that infection control researchers, practitioners and professional bodies engage and work with experts in the fields of systems ergonomics or human factors engineering to advance infection control practice.

It is clear to me that the efforts to control healthcare-associated infection (HCAI) and improve patient safety made by infection control teams and others working in healthcare have been laudable and not without success. Yet HCAI remains a challenge and continues to cause harm while conventional interventions are becoming less effective. The disciplines of human-factors engineering and systems ergonomics have much to offer to infection control practice but to date have not been systematically addressed within the research or practice communities. Without such work there is a danger that researchers and practitioners gain, at best, a partial view and newly developed interventions achieve limited success or fail to achieve their objectives at all (Harris, 2013).

I would contend that this work combined with the scholarly interrogation of IPC practice by the profession will assist us to refresh the drivers for and the practice of IPC to the greater benefit of our patients.