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Normalisation process theory: a new paradigm to analyse and interpret strategies to prevent and control healthcare-associated infection

Gould, Dinah, Hale, Rachel, Waters, E. and Allen, Davina Ann 2016. Normalisation process theory: a new paradigm to analyse and interpret strategies to prevent and control healthcare-associated infection. Journal of Hospital Infection
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All health workers must take responsibility for infection prevention. Recent reduction in key reported healthcare-associated infections in the United Kingdom are impressive but determinants of success are unknown and not explained by behavioural or organisational theory. It is imperative to understand how infection prevention strategies operate as new challenges arise and threats of antimicrobial resistance increase. Methods: Effectiveness of an action plan to reduce high rates of Clostridium difficile in a health board in Wales was attributed by managers to staff accepting ‘ownership’ (individual accountability) for infection prevention. Twenty participants were interviewed in an independent retrospective evaluation to explore whether and how ownership contributed to success. Data were analysed inductively into themes. Normalisation Process Theory was applied to the dataset. Findings: Ownership meant that staff knew their own metrics, contributed to collection and acted on findings. Engagement was promoted by customising infection-related messages to the needs of clinical teams, ensuring that information was accurate and timely. Meetings where infection prevention was discussed were considered important and a climate where staff could learn from adverse events was promoted. Despite recognised challenges to infection prevention, attitudes were positive. Facilitators included clear lines of communication and expectations for infection prevention within the organisation and externally. Conclusion: Applying Normalisation Process Theory can explain why infection prevention strategies are successful and additional actions needed to secure improvement. Further application could promote systematic comparison between organisations to establish successful practices, barriers and facilitators and help different groups and organisations embed and sustain infection prevention innovations.

Item Type: Article
Date Type: Completion
Status: In Press
Schools: Healthcare Sciences
Subjects: R Medicine > R Medicine (General)
Uncontrolled Keywords: Infection prevention and control Normalisation Process Theory Ownership Qualitative research
Publisher: Elsevier
ISSN: 0195-6701
Date of First Compliant Deposit: 10 October 2016
Date of Acceptance: 27 September 2016
Last Modified: 11 Jun 2019 15:29

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