Beyond the hospital infection control guidelines: A qualitative study using positive deviance to characterize gray areas and to achieve efficacy and clarity in the prevention of healthcare-associated infections 11 Medical and Health Sciences 1117 Public Health and Health Services

Anat Gesser-Edelsburg, Ricky Cohen, Adva Mir Halavi, Mina Zemach, Peter Vernon Van Heerden, Sigal Sviri, Shmuel Benenson, Uriel Trahtemberg, Efrat Orenbuch-Harroch, Lior Lowenstein, Dan Shteinberg, Asher Salmon, Allon Moses

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The literature is replete with attempts to design and promote customized guidelines to reduce infections during the care continuum. Paradoxically, these efforts sometimes result in gray areas where many staff members are unaware of what is required of them, which then leads to confusion, frustration, and uncertainty. We coined the phrase "gray areas" in this context to encompass the variety of situations on the care continuum that are not addressed in the accepted guidelines, and where staff members are unsure of how to proceed. The purpose of the present study was to characterize the gray areas that were reported by staff and to identify the practices of Positive Deviance (PD) individuals. We define to PD individuals as people who independently develop creative solutions to solve problems not identified by the majority in their community. Methods: A qualitative constructivist research methodology was used that included personal interviews, observations and video recordings of identified PD practices to enhance infection control. The study was conducted January through March 2018, in two Intensive Care Units (ICU) units at Hadassah Hospital, Jerusalem, Israel. Personal interviews were conducted with 82 staff members from the General ICU (GICU) and Medical ICU (MICU). Results: The study confirmed that guidelines cannot cover all the different situations that arise during the care continuum and can paradoxically result in the increased spread of hospital infections. Our study found there are numerous individuals who independently develop and implement solutions for gray areas. The creative and practical solutions of PD individuals can address the barriers and difficulties on the care continuum that were encountered by the staff in their communities. For example, inserting a central venous line is a complex practice in the general guidelines, while the PDs provided clear situation-specific solutions not covered in the guidelines. Conclusions: The recommendations of the present study are to encourage hospital personnel to create their own solutions for various situations on the care continuum, and to disseminate them within their units to achieve a bottom up change, in lieu of investing in new or specific written guidelines.

Original languageEnglish
Article number124
JournalAntimicrobial Resistance and Infection Control
Volume7
Issue number1
DOIs
StatePublished - 24 Oct 2018

Bibliographical note

Funding Information:
This research was funded by the Israel National Institute for Health Policy Research, grant number 2016\134\א.

Publisher Copyright:
© 2018 The Author(s).

Keywords

  • Efficacy and clarity
  • Gray areas
  • Infection control guidelines
  • Positive deviance approach
  • Qualitative study

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)

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