Analyzing Healthcare Workers’ Perspectives on Healthcare-Associated Infections and Infection Control Practices Using Video Reflexive Ethnography (VRE)

Abstract

Background: This study explores the perspectives of healthcare workers on the healthcare-associated infection (HAI) and infection control measures in a tertiary-care unit, through a self-administered questionnaire, semi-structured interviews, and reflexive sessions based on video-recorded sterile procedures performed in respondents’ work contexts. Video reflexive ethnography (VRE) is a method that provides feedback to medical practitioners through reflection analysis, whereby practitioners identify problems and find solutions. Methods: Quantitative questionnaire data were used to assess the knowledge of HAI among 50 healthcare workers and their attitude toward practice of infection control measures. Semistructured interviews based on an interview guide were used to collect qualitative data from 25 doctors and nurses. The interviews were audio recorded and transcribed verbatim immediately. Also, routine sterile procedures in the wards and intensive care unit were video recorded, and the footage was discussed by the infection control team and the personnel involved in the videos. This discussion was video recorded and transcribed. Both interview data and reflexive discussion of video-graph were analyzed using a thematic analysis. The quantitative data were analyzed using the Kruskal–Wallis test. Results: The quantitative data revealed no difference in the knowledge, attitude, and practice scores used to evaluate the infection control practices among the healthcare workers. We identified 4 themes from the qualitative data: (1) knowledge of HAI and infection control, (2) infection control measures in practice, (3) the shortfall in infection control measures and HAI, and (4) required implementation. Although the qualitative data indicated that the participants had excellent compliance with hand hygiene and personal protective equipment (PPE) use, the VRE and reflective sessions indicated otherwise. Some astounding lapses were revealed, like failure to engage in boundary maintenance between sterile and nonsterile areas, failure to observe proper hand hygiene measures, and use of traditional hijab face covers (used in an unsterile environment as well) instead of surgical masks. These findings demonstrate the advantage of combining VRE with qualitative and quantitative methodology to deduct the lapses in the practice of infection control among healthcare workers. Conclusions: Introduction of training programs focused on HAI and infection control measures in the educational system will help better inform medical and nursing students. Live video demonstrations of appropriate infection control practices during sterile procedures would be highly beneficial to educate the healthcare workers on correct infection control practices. Lapses in the use of PPE can be a possible reason for the outbreak of MERS-CoV, an endemic disease, in this part of Saudi Arabia.Disclosures: NoneFunding: None