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Beyond hand hygiene: a qualitative study of the everyday work of preventing cross-contamination on hospital wards
  1. Su-yin Hor1,
  2. Claire Hooker2,
  3. Rick Iedema3,
  4. Mary Wyer4,
  5. Gwendolyn L Gilbert2,5,
  6. Christine Jorm6,
  7. Matthew Vincent Neil O'Sullivan5,7
  1. 1School of Health Sciences, Faculty of Health, University of Tasmania, Darlinghurst, New South Wales, Australia
  2. 2Centre for Values, Ethics and the Law in Medicine, The University of Sydney, Camperdown, New South Wales, Australia
  3. 3School of Public Health & Preventive Medicine, Monash University,Clayton, Victoria, Australia
  4. 4School of Health Sciences, Faculty of Health, University of Tasmania, Darlinghurst, New South Wales, Australia
  5. 5Marie Bashir Institute for Infectious Diseases & Biosecurity, The University of Sydney, Westmead, New South Wales, Australia
  6. 6Sydney Medical School, Sydney University, Sydney, New South Wales, Australia
  7. 7Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, New South Wales, Australia
  1. Correspondence to Dr Su-yin Hor, University of Tasmania, School of Health Sciences, Education Centre, 1 Leichhardt St, Darlinghurst, NSW 2010, Australia; suyin.hor{at}


Background Hospital-acquired infections are the most common adverse event for inpatients worldwide. Efforts to prevent microbial cross-contamination currently focus on hand hygiene and use of personal protective equipment (PPE), with variable success. Better understanding is needed of infection prevention and control (IPC) in routine clinical practice.

Methods We report on an interventionist video-reflexive ethnography study that explored how healthcare workers performed IPC in three wards in two hospitals in New South Wales, Australia: an intensive care unit and two general surgical wards. We conducted 46 semistructured interviews, 24 weeks of fieldwork (observation and videoing) and 22 reflexive sessions with a total of 177 participants (medical, nursing, allied health, clerical and cleaning staff, and medical and nursing students). We performed a postintervention analysis, using a modified grounded theory approach, to account for the range of IPC practices identified by participants.

Results We found that healthcare workers' routine IPC work goes beyond hand hygiene and PPE. It also involves, for instance, the distribution of team members during rounds, the choreography of performing aseptic procedures and moving ‘from clean to dirty’ when examining patients. We account for these practices as the logistical work of moving bodies and objects across boundaries, especially from contaminated to clean/vulnerable spaces, while restricting the movement of micro-organisms through cleaning, applying barriers and buffers, and trajectory planning.

Conclusions Attention to the logistics of moving people and objects around healthcare spaces, especially into vulnerable areas, allows for a more comprehensive approach to IPC through better contextualisation of hand hygiene and PPE protocols, better identification of transmission risks, and the design and promotion of a wider range of preventive strategies and solutions.

  • Infection control
  • Clinical practice guidelines
  • Complexity
  • Qualitative research
  • Patient safety

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  • Contributors All authors made substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data, drafting the work, or revising it critically for important intellectual content and finally approval of the version published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work is appropriately investigated and resolved.

  • Funding National Health and Medical Research Council (1009178).

  • Competing interests None.

  • Ethics approval Western Sydney Local Health District Human Research Ethics Committee and University of Tasmania Human Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.