Prof. Lyn Gilbert1, Professor Ian Kerridge1
1Sydney Health Ethics, School of Public Health, University of Sydney, Australia
Published literature indicates that doctors are consistently less compliant than nurses with infection prevention and control (IPC) practices, such as hand hygiene. This is significant because preventable, potentially serious, healthcare associated infections (HAIs) still occur with significant frequency and rates correlate broadly with IPC practices. Differences in adherence, between nurses and doctors, is a source of inter-professional tension and doctors’ status means that their behaviours disproportionately influence those of other staff.
In a qualitative study of senior doctors, nurses and administrators in a Sydney tertiary hospital we found that factors, which potentially contribute to doctors’ relatively poor IPC practices, are complex. They include the fact that most doctors have an inherent aversion to “rules”, especially those imposed by others (nurses, managers); some regard IPC policies as unnecessary or discretionary; IPC policies are sometimes inflexible and/or inappropriately applied; and failure to observe them is rarely associated with (immediate) clinical or punitive consequences. Moreover, some doctors regard serious HAIs as rare and unavoidable and/or are unaware of the incidence, or implications for patients, of less serious, but more common, HAIs. Competing priorities may interfere with consultants’ public hospital commitments, which are poorly defined in employment contracts and unenforceable; without positive role models, busy/overworked junior doctors, may regard IPC practices as time-consuming and of low priority.
Our results suggest that moral exhortations, that doctors ‘must’ wash their hands, are likely to be ineffective. New clinical, organisational and socio-political strategies are needed to increase doctors awareness and responsiveness to IPC. The most basic of these would be: to reveal the true burden of HAIs, by targeted surveillance; to ensure that IPC policies are implemented according to clinical context, in consultation with all stakeholders, including doctors; and that organisational expectations of all staff, including senior consultants, were clearly defined in employment contracts and enforced.
Lyn Gilbert is an infectious diseases physician, with clinical and research interests in communicable disease epidemiology, surveillance and control, emerging infectious diseases and antimicrobial resistance, including their ethical implications. She is currently doing research on the ethics and politics of hospital infection prevention and control (IPC) and innovative methods of improving IPC practice.