What is needed to sustain improvements in hospital practices post-COVID-19? a qualitative study of interprofessional dissonance in hospital infection prevention and control

BACKGROUND: Hospital infection prevention and control (IPC) depends on consistent practice to achieve its purpose. Standard precautions are embedded in modern healthcare policies, but not uniformly observed by all clinicians. Well-documented differences in attitudes to IPC, between doctors and nurses, contribute to suboptimal IPC practices and persistence of preventable healthcare-associated infections. The COVID-19 pandemic has seriously affected healthcare professionals’ work-practices, lives and health and increased awareness and observance of IPC. Successful transition of health services to a ‘post-COVID-19’ future, will depend on sustainable integration of lessons learnt into routine practice. METHODS: The aim of this pre-COVID-19 qualitative study was to investigate factors influencing doctors’ IPC attitudes and practices, whether they differ from those of nurses and, if so, how this affects interprofessional relationships. We hypothesised that better understanding would guide new strategies to achieve more effective IPC. We interviewed 26 senior clinicians (16 doctors and 10 nurses) from a range of specialties, at a large Australian tertiary hospital. Interview transcripts were reviewed iteratively, and themes identified inductively, using reflexive thematic analysis. RESULTS: Participants from both professions painted clichéd portraits of ‘typical’ doctors and nurses and recounted unflattering anecdotes of their IPC behaviours. Doctors were described as self-directed and often unaware or disdainful of IPC rules; while nurses were portrayed as slavishly following rules, ostensibly to protect patients, irrespective of risk or evidence. Many participants believed that doctors object to being reminded of IPC requirements by nurses, despite many senior doctors having limited knowledge of correct IPC practice. Overall, participants’ comments suggested that the ‘doctor-nurse game’—described in the 1960s, to exemplify the complex power disparity between professions—is still in play, despite changes in both professions, in the interim. CONCLUSIONS: The results suggest that interprofessional differences and inconsistencies constrain IPC practice improvement. IPC inconsistencies and failures can be catastrophic, but the common threat of COVID-19 has promoted focus and unity. Appropriate implementation of IPC policies should be context-specific and respect the needs and expertise of all stakeholders. We propose an ethical framework to guide interprofessional collaboration in establishing a path towards sustained improvements in IPC and bio-preparedness.