An ethnographic study of infection prevention and control practices in a mental health trust

Health care associated infections are high on the National Health Service agenda due to associated increased morbidity and mortality rates and subsequently added pressure of reductionist performance targets. Failure to meet these results in financial penalties, cost pressures, litigation and poor public faith and confidence in non compliant organisations. Studies show many such infections are preventable, often resulting from poor compliance with infection prevention and control practices by healthcare workers. Focus to date of this research and data has been on acute healthcare facilities with little attention to mental health settings. This thesis presents the findings of a study based on ethnographic principles, exploring the perceptions of healthcare workers in a mental health care setting into what affects infection prevention and control practices. The impact of the organisational culture was the predominant context. Eighteen healthcare workers meeting the inclusion criteria participated in the study recruited from a large mental health trust in the north west of England, the majority being nurses. Their experiences were collected through in-depth, face to face semi-structured interviews with participants. These were tape recorded, transcribed verbatim and subjected to thematic content analysis. Participant observations of discussions held during four multi-disciplinary ward rounds were also undertaken. The study field was Older People in-patient areas chosen due to increased vulnerability of the client group to healthcare associated infections. Field notes were subjected to thematic analysis. Four overarching themes emerged from the data: experiences of healthcare workers in relation to perceived lack of infection prevention and control training and education; risks of healthcare associated infections to both patients and staff; effect of organisational culture on compliance with infection prevention and control; importance of leadership and role models in this area. The findings clearly offer a unique insight into a hitherto unexplored area in relation to the importance of infection prevention and control within mental health care settings, identifying a need for strategic direction for future policy and practice.