I’ve written this post in preparation for next Wednesday’s IPS Journal Club in partnership with the Infection Prevention Society (register here). (Please note, it will be a little earlier in the day than most previous Journal Clubs, so don’t miss it, and yes I stole this paragraph from Jon). 

The paper that I have chosen for the Journal Club is this one  in the Journal of Infection Prevention, exploring infection prevention behaviour in midwifery staff. 

Kerry, Jon and I had an interesting discussion last week about which ‘live’ we use for this journal club. I think I am an advocate for both and will remain rooted to the fence! Why? We are bringing the journal club to you live and also we want everyone to live Infection Prevention and Control! 

Why did I choose this article? 

• This is a qualitative study which I am reading more and more of as I try to understand and unpick the human behaviour and perception elements of IPC. In my opinion understanding these better can help support optimal delivery of IPC and patient care 
• The research was conducted amongst midwives which I was interested to read more about given the high demands on midwifery services and some of the negative press midwifery services have faced in recent years 
• I am big fan of ‘thematic analysis’ which was framework used for the analysis of the different themes arising from the semi structured interviews with midwives 

Design and methods 

• To aim was to understand midwives’ experiences of the barriers and facilitators when adhering to infection prevention and control guidelines
• Semi-structured interviews were conducted with 10 midwives working at a University Hospital in Ireland,  to form a qualitative descriptive study
• A range of experience levels among participants were sort, including registration with the national nursing and midwifery board and at least 1 year of experience
• Interviews were audio recorded, transcribed verbatim, and analysed utilising Braun and Clarke’s thematic analysis framework

Key findings 

• Two themes were identified from the data analysis; (1) the seesaw for equilibrium; and (2) back to basics: learning on your feet.

Seesaw for equilibrium

• Participants identified the need to find a balance between the demands and uncertainty of everyday practice and the desire to practice safely
• Participants expressed a difficulty in balancing the ability to adhere to IPC guidelines when performing night duty or working long days as well as the physical demands of the participants’ work
• Dealing with the effect of one’s workload and balancing workloads contributed to behaviours deviating from the IPC guidelines in the clinical practice setting.

Back to basics: Learning on your feet

• Participants expressed frustration in having to deal with other disciplines who appeared to adopt a culture of ‘blame the midwife’ when matters relating to IPC were not put in place
• At an environmental level, the ‘old’ and ‘not fit for purpose’ building infrastructure, physical layout and facilities of wards affected the participant’s ability to adhere to IPC guidelines
• Some participants felt there was an overuse of posters (such as poster promoting hand washing), and the behavioural prompter was lost 
• Participants experienced a ‘reactive rather than proactive’ approach from hospital management when there was an IPC issue

Strengths and limitations

• The number of participants was 10 and only represents a handful of views 
• All the participants were from the same hospital so it would be interesting to extend this out to others to see if the findings are generalizable 

Points for discussion 

• There are clearly challenges in the delivery of safe maternity care whilst trying to maintain IPC guidelines and factors such as work patterns, environment, and resource availability impact guideline adherence
• Do we need to reconsider visual overload? Do we have too many visual cues which confuse the messaging? How can we make our messaging more concise? 
• Strategies like the buddy system, huddle, ISBAR, and behaviour-focused education, along with management support, are crucial.
• There was a narrow focus on certain aspects of standard IPC precautions during the COVID-19 pandemic which led to neglect of other IPC elements. Do we need to revisit IPC guidelines post COVID? 
• How do we strike a balance between delivering IPC safe care whilst dealing with the challenges of a busy, emotionally charged and often stressful working environment?

What does this mean for IPC? 

• Fear, anxiety, professional integrity, and protection were key motivators for guideline adherence. How can we tackle these perceptions to make IPC guidelines less scary and more deliverable? 
• Rapid guideline changes around COVID led to confusion and frustration so do we need to rethink IPC guidance post COVID? Could a refresh help?