The overall aim of this research was to explore why some hospitals are more successful than others at reducing the acquisition rates of multidrug-resistant organisms. Using a socio-ecological perspective on health systems adapted from works in ecological restoration, ecosystems management, and healthcare, a participatory comparative case study design was employed. The study was collaboratively conducted on a surgical unit at a Netherlands hospital with very low rates of multidrug-resistant organisms and a surgical unit in a Canadian hospital with higher rates of these pathogens. The cases were selected on the basis that they were both academic health sciences centres of similar size in publicly funded systems; yet, they reported differing rates of MDRO infections. Research methods included a total of six unit observations, nine practitioner-led photo walkabouts of the units (n=13), six photo elicitation focus groups with practitioners (n=26), and the review of relevant policies and procedures and related infection prevention and control data.
Common findings across both cases include the perceived importance of engaged leadership, the presence of environmental design issues, a lack of antibiotic prescribing restrictions, and the frequent use of workarounds that may be problematic for infection prevention and control. Disparate findings between cases include differences in ratios of hospital beds per capita, bed occupancy rates, staffing practices, equipment cleaning processes, bed cleaning systems (centralized versus manual) and the presence, in one hospital, of an active grass roots Hygiene in Practice group engaging practitioners in several ongoing activities to promote infection prevention and control. There is a lack of comparable findings between the two cases on hand hygiene audit protocols, surveillance strategies, reporting of acquisition rates, and the nature and extent of high risk populations for community-acquired methicillin-resistant Staphylococcus aureus in the two hospitals catchment areas. The findings and methodological challenges identified in this study suggest that case selection in future comparative infection prevention and control case studies should be based on an expanded list of criteria. These criteria should include comparable audits, surveillance, and reporting practices and comparable demographic and other relevant data, such as data on the agricultural practices within and demographic attributes of vulnerable populations within the hospital catchment areas.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:AEU.10048/1818 |
| Date | 06 1900 |
| Creators | Backman, Chantal |
| Contributors | Marck, Patricia Beryl (Nursing), Krogman, Naomi (Rural Economy), Taylor, Geoffrey (Medicine and Dentistry), Sales, Anne (Nursing), Barton, Sylvia (Nursing), Stone, Patricia W. (Nursing) |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | en_US |
| Detected Language | English |
| Type | Thesis |
| Format | 7512833 bytes, application/pdf |
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