Infection prevention and safety performance – relevance and implications for patient safety

Abstract

The World Health Organization describes safe healthcare as a fundamental human right that have to be achieved in collaboration with patients. Organizational safety and patient safety are based on the human factors approach. A critical factor contributing to healthcare-associated infections, frailty and even death of nursing home residents is the knowing-doing-gap in evidence-based infection prevention measures. This dissertation improves patient safety in healthcare facilities through a deeper understanding of the human factors that influence infection prevention and safety performance. 1) The primary aim is to investigate the influence of individual and organizational factors on nurses' hand hygiene, focusing on managers role model. 2) The secondary aim is to explore the hand hygiene behavior of general practitioners while visits in nursing homes, their attitudes towards hygiene measures and their enablement of hand hygiene performance of residents. 3) The tertiary aim is to provide a general perspective on safety performance and to understand how this construct influences the work of healthcare professionals in ensuring patient safety. The Integrative Model of Workplace Safety by Christian et al. (2009) and the Systems Engineering Initiative for Patient Safety by Carayon et al. (2020) provide as the theoretical frameworks. (1) and (2) publications are based on data collected between 2011 and 2015 in six nursing homes as part of the project "Intersectoral Elderly Care for the Prevention of Nosocomial Infections and Antibiotic Resistance in Nursing Homes (PränosInAA)". (3) publication is based on data from the "Safety Performance of Healthcare Professionals (SPOHC)" project, which was carried out between 2018 and 2020. (1) is a mixed-methods study in which 165 nurses were surveyed and 27 care managers were interviewed. (2) is a qualitative study in which 24 semi-structured interviews were conducted with 12 GPs and 12 nursing home residents, using content analysis of the data.(3) a qualitative approach and content analysis of the data is used to examine the interviews of 23 healthcare professionals on the perspectives of safety performance in acute care. The findings emphasize the importance of human factors approaches to improving patient and workplace safety and highlight the critical role of patient engagement in ensuring patient safety. Further research is needed to validate these findings in current contexts, and interventions that focus on the spatio-temporal perspective of the patient journey are essential to improve patient safety in healthcare.