An exploration of cultural issues affecting staff compliance with recommended infection prevention and control practices in a ‘ring-fenced’ acute hospital elective surgical ward

Healthcare associated infection (HCAI) poses a serious threat to patients admitted into hospital as well as health care staff. Whilst recommendations for preventing HCAI exist, many research studies, primarily quantitative in nature, have reported serious concerns about the suboptimal infection prevention and control (IPC) practices adopted by healthcare workers (HCWs) within acute clinical settings. However, there remains a lack of understanding about why suboptimal practices persist. Although quantitative studies have identified poor staff compliance with the IPC recommended practices, attempts to tackle the problem have yielded limited success. It is suggested that a key reason for this is the failure to take into account the cultural context in which the non-compliant behaviours take place. This qualitative study, guided by ethnographic principles, uses a combination of focus groups and individual interviews with frontline staff and organisational leaders to explore cultural issues affecting staff compliance with recommended IPC practices in a ring-fenced acute hospital elective surgical ward (ESW). The study reveals that noncompliance with IPC policies and procedures in the ESW was legitimised and subsequently tolerated by both frontline and managerial staff, especially when the acute hospital was under stress. In particular, the ESW operational ring-fencing policy for protecting elective surgical patients from HCAI acquisition was repeatedly breached due to the conflicting pressures and competing demands of a busy hospital environment. The findings challenge the sustainability of the policy of ring-fencing the ESW as a discrete component of a busy acute hospital in order to protect elective surgical patients from HCAI in the context of the current healthcare system. It is highly likely that, as people live longer due to advances in medicine and technology, the demand for trauma and medical emergency beds will increase in the future, rendering the ring-fencing of any bed unsustainable in an acute hospital setting.