Background: All health workers should take responsibility for infection prevention and
control (IPC). Recent reduction in key reported healthcare-associated infections in the UK
is impressive, but the determinants of success are unknown. It is imperative to understand
how IPC strategies operate as new challenges arise and threats of antimicrobial resistance
increase.
Methods: The authors undertook a retrospective, independent evaluation of an action
plan to enhance IPC and ‘ownership’ (individual accountability) for IPC introduced
throughout a healthcare organization. Twenty purposively selected informants were
interviewed. Data were analysed inductively. Normalization Process Theory (NPT) was
applied to interpret the findings and explain how the action plan was operating.
Findings: Six themes emerged through inductive analysis. Theme 1: ‘Ability to make
sense of ownership’ provided evidence of the first element of NPT (coherence).
Regardless of occupational group or seniority, informants understood the importance of
IPC ownership and described what it entailed. They identified three prerequisites: ‘Always
being vigilant’ (Theme 2), ‘Importance of access to information’ (Theme 3) and
‘Being able to learn together in a no-blame culture’ (Theme 4). Data relating to each
theme provided evidence of the other elements of NPT that are required to embed
change: planning implementation (cognitive participation), undertaking the work
necessary to achieve change (collective action), and reflection on what else is needed to
promote change as part of continuous quality improvement (reflexive monitoring). Informants
identified barriers (e.g. workload) and facilitators (clear lines of communication
and expectations for IPC).