POORLY PERCEIVED PERSONAL ACCOUNTABILITY: INFECTION CONTROL'S MISSING LINK?

  

Purpose: Healthcare-associated infections (HAIs) inflict a substantial, preventable, burden of morbidity and mortality. Most interventions focusing on changing individuals’ infection control (IC) behaviour have not proven effective. Successful interventions, notably the central-venous-catheter infection prevention bundle, assign responsibility to teams, not individuals. We hypothesized that healthcare staff do not hold themselves personally responsible and accountable for the transmission of pathogens between patients.    

Method: Healthcare staff personnel were presented with a structured questionnaire inquiring about the perceived preventability of HAIs and whether such infections are thought to be personal and/or team failures. Additionally, they were presented with six models which had either a single staff member, or a team, attending patients. The individual/staff were either (a) completely none-compliant with IC measures; (b) had current compliance rates; or (c) completely compliant. Each model presented a group of hospitalized patients; one patient was colonized with a transmittable pathogen. Participants were asked to predict which of the other patients would become colonized.   

Result: Most respondents evaluated cross-transmission risk as dichotomous, idealizing complete IC compliance. The extent to which individuals attributed pathogen transmission to themselves was minimal and very similar to the hypothetical ideal staff member who completely complied with IC measures. Among individuals who reported a sense of personal failure, when their patients were newly colonized with HAIs, this dichotomy was less evident. Current team practices were associated with extensive pathogen transmission, equating with a completely IC non-compliant hypothetical team.   

Conclusion: Participants identified with ideal individuals; yet they denounced their teams, attributing cross-transmission of pathogens to group behaviour. IC policy must not rely on staff perceptions of pathogen transmission probabilities, as these are extremely biased; nor can it rely on individual sense of personal responsibility for pathogen cross-transmission, since it, too often, does not exist. Decision theory assumptions might not be applicable to many aspects of IC behaviour, which is acquired through long standing practice and mimicry. Rarely, if ever, do staff members realize the adverse consequences of their individual lack of IC compliance. Developing team-centered procedures and promoting team solidarity are potential avenues for improvement. However, novel behavioural work environments are required if these principles are to be applied to increase individuals’ hand-hygiene compliance – this single most important aspect of infection control.