Unpacking the social dimension of infection prevention and control – it’s not just about the germs. A blog by Julie Storr

Summary

In this blog, hub topic lead Julie Storr talks about her new book Infection prevention and control: A social science perspective, which explores new perspectives on and approaches to infection prevention and control (IPC). The book examines how people and their behaviour affect IPC, and how they are in turn affected by IPC measures. Julie highlights the importance of compassion in IPC policy and implementation and outlines the unintended negative consequences that IPC measures can have.

Among other contributors, Patient Safety Learning's Chief Executive Helen Hughes has written a chapter for the book highlighting the need for patient safety to be treated as a core purpose of health and social care.

Content

Almost every book or film review podcast I listen to these days starts with the author or director explaining that [insert name of book/film] was conceived or developed during the COVID-19 pandemic. My new book about infection prevention and control (IPC) and social sciences, written with two colleagues, is no different. We started work on the book well before 2020, and right in the middle of writing it, the COVID-19 virus dropped. Many of the themes we were focusing on suddenly materialised right before our eyes, and this inevitably influenced the book. 

Focusing on people, not germs

From the outset, our focus was not on germs but on people–those at risk from germs and those who can stop or limit them from spreading. We were also interested in the impact germs have on those who go on to develop an infection, including how individuals with infection and their loved ones are treated by their fellow humans. For example, in the book we give a voice to some of the people directly affected by the restrictions that were imposed on access to health and social care during the pandemic; where IPC was used as a blunt rationale for what became widely termed ’visitor bans’. 

Our book could not have been timelier, focusing on infection and the behaviour of human beings to stop its spread, and completed during this once-in-a-hundred-years global public health emergency. 

The journey to embed the social sciences in IPC

In Leadership Without Easy Answers,[1] written almost 20 years ago, Ron Heifetz suggested that one of the most common leadership mistakes is expecting technical solutions to solve adaptive problems. This theme gained traction with patient safety advocates such as Peter Pronovost and colleagues[2] over the intervening years and had a profound influence on my own perceptions on what we need to focus on in our endeavours to improve healthcare practices through IPC. The COVID-19 pandemic has quite rightly elevated the importance of social sciences in patient safety and IPC, something we see in the World Health Organization’s (WHO’s) commitment to harness the power of behavioural science to improve health.[3] I could not agree more with this focus. As our book reveals however, there is considerable work to do to embed social sciences into IPC competence, decision making and practice. 

Each of the book’s authors have long held the view that an understanding of the concept of the social sciences and its implications within IPC is important. Our first book, Infection Prevention and Control: Perceptions and Perspectives,[4] published in 2015, sowed the seeds of this journey of exploration into the non-technical aspects of IPC and set the foundations for our latest book. Keeping people safe from the risk of infection in healthcare requires deep understanding of medical microbiology and the epidemiology of infectious diseases. You only have to look at the existing textbooks, conferences, academic publications and even podcasts to see this. But we need more than this. At present the scales are categorically tipped in the direction of the very technical, disease specific aspects of IPC. In our book, we are calling for a rebalancing in this regard.

What’s in the book? Opening up the social science perspective

As we state at the start of the book, there is a growing appetite in IPC to look beyond the technical and towards the social, psychological and philosophical factors that influence human behaviour. This is the ethos of the book. We acknowledge that we still only touch the surface of many matters that comprise the social sciences, but our ambition is that we build on existing work so that this thinking continues to trickle outwards. We want it to influence others to pick up this topic and build the body of knowledge in this important area of safety and quality.

There are sixteen chapters and together with our 10 wonderful chapter authors who span several countries and disciplines, we consider a range of IPC issues and try to pull in some social science perspectives. We draw on psychology, sociology, anthropology and philosophy. In some chapters, this is done in a subtle and nuanced way and in others it is much more explicit. 

The book opens by considering the relevance of psychological theories and concepts and then builds on this across each chapter. It explores leadership and influence, power and compliance, patient safety and governance and compassion. Compassion as a social construct[5] is a permeating discourse within the field of healthcare quality[6] and I’m particularly delighted that we include a stand-alone chapter on communication and compassion that addresses the service user perspective. Given my own personal interest in compassion and IPC, the chapters I’ve penned reflect what happens in a ‘compassion void’. I use the example of the restrictions imposed across health and social care during the COVID-19 pandemic, explore the adverse consequences of this and outline the case for compassionate implementation of IPC guidance, explaining how the two are not mutually exclusive. 

The final part of the book looks at some real-world perspectives starting with a comprehensive exploration of human factors in IPC. It explores the use of words and the meaning of language in IPC, drawing on research that provides powerful insights into how the brain mediates behaviour. This focus on the words used in an IPC context has the potential to support guideline implementation. Other topics include social media, infectiousness and stigma and the unintended consequences of campaigns, including whether IPC campaigns make people anxious rather than reassured. Language is again a strong focus of scrutiny in this section. Some personal reflections from a frontline practitioner on the reality of IPC also add an important perspective to the book. 

The book concludes with some musings on philosophy and IPC, even considering the moral worth of microbes, and demonstrates that IPC has a value and philosophical imperative to continue to do what it does to protect humans from harm.

We are not social scientists and it’s important to acknowledge that this book doesn’t purport to be an academic social science textbook. It is our attempt to unpack the social science dimension of IPC so that those responsible for keeping people safe from healthcare associated infection–be they leaders or front-line implementers—consider the social influences and implications of the evidence-based guidance on this topic. 

We start the book by suggesting that the social sciences are the beating heart of infection prevention and control and hope that by the end, readers can make their own mind up on the extent to which this is true.

Related reading

• Infection prevention and control: A social science perspective (1 June 2023)
• Patient Safety Spotlight interview with Julie Storr, global infection prevention and control expert
• Infection Prevention and Control should be an enabler, not a barrier to safe, compassionate human interaction

References

1 Heifetz R. Leadership Without Easy Answers. Harvard University Press, 1998
2 Pronovost P. Navigating adaptive challenges in quality improvement. BMJ Qual Saf, 21 May 2011
3 Altieri E, Grove J, Lawe Davies O et al. Harnessing the power of behavioural science to improve health. Bull World Health Organ, 1 November 2021
4 Elliott P, Storr J & Jeanes A. Infection Prevention and Control Perceptions and Perspectives. Routledge, 2016
5 Blackstone A. Doing Good, Being Good, and the Social Construction of Compassion.  Journal of Contemporary Ethnography, 1 February 2009
6 Fotaki M. Why and how is compassion necessary to provide good quality healthcare? Int J Health Policy Manag, 16 March 2015

About the Author

Julie is a global healthcare consultant and is co-founder and director at the healthcare consultancy KHSC. She has twenty years' experience working at both national and international levels on a number of campaigns and patient safety improvement programmes, including for the World Health Organization. She is Past President at the Infection Prevention Society of the UK and Ireland.