Is infection prevention and control guidance fit for people? (a blog by Julie Storr)

Summary

Julie Storr is an expert in the field of patient safety, quality and infection prevention and control (IPC), and a Topic leader for the hub. 

In this blog, Julie explores how IPC guidance can inadvertently lead to psychological harm, when it is not applied through a person-centred lens. Drawing on literature and reflecting on the COVID-19 pandemic, she questions whether guidance supports both compassion and safety when applied in practice. 

Content

Infection prevention and control guidance

Healthcare guidance is designed to support the delivery of safe, high quality care by providing clear and consistent recommended best practices based on available evidence. In infection prevention and control (IPC), guidance typically focuses on:

• transmission routes
• precautions
• clinical interventions
• isolation and a range of environmental controls.

At the point of care, guidance is interpreted by health care workers, in context and often under pressure.

IPC is widely described as fundamental to patient safety and quality of care. Its foundations in microbiology and epidemiology have saved countless lives and it has deep roots in the biomedical model. From Louis Pasteur to Florence Nightingale, its legacy is grounded in germ theory, surveillance, and control. This has resulted in highly effective, evidence-based systems and has also shaped guidance that is often highly technical, precaution-focused, and written in absolutes.

The cost to human connection

During COVID-19 the gap between guidance and practice was brought to the forefront. Preventing the transmission of a single infection became the dominant goal, sometimes at the expense of human connection.

Stories of people dying without loved ones, or families waving through windows, are reminders that safety without humanity can equally result in harm.

This gap between policy and practice became highly visible and caught the attention of many working in the field of IPC and beyond, including myself. Elements of this story have been told many times now, including in a previous blog for Patient Safety Learning.

When ‘technically safe’ risks psychologically harm

In reviewing a sample of international and national IPC guidelines recently, a few things stood out. Many run to hundreds of pages, detailing precautions in depth. The language is directive, one guideline from the English NHS used the word “must” close to 100 times, reinforcing certainty and compliance. By contrast, words like person-centred, compassion, loneliness, or humanity were rarely, if ever, used. Even anxiety appears only occasionally, often without guidance on how to allay fear.

What is less visible in much IPC guidance is the person. This has been described by colleagues as the grey space, where the human dimension is under-specified and staff are left to navigate complexity themselves often under pressure.

In those conditions, guidance can quickly become black and white. This can lead to decisions that are technically safe but that may contribute to psychological harms. As one reflection from the period of the pandemic put it, in the case of some loved ones “we protected them to death.”

The implementation gap

This tension between IPC guidance as written and as experienced in practice reflects a wider challenge, long recognised in patient safety: the implementation gap. As highlighted by Patient Safety Learning, this is the disconnect between patient safety guidance working in theory, but not in practice.

Actions that may appear to address patient safety issues failing to account for a wide variety of organisational context, culture and capacities.

In the context of IPC, guidance may be evidence-based and technically robust, but if it does not account for the realities of care delivery or the human needs of patients, it risks being applied in ways that are rigid, inconsistent or inadvertently harmful. Patient Safety Learning have emphasised that this gap persists where there is a lack of joined-up approaches, weak systems for sharing learning, limited oversight, and unclear leadership.

Building on existing learning

There are examples to learn from.

• Some guidance now acknowledges the psychological impact of isolation on people and a recent IPC guideline from Ireland is strong on person centredness.
• Frameworks from America and Canada have been developed that support ethical decision-making. But certainly within the guidelines I reviewed, in the majority, these elements are often brief, dare I say tokenistic, a sentence or at most a paragraph in documents of hundreds of pages, rather than embedded.
• Patient safety literature is increasingly recognising the importance of compassion as a core mechanism for safer care. As one review puts it, “compassionate interactions… can help to identify and address potential risks… that could endanger patient safety”.  

If IPC guidance is to be truly fit for purpose and for all people, it must move beyond acknowledging person-centredness to embedding it as a core element of patient safety.

That means supporting staff to communicate risk in ways that inform rather than alarm, creating space for proportionate discretion, and treating patients and families as partners in prevention rather than passive recipients of rules. IPC can be person-centred. Some are already leading the way. But there is some way to go for this to be fully considered the norm across our health care systems.

So where do we go from here?

When IPC practitioners were asked on a recent webinar what person-centred IPC looks like, the answers were strikingly human: compassion, empathy, dignity, connection. For those designing, leading and delivering healthcare, a simple question may therefore be useful:

Does our guidance support not only the prevention of infection, but the experience of safe, compassionate care?

If the answer is not yet fully yes, then there is an opportunity for improvement.