Identifying research priorities for infection prevention and control. A mixed methods study with a convergent design

Background

Meaningful research creates evidence for Infection Prevention and Control (IPC) practice.

Aim

To establish Infection Prevention Society (IPS) members' research priorities to support future research projects.

Methods

A mixed methods convergent parallel design incorporating a cross-sectional survey of IPS members (2022-2023), and focus group findings from the IPS Consultative Committee, (October 2022). Quantitative data were analysed using descriptive statistics. Qualitative data were transcribed verbatim, entered into NVivo 12, and analysed using a thematic analysis approach.

Findings/Results

132 IPS members responded to the survey, including 120 (90.9%) nurses. The three most prevalent priorities were: Quality Improvement and Patient Safety (n = 84, 16.1%); IPC Training and Education (n = 77, 14.8%); and IPC Evidence-based Guidelines (n = 76, 14.6%). Analysis of the focus group transcripts identified six emergent themes 'Patient Centred Care', 'Training and Education', 'IPC Role and Identity', 'IPC Leadership', 'IPC is Everyone's Responsibility', and 'Research Activity'. Triangulation of findings demonstrated concordance between quantitative and qualitative findings with Quality Improvement and Patient Safety (QIPS) and Training and Education identified as priority research areas.

Discussion

This study highlights the necessity of developing support systems and incorporating research priorities in QIPS, as well as Training and Education. The findings of this study align with the recommended core competencies and components for effective infection prevention and control programs, making them relevant to QIPS initiatives. The outcomes of the study will serve as a valuable resource to guide the IPS Research and Development Committee in delivering practical support to IPS members.

Ethnographic study using Normalization Process Theory to understand the implementation process of infection prevention and control guidelines in Ireland

OBJECTIVE

The aim of this study was to explore how infection prevention and control (IPC) guidelines are used and understood by healthcare professionals, patients and families.

DESIGN

Ethnographic study with 59 hours of non-participant observation and 57 conversational interviews. Data analysis was underpinned by the Normalization Process Theory (NPT) as a theoretical framework.

SETTING

Four hospitals in Ireland.

PARTICIPANTS

Healthcare professionals, patient and families.

RESULTS

Five themes emerged through the analysis. Four themes provided evidence of the NPT elements (coherence, cognitive participation, collective action and reflexive monitoring). Our findings revealed the existence of a 'dissonance between IPC guidelines and the reality of clinical practice' (theme 1) and 'Challenges to legitimatize guidelines' recommendations in practice' (theme 3). These elements contributed to 'Symbolic implementation of IPC guidelines' (theme 2), which was also determined by a 'Lack of shared reflection upon IPC practices' (theme 4) and a clinical context of 'Workforce fragmentation, time pressure and lack of prioritization of IPC' (theme 5).

CONCLUSIONS

Our analysis identified themes that provide a comprehensive understanding of elements needed for the successful or unsuccessful implementation of IPC guidelines. Our findings suggest that implementation of IPC guidelines is regularly operationalised through the reproduction of IPC symbols, rather than through adherence to performance of the evidence-based recommendations. Our findings also provide insights into changes to make IPC guidelines that align with clinical work.

Tumor activity confirmation and isodose curve display for patients receiving iodine-131-labeled 16.88 human monoclonal antibody

A study was performed to correlate activity quantitation derived from external imaging with surgical tumor specimens in patients who received radiolabeled monoclonal antibody. Patients were given I-131 labeled 16.88 human antibody and scanned 3-5 times by planar and/or single photon emission computed tomography imaging methods to acquire time-dependent activity data in tumor and normal tissues. A method also was developed to assess the heterogeneous activity distributions in tumor samples. Postsurgical tumor and normal tissue samples were subdivided into volume elements (voxels) of 0.5 cm x 0.5 cm x 0.05 cm thick, which were used to verify the activity quantitation computed by the conjugate view method and to appraise the heterogeneity of radiolabeled antibody uptake. Through the use of the measured voxel activities, along with the time-dependent activity curves available for the entire tumor specimen derived from imaging, the cumulated activity and absorbed dose for each voxel were uniquely determined. The calculated total absorbed dose values were color-coded as isodose curves and overlaid on a correlated computed tomographic image. In two patients, activity quantitation derived from external imaging correlated with surgical tumor resection specimens within +/- 11%. The tumor-absorbed dose heterogeneity ratio was found to be as high as 10:1, with an average tumor to whole body absorbed dose ratio of 4:1. The mapping of activity with a histologic overlay showed a good correlation among activity uptake, the presence of tumor, and antigen expression on a microscopic scale. The resultant isodose curves overlaid on correlative computed tomographic scans represent the first images obtained with actual radiolabeled antibody biodistribution data in patients.