Back to Nurture

Building an IPAC culture improves care, outcomes

By Craig Yee

It is well established in healthcare facility environments that infections related to construction, renovation or maintenance activities are a result of several breakdowns, such as lack of proper or clear policies and requirements, including sufficient control methods and measures; late or improper planning and design; late, improper, inadequate or no risk communications; and inadequate education, training and instruction.

These represent symptoms of negative or fractured infection prevention and control (IPAC) cultures that exist and persist, even in today’s modern healthcare environments.

If the objective is to protect occupants from infection risks, then these breakdowns cannot occur. Involved stakeholders must be on the same page to achieve IPAC success.

A workplace culture is the character and personality of an organization, including shared attitudes, values, beliefs, perceptions, traditions, interactions and behaviours. With regard to IPAC, it is a healthcare facility’s foundation upon which susceptible individuals are safeguarded from infections.

Positive, collaborative and transparent healthcare facility cultures are critical to protect occupants from disease. At a high level, culture can significantly impact IPAC as demonstrated by many negative trends based on known evidence; indeed, infectious diseases resulting from various work tasks is not necessarily a result of random error or chance but caused by breakdowns in systems, processes, policies, communication and more.

Positive cultures drive engagement and performance to achieve set goals and objectives. For stakeholders to really ‘buy into’ an IPAC culture, several elements need promoting. This includes senior leadership/ management commitments; implementing realistic, specific practices for addressing and mitigating infections; properly communicating across involved stakeholders (focusing on care and concern for occupant well-being); and committing to continuous organizational learning and improvement.

An IPAC culture is not unlike worker safety culture — infection control to population risk groups is essentially the same as safety to protect workers from hazards. The intents and principles are quite similar but the stakeholders and protection measures are slightly different. Like any workplace culture, it needs to be properly built and maintained for any modicum of success.

If not, consequences can be quite significant, from unintended transmission of incurable diseases to occupant fatalities. Moreover, unaddressed risks can lead to other downstream problems, such as liability, culpability, reputational risks and even loss of public trust. One only needs to look at current infection events to understand the adverse outcomes when a broken, negative culture is allowed to persist.

Committing to and focusing on a proactive, positive IPAC culture can prevent these consequences, over time. Organizations with positive commitments can better prioritize IPAC; anticipate risks, issues and problems; correct, rectify and control problems before harm is done; collaborate with various required stakeholders; and ‘own’

accountability to protect occupants and improve safety outcomes.

However, the road to achieving a positive IPAC culture is beset with several challenges that need to be considered (and controlled). These include: lack of organizational, management and leadership commitment; uncertainty about who needs to be involved; prioritizing production or schedule over IPAC; miscommunications across the organizational hierarchy; ignoring ‘lessons learned;’ absence of proper education, training and instruction; competency failures; and fear of not adhering to political agendas and work schedules.

Regardless of these roadblocks, the most significant question that needs to be asked is: What is each person doing to prevent infections?

If the belief is that infections are preventable (just like safety accidents), then not doing anything or accepting the status quo is, in actuality, intending to have an infectious disease.

For this reason, a paradigm shift is necessary. In fact, it can be argued that this shift is mandatory to protect occupants from potentially significant consequences of infectious disease.

There is great opportunity for positive change. It is never too late to improve efforts to protect occupants from infection risks. However, tough questions need to be asked. Inquiries into why things are the way they are must occur. There is the opportunity to learn from past and current breakdowns, and make necessary improvements to start building a positive IPAC culture.

Stewardship, ownership and leadership is required to challenge the status quo; accept past performance as not ‘good enough;’ rethink previous and current IPAC measures, practices and protocols; move toward more successful IPAC practices; and evolve from what was accepted to continuous improvement.

To create a positive IPAC culture, several foundational building blocks need to be implemented, established and maintained, including leadership/management commitments; risk management systems; continuous improvement systems; clear hierarchies (organizational, reporting); practical IPAC policies, standards and requirements; inspection, monitoring and auditing systems; processes and protocols; and education, training and instruction.

So, what can be done?

There are several ‘low hanging fruit’ items that can be implemented to help start building (or re-building) culture, such as defining clear IPAC policies, requirements and protocols; proactively participating in, and contributing to, multi-disciplinary meetings (where setup); directly engaging and working more collaboratively and openly with IPAC practitioners before facility management work commences; inviting practitioners to participate in planning strategy meetings; and properly communicating with involved healthcare facility stakeholders.

Building a positive IPAC culture takes work but it is necessary to protect those most vulnerable to infectious disease. This requires leaders to lead and others to step up, stakeholders to positively work with one another, and respect and commitment to maintaining and even improving patient outcomes.

After all, when healthcare facilities lose sight of the mission of protecting occupants, it can only detract from keeping those in their care safe.

Craig Yee, founder of Infection Control Training Group, is an industrial hygienist and infection control expert with nearly 20 years’ experience. He has assisted many stakeholders on more than a dozen healthcare facility projects with identifying and managing their infection risks. Craig can be reached at 604-428-8782 or craig@ictg.ca.

OVERCOMING OBSTACLES

Several things can interfere with creating and establishing a long-lasting, positive infection prevention and control (IPAC) culture. These include:

Leadership

• Who is in charge? • How/when are decisions made? • What values, beliefs, perceptions are reinforced? • How do leaders get buy-in?

Management

• How is IPAC managed within the organization? • How are stakeholders supported and empowered? • Are managers consistent in executing their IPAC duties?

Workplace Practices

• What protocols and practices exist? • What has been done? What more is needed? • How is performance tracked and managed?

Policies and Philosophies

• What are the prevailing beliefs? • What policies have been established? Are they being consistently followed? • What actions and behaviours are allowed and condoned?

People

• What people are required? Who is in place and engaged? • What are their daily behaviours and actions? • What level of education and training is needed?

Mission, Vision and Values

• What is the IPAC mission and vision? • Are messages clear and consistently and widely communicated to involved stakeholders? • Are key messages understood?

Work Environment

• What is the current workplace status?

Does it promote positivity and collaboration? • Does it facilitate and support proper IPAC? • What are past and prevailing culture challenges, obstacles and issues?

Communications

• Are systems and reporting hierarchies in place? • What are the communication measures and means? • Are messages clear, transparent and honest?