Lyn Gilbert1, Suyin Hor1,2, Mary Wyer1
1Westmead Institute for Medical Research and Sydney Health Ethics, University of Sydney
2Faculty of Health, University of Technology, Sydney.
Video-reflexive ethnography (VRE) is a relatively new methodology, which has been used in several areas of healthcare research, to stimulate “exnovation” – a process by which healthcare workers (HCWs) can review and reflect on their often taken-for-granted practice. Video footage of real-time practices are shown back to participants and their colleagues in reflexive sessions where they collectively make sense of their work and negotiate meaningful, context-appropriate ways to improve it.
Our group has recently used VRE (renamed video-reflexive methods, VRM, for IPC projects), to partner with frontline HCWs, to understand the complexity of their routine work and the problems they encounter in enacting some IPC “rules” in busy clinical settings and to enable them to identify ways to modify practices to take account of local conditions, whilst remaining faithful to the rules’ intent.
In 2 surgical wards with very high MRSA prevalence, we used periodic point prevalence surveys of MRSA colonization and retrospective monitoring of MRSA infection (inferred from clinical isolates) to assess the effectiveness of VRM methods in addition to conventional IPC measures (hand hygiene education and audits and enhanced environmental cleaning). All MRSA isolates were strain-typed.
There was a steady fall in colonization prevalence, which began during the 6-month VRM project and was maintained over the 3-year study period. MRSA clinical isolation rate fell, overall, although it increased temporarily when an ST22 strain replaced ST239 as the predominant circulating clone.
Qualitative data, recorded during reflexive sessions, confirmed that observation and discussion of video clips stimulated HCWs and patients’ awareness of potential MRO transmission risks and enabled them to develop innovative solutions for safer care. Furthermore, when HCW were presented with footage of patients analysing videoed care for infection risks, HCW were motivated to reflect on and reshape their assumptions and practices around patient involvement in IPC.
Based on this experience we have embarked on a series of projects to assess the effectiveness of VRM in HCW training in the use of personal protective equipment and other IPC measures, with the aim of improving the routine use of PPE and standard of IPC practice and preparing frontline HCWs for any future infectious disease emergency.