Infection Prevention and Control in Residential Aged Care Facilities In and Out of Recent Pandemics: A Scoping Review Protocol

Abstract Background The longstanding problem of infection prevention and control (IPC) in residential aged care facilities (RACFs) has been highlighted and seriously exacerbated by the COVID-19 pandemic. The risk of severe illness and death from COVID-19 among aged care residents is increased by age, comorbidities and the congregate living arrangements, which often also function as healthcare settings. Implementation of IPC practices are intended to protect residents and staff from infectious disease risks, but can also impact on other dimensions of wellbeing and safety. Objectives To identify evidence of effective IPC strategies in RACFs and their impacts on resident or staff safety or wellbeing, during both ‘business as usual’ and infectious disease outbreaks. Methods We will search relevant databases for original research articles, published in 2000 or later, that examine (1) IPC measures and/or (2) infectious disease outbreaks in (3) in residential aged care settings, whilst (4) considering resident and/or staff wellbeing and/or safety. Following Preferred Reporting of Systematic Review and Meta-Analysis for Scoping Reviews (PRISMA-SCR) and consultation with a university librarian, we have devised a search strategy for review of relevant key articles. One author customised the search strategy for each database (CINAHL, Embase, Cochrane, MEDLINE, Scopus and Web of Science) and reviewed each term before inclusion. After deletion of duplicates, 2-4 reviewers will screen references by title and abstract, then review full texts of selected articles. Items included will be charted with respect to publication details and quality assessment performed. Results will be grouped according to thematic contributions. Results Systematic searches began at the end of 2021 and data extraction will progress in early 2022, followed by data analyses and writing. Anticipated conclusions Implementation of IPC practices in RACFs must balance effectiveness, feasibility, and wellbeing and safety of residents and staff. This review will summarise, and identify gaps in, evidence for how best to protect residents and staff from infection in long term aged care settings. Support Partial financial support for this project has been provided by the Sydney Institute for Infectious Diseases, University of Sydney

Disagreement among experts about public health decision making: is it polarisation and does it matter?

It is common for aspects of the COVID-19 response - and other public health initiatives before it - to be described as polarised. Public health decisions emerge from an interplay of facts, norms and preferred courses of action. What counts as evidence\u27 is diverse and contestable, and disagreements over how it should be interpreted are often the product of differing choices between competing values. We propose a definition of polarisation for the context of public health expertise that acknowledges and accounts for epistemic and social values as part of evidence generation and its application to public health practice. The polarised\u27 label should be used judiciously because the descriptor risks generating or exacerbating the problem by oversimplifying complex issues and positions and creating groups that seem dichotomous. Independence\u27 as a one-size-fits-all answer to expert polarisation is insufficient; this solution is premised on a scientistic account of the role of evidence in decision making and does not make room for the value difference that is at the heart of both polarisation and evidence-based decision making

Facilitating Whole Person Care Using Video Reflexive Ethnography

Aim: Explore the application and potential of video reflexive ethnography (VRE) to facilitate whole person care (WPC).Objectives: Discuss the ethical issues associated with VRE; explore the foundations of the methodology; and discuss its potential to facilitate WPC.Description: WPC requires a paradigm shift in how we see those we care for, how we see our co-workers and how we see ourselves. VRE involves videoing real-time everyday clinical practice and or patient and family accounts of care, and then involving participants to analyse the visual data that they feature in or have gathered themselves. Uniquely, video footage can challenge the taken for granted and attune people to dimensions of themselves and others that they might not otherwise have considered. This has the potential to open people up to alternative ways of thinking and perceiving, being and acting. It offers “transformative potential” towards WPC.We draw from our diverse disciplinary perspectives to explore the potential of VRE as a tool to facilitate WPC. Using specific examples from five research studies, this workshop will demonstrate the use of VRE in a variety of health care contexts. The contexts of the studies we draw from include: end of life care; autism diagnostics; infection control, and intensive care.The workshop proceeds in four parts. We first invite you, the participant, to engage in a video reflexive event, where you are expected to reflect on the socio-interactive conduct that you produce as a group in response to a specific task.  We then describe the process of VRE, outline its pedagogic and theoretical foundations, and present some examples from our research. We then invite questions about the theoretical basis and practical approach of VRE. Finally, participants will be asked to project a version of reflexive video onto their 'home' area of research, and reason about potential outcomes.1. Carroll, K., Iedema, R.  and  Kerridge, I. 2008, 'Reshaping ICU Ward Round Practices Using Video Reflexive Ethnography', Qualitative Health Research, vol. 18, no. 3, pp. 380-390.2. Collier, A. 2012, 'Safe Healing Environments', in N. Godbold  and  M. Vaccarella (eds), Autonomous Responsible Alone: The Complexities of Patient Empowerment, Interdisciplinary Press, London, pp. 155-170.3. Iedema, R. 2011, 'Creating Safety by Strengthening Clinicians' Capacity for Reflexivity ', British Medical Journal, vol. 20, pp. S83-S86.4. Iedema, R.  and  Carroll, K. 2011, 'The 'clinalyst': Institutionalising reflexive space to realise safety and flexible systematisation in health care', Journal of Organisational Change Management vol. 4, no. 1, pp. 65-86.5. Iedema, R., Long, D., Forsyth, D.  and  Lee, B.B. 2006, 'Visibilising Clinical Work: Video ethnography in the contemporary hospital', Health Sociology Review, vol. 15, pp. 156-168

Paradoxes of pandemic infection control: Proximity, pace and care within and beyond SARS-CoV-2

From the adoption of mask-wearing in public settings to the omnipresence of hand-sanitising, the SARS-CoV-2 pandemic has brought unprecedented cultural attention to infection prevention and control (IPC) in everyday life. At the same time, the pandemic threat has enlivened and unsettled hospital IPC processes, fracturing confidence, demanding new forms of evidence, and ultimately involving a rapid reassembling of what constitutes safe care. Here, drawing on semi-structured interviews with 63 frontline healthcare workers from two states in Australia, interviewed between September 2020 and March 2021, we illuminate some of the affective dimensions of IPC at a time of rapid change and evolving uncertainty. We track how a collective sense of risk and safety is relationally produced, redefining attitudes and practices around infective risk, and transforming accepted paradigms of care and self-protection. Drawing on Puig de la Bellacasa's formulation, we propose the notion of IPC as a multidimensional matter of care. Highlighting the complex negotiation of space and time in relation to infection control and care illustrates a series of paradoxes, the understanding of which helps illuminate not only how IPC works, in practice, but also what it means to those working on the frontline of the pandemic

The National Open Disclosure Pilot: evaluation of a policy implementation initiative

Objective: To determine which aspects of open disclosure "work" for patients and health care staff, based on an evaluation of the National Open Disclosure Pilot. Design, setting and participants: Qualitative analysis of semi-structured and open-ended interviews conducted between March and October 2007 with 131 clinical staff and 23 patients and family members who had participated in one or more open disclosure meetings. 21 of 40 pilot hospital sites, in New South Wales, South Australia, Victoria and Queensland, were included in the evaluation. Participating health care staff comprised 49 doctors, 20 nurses, and 62 managerial and support staff. In-depth qualitative data analysis involved mapping of discursive themes and subthemes across the interview transcripts. Results: Interviewees broadly supported open disclosure; they expressed uncertainty about its deployment and consequences, and made detailed suggestions of ways to optimise the experience, including careful pre-planning, participation by senior medical staff, and attentiveness to consumers' experience of the adverse event. Conclusion: Despite some uncertainties, the national evaluation indicates strong support for open disclosure from both health care staff and consumers, as well as a need to resource this new practice