A Qualitative Examination of Interprofessional Teamwork for Infection Prevention: Development of a Model and Solutions

Abstract

Health care–associated infections (HAIs), such as central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs), are associated with patient mortality and high costs to the health care system. These are largely preventable by practices such as prompt removal of central lines and Foley catheters. While seemingly straightforward, these practices require effective teamwork between physicians and nurses to be enacted successfully. Understanding the dynamics of interprofessional teamwork in the HAI prevention context requires further examination. We interviewed 420 participants (physicians, nursing, others) across 18 hospitals about interprofessional collaboration in this context. We propose an Input-Mediator-Output-Input (IMOI) model of interprofessional teamwork in the context of HAI prevention, suggesting that various organizational processes and structures facilitate specific teamwork attitudes, behaviors, and cognitions, which subsequently lead to HAI prevention outcomes including timeliness of line and Foley removal, ensuring sterile technique, and hand hygiene. We then propose strategies to improve interprofessional teamwork around HAI prevention.

Communication openness and nosocomial infection reporting: the mediating role of team cohesion

“…Theses findings clarify the unknown relationship between communication openness, team cohesion and nosocomial infection reporting, since most previous studies focused on the direct role of team cohesion rather than the mediation [ 26 , 35 ]. Furthermore, previous studies on the mediating effect of team cohesion were mostly reflected in public management and leadership management [ 14 , 38 ].…”

“…Quantitative study showed that pharmacists with good communication openness were 40% more likely to have submitted a medical error reporting, therefore communication atmosphere potentially impacted the likelihood of error reporting, which in turn, could impact patient safety [ 19 ]. Medical staff avoided to report publicly adverse events and discussing errors (such as unreasonable aseptic techniques and hand hygiene), possibly due to internal pressure from fear of recrimination or punishment [ 18 , 26 ]. However, Manojlovich explored the relationship between nurses’ perceptions of elements of communication (one being communication openness) and rates of selected outcomes (pressure ulcers and nosocomial infection), and found that communication openness between physicians and nurses was not related to outcomes [ 31 ], which was inconsistent with the results of this study.…”

“…It was consistent with the results of related studies.The results of a meta-analysis revealed stronger correlations between cohesion and performance when performance was defined as behavior [ 35 ]. Cross-disciplinary collaboration between medical professionals may contribute to the enhancement of psychologically safe atmosphere and cohesion, so as to be key to preventing nosocomial infection [ 26 ]. Previous study has found that leaders play a significant role in promoting team cohesion.…”

“…The view that effective team cooperation in health care can create a positive organizational atmosphere and improve treatment outcomes was supported [ 25 ]. Moreover, if teams were indeed working well together, they were subject to less internal pressure to speak up about infections thus improving adverse outcomes [ 26 ]. Based on the effect of team cohesion on healthy behaviors, we propose the third hypothesis that team cohesion is positively related to nosocomial infection reporting (Hypothesis 3).…”