Dr Joanna Harris1, Dr Hazel Maxwell2, Prof Susan Dodds3
1Illawarra Shoalhaven Local Health District, Warrawong, Australia
2University of Tasmania, Sydney, Australia
3La Trobe University, Melbourne, Australia
This presentation describes a qualitative interpretive description study scaffolded on theories of biomedical ethics, theory of planned behaviour, and the contemporary infection prevention and control evidence base. The research question asked: ‘Are Contact Precautions ethically justifiable in contemporary hospital care?’ Four themes, demonstrating conflicts with bioethical principles of respect for autonomy, justice, beneficence and non-maleficence, were found. The wider evidence base fails to confirm CP as effective in preventing MRO acquisition. Recommendations for ethically strengthened infection prevention and control policy and practice, and suggestions for further research are made.
Introduction: Health policymakers are committed to controlling multi-resistant organisms (MROs) in hospitals. Infection prevention and control (IPC) measures known as Contact Precautions (CP) were developed in the 1980’s however MROs persist. Research objectives were to understand the impact of CP on patients and health-professionals, to discuss study findings from a bioethical perspective, and make recommendations for ethically sound management of MRO-colonised hospital patients.
Methods: Interpretive description scaffolded upon theories of planned behaviour, principles of bioethics, and extensive researcher experience in IPC, framed this qualitative study. Findings derived from thematic and axial coding of 33 semi-structured interviews were explored alongside contemporary published research.
Results: Four themes were: Powerlessness moving to acceptance; You feel a bit of a pariah; Others need protection, but I need looking after too; Doing Contact Precautions is not easy.
Conflicts are identified with the bioethical principle of respect for personal and professional autonomy due to suboptimal communication, particularly regarding adherence to informed consent requirements. Patients experience inequality of care provision and discriminatory practices, which breach the principle of justice. CP elicit stigma for patients, and moral distress and inter-personal conflict for staff, breaching the principle of non-maleficence. Under the principle of beneficence, a pluralistic cost–benefit assessment of CP situates them as a low-value practice.
Conclusion: CP challenge organisational culture, professional well-being, and person-centred ethical care. This study finds ethical costs of CP outweigh benefits, thereby placing an obligation upon IPC policy-makers to reconsider using CP as the core IPC mechanism for patients colonised with an MRO.
Biography: Dr Joanna Harris qualified as a nurse and a midwife in the UK and has practised in hospital and community-based settings. She has more than 25 years experience in infection prevention and control in the UK and in NSW, Australia where she has lived since 2007. Her mission is that health care associated infection should not be accepted as a normal part of contemporary healthcare.
Joanna is proud to present this work, which was the subject of her recently completed PhD (Nursing) with the University of Tasmania.