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Iterative co-creation for improved hand hygiene and aseptic techniques in the operating room: experiences from the safe hands study

Journal article
Authors Annette Erichsen Andersson
Maria Frödin
Liselott (Lisen) Dellenborg
Lars Wallin
Jesper Hök
Brigid M. Gillespie
Ewa Wikström
Published in BMC Health Services Research
Volume 18
Issue 1
Pages 2
ISSN 1472-6963
Publication year 2018
Published at University of Gothenburg Centre for person-centred care (GPCC)
Department of Business Administration, Management & Organisation
Institute of Health and Care Sciences
Pages 2
Language en
Subject categories Business Administration


Background: Hand hygiene and aseptic techniques are essential preventives in combating hospital-acquired infections. However, implementation of these strategies in the operating room remains suboptimal. There is a paucity of intervention studies providing detailed information on effective methods for change. This study aimed to evaluate the process of implementing a theory-driven knowledge translation program for improved use of hand hygiene and aseptic techniques in the operating room. Methods: The study was set in an operating department of a university hospital. The intervention was underpinned by theories on organizational learning, culture and person centeredness. Qualitative process data were collected via participant observations and analyzed using a thematic approach. Results: Doubts that hand-hygiene practices are effective in preventing hospital acquired infections, strong boundaries and distrust between professional groups and a lack of psychological safety were identified as barriers towards change. Facilitated interprofessional dialogue and learning in "safe spaces" worked as mechanisms for motivation and engagement. Allowing for the free expression of different opinions, doubts and viewing resistance as a natural part of any change was effective in engaging all professional categories in co-creation of clinical relevant solutions to improve hand hygiene. Conclusion: Enabling nurses and physicians to think and talk differently about hospital acquired infections and hand hygiene requires a shift from the concept of one-way directed compliance towards change and learning as the result of a participatory and meaning-making process.

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