Silent practices: imperatives of a culture of urgency

Abstract

Despite advances in both technology and the delivery of health care services, health care associated infection (HAI) continues to exact a significant cost from both the patient and the health care provider. Studies monitoring practice and investigating outbreaks of HAI indicate that many of these infections are preventable if clinicians comply with basic infection control principles. Success in improving infection control practice has, to date been poor. This study sought to identify the impact of the clinical culture of the intensive care unit (ICU) on infection control practice. A clinical ethnography was undertaken at a large regional acute care facility. Data were collected through participant observation and individual interviews. This paper reports a part of the findings, specifically an issue conceptualised as silent practices. These are constructions that reflect imperatives of the intensive care environment and how these interact with infection control practice. The findings reported here indicate that, in the ICU, environmental dynamics construct imperatives and priorities that have a negative impact on infection control practice.