Using a clinical governance framework to identify barriers to infection control practice

Kate Halton 1, Lisa Hall 1, Anne Gardner 2, Deborough MacBeth, Brett Mitchell 2,4

Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD

School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Dickson, ACT

Faculty of Nursing Arts, Nursing and Theology Health, Avondale College of Higher Education, Wahroonga, NSW


Background: Strong clinical governance is recognised globally as integral to the provision of safe, high quality health services. Clinical governance includes the dimensions of quality methods, performance, coherence, infrastructure, culture and risk avoidance. Traditionally, the areas of surveillance, auditing for quality improvement and performance have been key areas for infection control practice, in addition to evidence based practice and policy. We explored how contextual and organisational factors influence the nexus between evidence based practice and strong clinical governance for infection control professionals.

Methods: A cross sectional online survey of infection control professionals in Australia and New Zealand was undertaken to elicit perceptions about context, culture and leadership with their team and their organisation. Responses were mapped against dimensions of Scally and Donaldson’s clinical governance framework.

Results: Surveys were completed from 300 infection control professionals .The biggest challenge to strong clinical governance was the lack of leadership or resistance to infection control within the organisation. Further challenges included a lack of Information technology solutions, and poor access to specialist expertise. Infection control professionals were heavily engaged in policy development and strategic planning, activities that assist the implementation of evidence based practice.

Conclusion: Using the clinical governance framework to understand the context in which infection control operates, may be a useful in identifying barriers to practice and good governance. To assist infection control professionals in facilitating the implementation of evidence based practice, there needs to be a focus on strengthening contextual factors, such as coherence, infrastructure and culture at the organisational level.

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