The structure of causal attribution in Healthcare-Associated Infections: A Network Analysis

Background: Globally, healthcare-associated infection (HCAI) affects one in ten patients admitted to hospitals (Lahsaeizadeh, et al., 2008). It is unfortunate that some patients who come to the healthcare facilities to get treated of their different ailments would encounter HCAIs at a point in delivering the course of treatment or management; and these occurring through healthcare workers (Sie, et al., 2008; Ulger, et al., 2009).

Objective: The purpose of this study is to elucidate the spatial structure, pattern, extent and direction of causal attribution in HCAIs using a network analysis, especially to establish whether there exists a consensual representation, and if established, which inferred causes of the healthcare-associated infections were perceived as being proximal or distal causes and which were perceived to modify the effects of other causes.

Methods: This study focused on 145 healthcare workers (nurses, phlebotomists, doctors and healthcare assistants) in two Irish University Hospitals in Dublin who care for in-patients and out-patients between the periods of June, 2009 through August 2009. A quantitative research methodology using a cross-sectional questionnaire-based study was undertaken to gather a minimum set of data information from the participants on their perception of causal attribution of HCAIs: rate the strength of the causal attribution using a network analysis. Thereafter, an inductive eliminative analysis (IEA) was used to produce the networks and multidimensional scaling (MDA) was used to determine the spatial structure of the networks.

Results: The result of the Network was highly endorsed (57.5% of participants) and consensual. Multidimensional Scaling of the causal ratings revealed a two-dimensional solution, with an acceptably low level of stress of .027, and a dispersion accounted for (DAF) of .97 indicating a good fit between the data and solution. The results indicate that poor hospital policy, poorly conducted clinical procedures by staff, staff personal hygiene unhealthy patients’ behaviour were highly endorsed causal attribution of HCAIs highlighting their intermediary role. The poor hospital policy was recognised as the epicentre of the causal attributions of HCAIs, poor health status of patients was the only identifiable proximal cause of HCAIs. There was no elicited distal cause. Every causal attribution factors contributed to the network.

Conclusions: Healthcare workers demonstrated to hold a highly consensual, intricate and complex interplay of representations of HCAIs. In support of the inputs from different bodies in HCAI, this understanding would be priceless in the overall holistic approach towards achieving the healthcare agenda of patients’ safety, reduce the cost of healthcare delivery, burden and control of HCAIs; this involves a multidisciplinary strategies.