New research from Halmstad University, Sweden, investigates the prevention of health care associated infections and gives a clue on how to avoid the spread of for instance covid-19 in hospital settings. PhD-student Luís Fernando Irgang dos Santos points out health care-professionals’ decision-making skills as key to limiting infection outbreaks.    

Health care associated infections – infections that patients acquire while receiving health care for other conditions – affect millions of patients world-wide and cause hundreds of thousands of deaths each year.

“Health care associated infections, for instance hospital spread of covid-19, are a big issue, especially in developing countries such as my home country Brazil. When comparing developing countries with developed ones, such as Sweden, I have found several differences in how infections are detected and handled in health care environments. There are discrepancies in management and implementation of procedures and guidelines as well as in practice” says Luís Fernando Irgang dos Santos.

Multi-disciplinary teams key to success

Infection prevention and control teams are responsible for keeping health care associated infections at bay. The first step to successful infection prevention and control is for the teams to separate the prevention stage from the control stage of a possible infection outbreak.

“I have identified two different modes of decision making, each consisting of separate sets of practices ideal for either prevention or control, but not for both. The infection prevention and control teams have to know how and when to switch between these two skills sets, and to do this, they need to be able to correctly identify which stage a possible infection outbreak is at”, Luís Fernando Irgang dos Santos explains and continues:

“It is vital that the team make the correct assessments and prioritisations early on in the process. If they decide to treat an infection as a possible outbreak too soon, they might end up wasting time and money on something that might have been just one isolated case. However, if they don’t react fast enough, they risk widespread infections.”

Follow the problem

By focusing on the infection and its’ unique characteristics, it is possible to make the correct decisions and contain a possible outbreak.

“In my approach, the problem – rather than the decision-making or the resources available – is the unit of analysis. By following the problem and identifying what decision-making mode is needed in each stage of the process, infection prevention and control teams can gain new understanding and make the correct decisions in order to avoid health care associated infection outbreaks. It is not enough to lean on instinct when it comes to these matters. The infection preventionists have to acquire decision-making skills, and in order to do so, health care institutions need to facilitate organisational learning. This can be a problem, especially in smaller hospitals where the infection prevention and control teams tend to be less structured, and where management is not always part of the teams” says Luís Fernando Irgang dos Santos.

Implementations of recommendations regarding covid-19 due to both cognitive and emotional aspects

Part of Luís Fernado Irgang dos Santos’ research is focused on covid-19. It investigates how infection prevention and control teams in Brazil implement the recommendations issued by the World Health Organization, and what the consequences are when the recommendations are not implemented alike by all teams. There are both cognitive and emotional aspects that can influence the way in which the recommendations are implemented:

“Infection prevention and control teams have an important role in controlling the emotional environment in which they work. If they are not successful in doing so, they will encounter problems when it comes to implementing recommendations in situations like the present pandemic. I have identified three different aspects which are important when it comes to the control of emotions; authority, safety and organisational change. Firstly, the infection preventionists need to be credible. Support from the management is vital, and the people who work in the infection prevention and control teams need to have their coworkers trust. Secondly, the employees have to feel safe at work. They have to trust that they will be safe if they follow the instructions from the infection preventionists. Thirdly, the infection prevention and control teams have to create organisational change in a way that creates flexible organisations. The coworkers have to be prepared for conditions to change, and they have to trust in management to have their best interests at heart” says Luís Fernando Irgang dos Santos.

Differences between developed and developing countries

One of Luís Fernando Irgang dos Santos’ goals is to compare the strategies of infections prevention and control teams in developing countries, for instance Brazil, to those of their counterparts in developed countries, for instance Sweden.

“I have found significant differences in the decision making-skills and -strategies between Brazilian and Swedish infection prevention and control teams. The Swedish teams are far superior in switching between the prevention mode and the control mode at the right time, resulting in them being more successful in containing outbreaks of health care associated infections”, says Luís Fernando Irgang dos Santos, continuing:

“The differences in decision making and how well the teams are able to switch between the two modes can have a number of different reasons. One important factor is cultural differences. In Brazil, the government has not been able to establish a feeling of safety and trust. The health care professionals have not felt safe during the covid 19-pandemic, nor has the people. Instead, fake news has caused insecurity, and the number of people who don’t believe there is a pandemic is significant. In Sweden, the situation is quite different. The Swedish government and the Public Health Agency of Sweden base their decisions and recommendations on science, and this builds trust, resulting in the recommendations being upheld.”


Luís Fernando Irgang dos Santos

PhD-student in Innovation Sciences, Halmstad University