Table 4 Illustrative participants’ quotes (Q) describing inter-/intra-professional differences in attitudes to and practice of infection prevention and control (IPC)

Professional characteristics—stereotypes

 Q4:1 A medical divisional director’s (MDD1) description of nursing and medical stereotypes

Nurses are very process driven. They have very … hierarchical structures that they stick rigidly within. If they drift outside they get jumped upon, they eat their young… Most of the sort of people that go into medicine are more independent thinkers and they don't like to be told what to do by anyone and the further up the tree you go the more like that you become… [they have] a view about themselves that … they're above criticism

 Q4:2. A nursing divisional director’s (NDD1) different view of stereotypes

I think the nurses are very keen to do the right thing… to the best of their ability.… it's disheartening when you see others coming in and out of rooms and not doing that and… when you [speak] to them there's a stand-up argument about hand hygiene

 Q4:3. An IPC nurse clinical consultant (CNC1) blames rigid application of rules for doctors’ lack of respect for IPC

I think medical staff are really driven by evidence, the fact that contextually they can see… validity. So if they think something's stupid… and they’re just doing it because it's [the rule] … they lose respect for it. … there's a lot of infection control procedures like that. … Whereas the nurses are more accepting of tradition—that's the way we've done it because… Florence has done it… And they're not looking as much for that evidence

Unflattering, but varied interprofessional perceptions

 Q4:4. MDD2 suggests bias on the part of ward auditors

The audits say that the doctors are terrible, but most of the audits are done by the nurses. So you wonder whether there’s a bit of payback. …it’s Schadenfreude, isn’t it? Maybe they feel they’re kicked around by doctors all the time. It’s nice to point out that the doctors aren’t perfect

 Q4:5. MDD4 suggests bossy nurses as hand hygiene leaders

Who is leading? … the nurses would be much better [than doctors] at bossing people around about hand washing, because they’re pretty good at bossing you around about everything else

 Q4:6. NDD1 speaks of NUMs’ problem with doctors’ poor hand hygiene compliance

I'd look at my rates across the wards [and ask the NUM] ‘Your rates are sitting below the benchmark, what are you doing about that in your ward?’ I would get back: ‘When I break it down… the medical staff sit quite low and …they’re not my responsibility so I can’t impact them’

 Q4:7. NDD2 on nurses varied approaches to and responses from medical teams about IPC practices

When I was a NUM, I had a very good relationship with the team so I could say to them ‘Hey, you haven’t even washed your hands’ and they would listen. [Other] people don't feel that they can say that, or they’ve got 10 teams coming through and it's very hard to build relationships…. So if you pull someone up they’re going, ‘Oh, don't worry about it, we’ll just move on, let’s get through this and don't worry about her’

 Q4:8. MDD1 admits doctors are ignorant

Some feedback clinicians get sounds a bit like they’re deliberately doing people harm—most of it is acts of ignorance

 Q4:9. A nursing unit manager (NUM1) describes poor IPC attitudes & practice in a surgical unit

The infection control team were just flabbergasted. They said ‘They didn't wash their hands at all, not once that whole ward round. They were touching open wounds and then going off and touching the next patient.’ …[the MUD].. was livid, but, not at his team. He was livid at us that we did this audit [and that it was] was out there for everyone to see

Doctors reluctance to accept advice from expert nurse consultants

 Q4:10. CNC1 on surgeons’ response to high surgical site infection rates

The only feedback we’ve had was that … [our hospital] was one of the worst-performing globally. …they [surgeons] engaged [infectious diseases physician] to look at their strategies…. [who] came to us for information, [but] there’s a lot …being missed just based on her length of experience

 Q4:11. MDD2 on senior doctors’ response to Ebola preparations

I thought the intensivists’ behavior, rather than dampening fears, exaggerated them… nursing staff behaved far better..[although] they were far greater at risk. …there was great debate about the reliability and validity of the [IPC unit’s] advice….Professor Google became problematic.”

The “doctor-nurse game”

 Q4:12. A medical consultant on nurses’ approaches to doctors

Junior doctors, don’t mind being told what to do, but only in a way that’s appropriate… So [a nurse] who comes along and says you have to do these things…there’s no flexibility … that’s always going to meet resistance.”

 Q4:13. MDD4 recounts junior doctors’ complaints that nurses interpret policy too literally

Residents …were saying that some wards will take [peripheral intravenous cannulas] out – ‘oh, it’s 72 h, we’ll whip it out’—they haven’t looked at it; they haven’t looked to see when the next [antibiotic] dose is, and they call you, and you have 15 other calls that shift… they’re not equally shouldering the responsibility.”