Not merely the absence of disease
I read a book a while ago that reminded me of something I hadn’t thought about in any depth for many years. It recalled the World Health Organisation’s (WHO) definition of health, taken from its Constitution – “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This is relevant because I was part of a webinar, part of a panel in fact: “A conversation on compassion: shaping the future of person-centred infection prevention and control (IPC)” facilitated by IPAC and IPS, the Canadian and UK and Ireland professional IPC societies in January 2026.
Essentially, it comes down to what we mean when we talk of health and health outcomes in relation to IPC. On that WHO definition of health, I remember learning it off by heart when I was studying for my nursing degree and it has stayed with me. What the author of the book I recently read suggested was that during the pandemic of 2020 the world effectively, rightly or wrongly, redefined health more narrowly than ever before. Health came to be redefined as the absence of disease or infirmity caused by SARS-CoV-2. His take was that nothing else seemed to matter. While the webinar panel I participated in was not about COVID 19, what happened during those days, months and subsequent years certainly acted as a trigger for some elements of the panel conversation. When we think of both health and health care, there are some things that should always matter – how we treat people, matters of dignity, respect, humanity and the psychosocial needs that people have.
Ultimately, IPC at its core is about more than solely protecting people from pathogens.
What does compassionate IPC mean to you?
The first question I was asked to kick-start the panel conversation was “what does compassion in IPC mean to me and what sparked my interest in this subject?”
Before I responded I took a mental step back and thought about some definitions – what do we mean when we talk about compassion and what’s the relationship between person-centred care in an IPC context and compassion? Myself and colleagues addressed this recently in a paper in the Journal of Research in Nursing on The relevance of nursing to the achievement of person-centred infection prevention and control. In this paper we highlighted the UK Health Foundation’s report. The Health Foundation explained that person centred care is care that’s personalised – i.e. we should always look at the context in which a person finds themselves in and their vulnerabilities; it’s also coordinated and it is enabling and within all of this the person – the patient – the client, is treated with dignity, respect and compassion. So to me, compassion within the context of IPC is about recognising that every policy, precaution, practice, intervention and interaction is experienced by a human being – often at a moment of extreme vulnerability. But it importantly means that we don’t just recognise this – we do something about it. This is what differentiates compassion from empathy. Empathy is the ability to feel and understand another person’s suffering – compassion goes a step further by turning that understanding into action or attempted action to address the suffering – to stop it. As I have written before, when IPC is delivered with compassion through how we speak, how we listen, and how we design our health systems, we’re on the path to ensuring high quality person-centred care.
I have spoken a lot about what sparked my interest in this subject, but in a nutshell since I first trained as a nurse and then an infection preventionist, I’ve always had an interest in making sure the things we do and say take account of people’s humanity. For example, in the early days of my career I was interested in how some parts of the health sector and society as a whole treated people with HIV and AIDS. I was interested when MRSA was a new thing, how we talked to people who were MRSA positive. And then COVID brought all of this to a head and I worked with many colleagues and the charity sector to try and make sure IPC was an enabler not a barrier, to ensure safe human-to-human interaction – in some cases this included coming up with solutions so that people could see their loved ones – in real life – at the end of their life.
The webinar panel conversation lasted a full hour and I don’t intend to replicate it here but as many things we do in our professional life, when preparing, it made me pause for a moment and contemplate a number of things that remain important and, in some way, unresolved.
What story is being told by our guidelines?
One of the other things I reflected on, which is in the paper I mentioned earlier, is whether the very title of the specialty of IPC tells us something – anything – about these matters? IPC is about halting germ transmission. Unlike the related field of patient safety, for example, there is no mention of the person in the name of the specialty. This may be a matter of semantics. However, national and international guidance tends to follow similar patterns focusing predominantly on the different precautions for specific diseases and clinical settings.
So, in preparation for the panel I took yet another look at some of the policies and guidelines available at the click of a button, on IPC, to see whether things are changing in terms of a balance between the technical, biomedical side of IPC and the person-centred side. It is a balancing act. I have struggled in the past to find evidence of person centredness in the guidelines and the protocols that we write on IPC. Personally I think things are changing – cause for optimism. But still some way to go.
My snapshot review of national and professional society guidelines revealed that the “person” element is either light touch or still largely absent. I am not going to name the guidelines but they are easy to find and from some of the big name societies and countries.
Often there’s a short section on patient and family education and links to leaflets on different infections – is this enough to achieve person centredness?
One IPC workbook talked about “the challenge in communicating organizational expectations and patient, resident, family, and visitor responsibilities” – what does that mean to a busy nurse or doctor who the guidelines are intended for?
One high income country’s national IPC manual mentions communication just twice – both concerned with patient confidentiality – what drove this decision?
One sub-national guideline addresses psychological problems, including anxiety as a potentially negative consequence of isolation, but it also counters this by suggesting that many people actually prefer to be “isolated” – I wonder about the work that informed this?
Some of the guidance documents in relation to specific infections, central line associated blood stream infection (CLABSI) to take but one example, state: “Educate patients and family prior to insertion of a CVC, as needed about CLABSI prevention strategies.”
As you read this, I wonder if you are reflecting on what your own policies and protocols and guidelines say about the psychosocial aspects of the IPC practices and how you might find the right balance?
IPC is personal
It’s 80 years now since the WHO Constitution that I mentioned at the start of this blog, including the definition of health, was signed off in New York. So remembering this and its relevance still today, I think it is a powerful guiding light for IPC to continue to move beyond a purely biomedical, risk-elimination mindset. It helps to remind us that preventing infection is not the only outcome that matters – how people experience care matters too.