Reframing the hospital as an enabling environment: a qualitative study of social, material and affective resources in care provision for injecting‑related infections

BACKGROUND: Injecting-related infections are rising globally, positioning hospitals as critical environments that shape patient outcomes. Understanding how institutional conditions enable, shape and constrain care is essential to improve outcomes for people who inject drugs. This study examines healthcare providers' (HCPs) reflections on caring for patients with invasive injecting-related infections. METHODS: We conducted in-depth qualitative interviews with HCPs in an acute care hospital in Melbourne, Australia, in 2023. Thematic analysis was guided by Duff's framework of enabling environments, focusing on how social, material and affective resources are mobilised, or constrained, within clinical practice. FINDINGS: Twenty HCPs participated, with clinical experience ranging from eight months to 31 years. Institutional policies and medicolegal requirements emerged as key material resources that could support patient-centred care. However, uncertainty, fear and divergent interpretations often hindered their effective use. Supportive ward micro-cultures, particularly senior clinicians modelling harm reduction and multidisciplinary collaboration, operated as social resources that enabled flexible, patient-centred care. Conversely, dominant abstinence-only norms produced restrictive environments. Affective resources, including HCPs' orientations toward the perceived futility or value of treatment, shaped the affective climate of care and directly influenced clinical decision-making. These resources were interdependent, with their alignment, or misalignment, shaping the possibility of an enabling care environment. CONCLUSION: We identified key resources that could enable optimal treatment and care delivery for people with injecting-related infections. Improving treatment outcomes requires interventions that clarify material medicolegal supports, strengthen collaborative and harm reduction-oriented social norms, and cultivate affective conditions to promote patient autonomy, staff confidence and relational, equitable care.