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Healthcare personnel experiences implementing carbapenem-resistant Enterobacterales infection control measures at a ventilator-capable skilled nursing facility—A qualitative analysis

Published online by Cambridge University Press:  21 June 2021

Katharina R. Rynkiewich Open the ORCID record for Katharina R. Rynkiewich [Opens in a new window] ,
Jinal Makhija ,
Mary Carl M. Froilan ,
Ellen C. Benson ,
Alice Han ,
William E. Trick ,
Robert A. Weinstein ,
Mary K. Hayden ,
Michael Y. Lin  and
CDC Prevention Epicenters Program
Katharina R. Rynkiewich*
Affiliation:
Case Western Reserve University, Cleveland, Ohio
Jinal Makhija
Affiliation:
Rush University Medical Center, Chicago, Illinois
Mary Carl M. Froilan
Affiliation:
Rush University Medical Center, Chicago, Illinois
Ellen C. Benson
Affiliation:
Rush University Medical Center, Chicago, Illinois
Alice Han
Affiliation:
Metro Infectious Disease Consultants, Chicago, Illinois
William E. Trick
Affiliation:
Rush University Medical Center, Chicago, Illinois Cook County Health, Chicago, Illinois
Robert A. Weinstein
Affiliation:
Rush University Medical Center, Chicago, Illinois Cook County Health, Chicago, Illinois
Mary K. Hayden
Affiliation:
Rush University Medical Center, Chicago, Illinois
Michael Y. Lin
Affiliation:
Rush University Medical Center, Chicago, Illinois
*
Author for correspondence: Katharina R. Rynkiewich, Email: katharina.rynkiewich@case.edu
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Abstract

Objective:

Ventilator-capable skilled nursing facilities (vSNFs) are critical to the epidemiology and control of antibiotic-resistant organisms. During an infection prevention intervention to control carbapenem-resistant Enterobacterales (CRE), we conducted a qualitative study to characterize vSNF healthcare personnel beliefs and experiences regarding infection control measures.

Design:

A qualitative study involving semistructured interviews.

Setting:

One vSNF in the Chicago, Illinois, metropolitan region.

Participants:

The study included 17 healthcare personnel representing management, nursing, and nursing assistants.

Methods:

We used face-to-face, semistructured interviews to measure healthcare personnel experiences with infection control measures at the midpoint of a 2-year quality improvement project.

Results:

Healthcare personnel characterized their facility as a home-like environment, yet they recognized that it is a setting where germs were ‘invisible’ and potentially ‘threatening.’ Healthcare personnel described elaborate self-protection measures to avoid acquisition or transfer of germs to their own household. Healthcare personnel were motivated to implement infection control measures to protect residents, but many identified structural barriers such as understaffing and time constraints, and some reported persistent preference for soap and water.

Conclusions:

Healthcare personnel in vSNFs, from management to frontline staff, understood germ theory and the significance of multidrug-resistant organism transmission. However, their ability to implement infection control measures was hampered by resource limitations and mixed beliefs regarding the effectiveness of infection control measures. Self-protection from acquiring multidrug-resistant organisms was a strong motivator for healthcare personnel both outside and inside the workplace, and it could explain variation in adherence to infection control measures such as a higher hand hygiene adherence after resident care than before resident care.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 8 , August 2022 , pp. 1010 - 1016
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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