Staff Knowledge, Awareness, Perceptions, and Beliefs About Infection Prevention in Pediatric Long-term Care Facilities

Abstract

Background The burden of healthcare-associated infection worldwide is considerable, and there is a need to improve surveillance and infection control practices such as hand hygiene. Objectives The aims of this study were to explore direct care providers’ knowledge about infection prevention and hand hygiene, their attitudes regarding their own and others’ hand hygiene practices, and their ideas and advice for improving infection prevention efforts. Methods This exploratory study included interviews with direct care providers in three pediatric long-term care facilities. Two trained nurse interviewers conducted semistructured interviews using an interview guide with open-ended questions. Two other nurse researchers independently transcribed the audio recordings and conducted a thematic analysis using a strategy adapted from the systematic text condensation approach. Results From 31 interviews, four major thematic categories with subthemes emerged from the analysis: (a) hand hygiene products; (b) knowledge, awareness, perceptions, and beliefs; (c) barriers to infection prevention practices; and (d) suggested improvements. There was confusion regarding hand hygiene recommendations, use of soap or sanitizer, and isolation precaution policies. There was a robust “us” and “them” mentality between professionals. Discussion One essential driver of staff behavior change is having expectations that are meaningful to staff, and many staff members stated that they wanted more in-person staff meetings with education and hands-on, practical advice. Workflow patterns and/or the physical environment need to be carefully evaluated to identify systems and methods to minimize cross-contamination. Further studies need to evaluate if personal sized containers of hand sanitizer (e.g., for the pocket, attached to a belt or lanyard) would facilitate improvement of hand hygiene in these facilities.

Healthcare workers’ attitudes toward hand hygiene practices: Results of a multicentre qualitative study in Quebec

“…Furthermore, adequate nurse staffing levels have been associated with lower rates of patient mortality and morbidity and lower rates of HAIs [36,37]. Similar to previous studies, environmental barriers consisted of poor physical structure and lack of resources, such as poor placement or absence of sinks and handwashing stations [18,36,38,39]. While singlepatient rooms may facilitate patient management [40], our findings and other studies indicate that on their own they are unable to reduce HAI transmission [41][42][43].…”

Understanding of safety monitoring in clinical trials by individuals with CF or their parents: A qualitative analysis

“…Thematic analysis was conducted in an ongoing, iterative process and informed by the systematic text condensation approach described by Malterud [5] and previously implemented by this study's qualitative nurse researcher (A.H.) [6]. The pediatric resident and nurse researcher independently immersed themselves in the interview content and agreed to preliminary thematic categories.…”

Family Experiences and Perspectives on Infection Prevention in Pediatric Long-Term Care

“…Previous observations by this research team of pLTCF staff behavior and their feedback related to IP yielded insights about existing facilitators of and barriers to optimal adherence to hand hygiene and other key IP practices (Løyland, Wilmont, Cohen, et al, 2016; Løyland, Wilmont, Hessels, et al, 2016). During these observations of staff behaviors, two observers witnessed inadequate IP practices among family members and other visitors at residents’ bedsides and during their movements around the facilities.…”

“…We learned that IP challenges are unique in this setting and that guidelines adopted in the adult long-term care and rehabilitation and pediatric acute care areas are ill-suited to pLTCF. However, it is still worthwhile to explore the utility of adapting them to meet the unique challenges of pLTCF providers and families (Løyland, Wilmont, Cohen, et al, 2016; Løyland, Wilmont, Hessels, et al, 2016; Uchida et al, 2013). Family members may benefit from training specifically tailored to their needs to be more comfortable and skillful in IP practices.…”

“…Our research to date in pLTC, funded by the Agency for Healthcare Research and Quality (R01HS021470), has focused primarily on outbreak surveillance and control, antimicrobial stewardship programs, and hand hygiene knowledge, attitudes, and practices/behavioral observations among staff (Buet et al, 2013; Løyland, Wilmont, Cohen, & Larson, 2016; Løyland, Wilmont, Hessels, & Larson, 2016; Murray et al, 2015; Neu, Plaskett, Hutcheon et al, 2012). Unlike research on visitors and family members in adult long-term care and pediatric acute care, families of pLTC residents are underrepresented in the literature (Abdolahi et al, 2012).…”