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Infection prevention and control in nursing homes: a qualitative study of decision-making regarding isolation-based
Catherine Crawford Cohen1, Monika Pogorzelska-Maziarz2, Carolyn T A Herzig1
1Center for Health Policy, Columbia University School of Nursing, New York, New York, USA.
BMJ Quality & Safety
|May 24, 2015
Summary
Nursing home infection control varies significantly. Decision-making balances resident quality of life with infection transmission risk, influenced by resources and staff understanding. Guidelines need refinement for consistent practices.
Area of Science:
- Healthcare Management
- Infection Prevention and Control
- Geriatric Care
Background:
- Nursing homes (NHs) face unique challenges balancing resident quality of life with infection transmission prevention.
- Current isolation practices in NHs are not well-characterized.
- Reconciling care goals with infection control in NHs requires specific strategies.
Purpose of the Study:
- To explore the decision-making processes involved in isolation-based infection prevention and control (IPC) practices within NHs.
- To understand how NH staff make decisions regarding isolation protocols.
- To identify factors influencing IPC decision-making in the NH setting.
Main Methods:
- Qualitative study involving 73 interviews with NH staff across 10 US NHs.
- Semistructured, role-specific interviews analyzed using directed content analysis.
- Emerging themes were discussed among the research team to ensure consensus.
Main Results:
- Significant variation exists in NH isolation practices concerning resident selection, timing, implementation, and tailoring.
- Staff decision-making is influenced by perceived transmission risk, resident quality of life, and available NH resources (e.g., private rooms, staff time, communication).
- A notable lack of understanding of key IPC concepts among some staff was identified.
Conclusions:
- Existing clinical guidelines for NH isolation practices are insufficient for consistent application given care goals and resource constraints.
- Further epidemiological research is needed to guide effective isolation practices in NHs.
- Enhanced IPC education for NH staff is likely necessary to improve practice consistency and resident care.