Device-Specific Factors Associated With Device-Related Infection Prevention and Control Practices in Long-Term Care...

To examine multilevel factors associated with Foley catheter- and central venous catheter (CVC)-related infection prevention and control (IPC) practices among nursing staff in long-term care hospitals (LTCHs) and to test whether resource support mediates the relationship between organizational culture and IPC practices.

LTCHs are vulnerable to device-related healthcare-associated infections, yet evidence on how individual- and organizational-level factors shape IPC practices across device types in these settings remains limited.

In this multicenter cross-sectional study, we surveyed 197 nursing staff with at least 6 months of clinical experience from 11 LTCHs with 150 or more beds in South Korea. Foley catheter and CVC IPC practice scores were the primary outcomes. Potential associated factors included IPC knowledge, job stress, organizational culture, and resource support. Linear mixed models with hospitals as a random effect were used to identify associated factors, and bootstrap mediation analysis (2000 replications) was used to test the indirect pathway from organizational culture through resource support to IPC practice.

Resource support was most strongly associated with both Foley (β = 0.334, p < 0.001) and CVC (β = 0.379, p < 0.001) practice scores. Organizational culture was significantly associated with Foley catheter IPC practice (β = 0.233, p = 0.007) but not CVC IPC practice (p = 0.292). Mediation analysis with resource support as the mediator revealed partial mediation for Foley catheter IPC practice (mediation ratio = 48.8%) and near-complete mediation for CVC IPC practice (mediation ratio = 75.3%). IPC knowledge was significant only for CVC IPC practice (β = 0.198, p = 0.004), whereas job stress showed a suppressive effect, becoming significant in the multivariate model for both devices.

The same mediation model operated through qualitatively different pathways depending on the device type. These findings suggest that a one-size-fits-all approach may be insufficient to improve device-related IPC practices in LTCHs.

Nurse managers in LTCHs should target different levers by device-securing structural and training readiness for CVC care, while reinforcing accountability norms and peer monitoring for Foley catheter care.