Exploring infection prevention practices in home-based nursing care: A qualitative observational study

Risk factors for infection in older adults with home care: a mixed methods systematic review with meta-analysis

Worldwide, home care in the form of home healthcare and home help, has become increasingly more available. This systematic review aims to provide a deeper understanding of factors that are of particular importance for infection control in the home care setting for older adults. Five databases were searched (MEDLINE, Embase, ProQuest, Web of Science, CINAHL) for eligible studies using any research design reporting on individual, medical, behavioral and environmental factors. Retrieved studies were screened and assessed for quality. The Joanna Briggs Institute manual guided the research process and the work of generating a synthesis. Qualitative findings were compiled using meta-aggregation. For quantitative evidence, meta-analyses were conducted when possible. Of 19,484 unique records, 27 studies (7 cohort studies, 9 cross-sectional and 11 qualitative) were included in the review. Risk factors for infection reported in the quantitative studies referred to individual, medical, social, behavioral, environmental, and organisational aspects. Meta-analyses showed associations between urinary catheter use (OR 3.97, 95%CI 2.56-6.15) and limited mobility (OR 1.49, 95%CI 1.31-1.68), respectively, and risk of infection. Pooled ORs of urinary incontinence and risk of infection were not statistically significant. Findings from the qualitative studies covered perceived and observed risk factors to infection control and prevention. The evidence resulted in five synthesised findings covering attitudes, behaviors, home environment, personal interactions, lack of equipment, unsafe disposal of material, pets, unsafe practices and procedures, and lack of training. The combined quantitative and qualitative evidence sheds light on separate yet interconnected elements of risks for infection that may reinforce each other, potentially exposing vulnerable older adults to amplified risks.

Home-based nursing care for clients carrying multidrug-resistant organisms: A focus group study in the Netherlands

BACKGROUND

The growing population of vulnerable clients receiving home-based nursing care (HBNC), combined with the worldwide increase in the prevalence of multidrug-resistant organisms (MDROs), poses a new burden on nursing staff. This study explored the attitudes, perceptions, experiences, challenges, and needs of nursing staff providing HBNC for clients carrying MDROs.

METHODS

Seven focus groups with home-based nursing staff (N = 34) were performed in the Netherlands between April and July 2022, using a semistructured, open-ended topic list based on the integrated-change model and seven domains of practice. Data were analyzed using thematic analysis.

RESULTS

Participants experienced ambiguities in infection prevention and control recommendations in MDRO guidelines or protocols. At times, the proportionality of these measures was questioned, including the effect on compliance. Participants indicated to be influenced by perceptions and behavior of their colleagues and clients. Furthermore, participants experienced inadequate information exchange about MDRO carriage and debated about the roles and responsibilities of involved health care professionals.

CONCLUSIONS

There is a need for tailored MDRO guidelines for HBNC. Expanding knowledge, sufficient resources, and improving information exchange about MDRO carriage among health care professionals, clients (including their family members), and HBNC organization boards are essential to respond to current developments in HBNC.

A Tailored De-Implementation Strategy to Reduce Low-Value Home-Based Nursing Care: A Mixed-Methods Feasibility Study

AIM

To facilitate the delivery of appropriate care, the aim was to test if a tailored, multifaceted de-implementation strategy (RENEW) (1) would lead to less low-value nursing care and (2) was acceptable, implementable, cost effective and scalable in the home-based nursing care context.

DESIGN

A mixed-methods design.

METHODS

The RENEW strategy with components on education, persuasion, enablement, incentives and training was introduced in seven teams from two organisations in the Netherlands. To estimate the effect size, data were collected at baseline (T0) and follow-up measurement (T1), on the volume of care in both frequency and time in minutes per week and independent samples t-tests were performed. A qualitative evaluation was conducted to understand feasibility aspects, see how the strategy works and identify influencing factors and used document analyses and semi-structured interviews. Deductive coding was used to analyse the results.

RESULTS

The time spent on low-value nursing care (mean, minutes per week per client) in seven teams for 210 clients in T1 compared to 222 clients in T0 reduced statistically significant. The difference between T0 and T1 equals 17.94%. The frequency of delivered low-value nursing care (mean per week) reduced but not statistically significant. From the transcripts of eight semi-structured interviews and documents, a list of 79 influencing factors were identified. Practical implementation tools, workplace coaching and sharing experiences within and between teams were considered as the most contributing elements.

CONCLUSION

The results showed that for the seven home-healthcare teams in this study, the RENEW strategy (1) leads to a reduction in low-value care and (2) is-conditional upon minor modifications-acceptable, implementable, cost effective and scalable.

REPORTING METHOD

Standards for Reporting Implementation Studies (StaRI) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Knowledge, Attitudes, and Practices toward Antimicrobial Resistance among Young Italian Nurses and Students: A Multicenter, Cross-Sectional Study

Background: Nurses play a pivotal role in combating antimicrobial resistance (AMR). However, the success of local and national AMR containment efforts hinges on the knowledge, attitude, and practice (KAP) of nursing staff and undergraduate students. Objectives: This study aims to explore the determinants of nurses' KAP regarding AMR, offering insights to control the emergence and spread of drug-resistant pathogens. Methods: This cross-sectional, multicenter survey involving Italian nurses, nursing students, and healthcare professionals was conducted administering an anonymous online questionnaire focusing on AMR. The median score of 12 was taken as the cutoff for "good KAP." The association between study variables and good KAP was assessed using chi-square or t-tests, followed by multivariable logistic regression analysis for statistically significant (p < 0.05) variables. Findings: Among 848 participants, 61.9% (n = 525) were students, and 39.6% (n = 336) scored as having "low KAP." High KAP was associated with being female and studying AMR independently. Conversely, living in southern Italy and receiving AMR training from pharmaceutical companies were associated with low KAP. Conclusions: Among Italian nurses, AMR awareness relies on those who have studied AMR as self-taught and is affected by gender and region. Italian universities lack in lectures on AMR management, and much needs to be done to improve awareness of antimicrobial stewardship among nonmedical health workers.

Educational needs of community visiting nurses for infection prevention and control: Application of the Borich needs assessment and the Locus for Focus models

OBJECTIVES

This study aimed to assess the educational needs and analyze the priorities of infection prevention and control (IPC) for community-visiting nurses.

DESIGN

This is a cross-sectional descriptive study.

SAMPLE

This study was conducted with 144 visiting nurses working in public health centers and long-term care facilities in South Korea.

METHOD

A total of 23 questions in five subcategories were used to measure the current knowledge and perceived importance of IPC in community-visiting nursing. Data were collected from June 23 to October 30, 2021, during the COVID-19 pandemic. Data were analyzed paired t-test, the Borich needs assessment, and the Locus for Focus models.

RESULTS

Top-priority content was defined as content belonging to two models, the first 10 contents of Borich needs assessment and the contents located in the Quadrant I of the Locus for Focus models. "Reporting in case of infection-related accidents," "Mandatory vaccination for visiting nurses," "Standard precaution," "Airborne precaution," "Contact precautions," "Respiratory infection control," and "Post-visit management."

CONCLUSIONS

This study suggests that it is necessary to provide visiting nurses with more opportunities for IPC education and to develop standardized IPC programs that consider educational priorities.

Infection prevention practice in home healthcare: a mixed-method study in two Swiss home healthcare organisations

BACKGROUND

Infection prevention and control (IPC) research has long neglected the home healthcare sector with its unique challenges. This study aimed to gain an understanding of the barriers to the implementation of infection prevention practices relevant to this setting, the related attitudes, perceived relevance and priorities from the home healthcare worker perspective in Switzerland.

METHODS

The mixed-method study involved semi-structured interviews (n = 18) and an anonymous web-based survey (n = 144) among nursing assistants and nurses from two home healthcare organizations in northwest Switzerland. Questions in both sub-studies focused on perceived challenges to infection prevention practices, perceived relevance, and related attitudes and mitigation strategies. Using an exploratory-sequential design, survey questions were designed to quantify and complement the findings from the interview study.

RESULTS

Healthcare workers in these two organisations felt adequately protected, trained and supported by their organisations regarding IPC (survey agreement rates > 90%). General challenges to IPC in the home environment most agreed on were lack of cleanliness, lack of space, and the priorities of the patient to be respected (survey agreement rates 85.4%, 77.1%, and 70.8%, respectively). Practices and perceived challenges in the case of colonisation with multi-drug resistant organisms (MDRO) and potentially infectious diarrheal or respiratory illnesses varied highly regarding information transfer, use of protective equipment, and use and disinfection practices of multi-use equipment. Challenges to hand hygiene, sharps safety, waste management and decontamination of equipment did not feature as a prominent concern.

CONCLUSIONS

This study is the first to characterise the implementation of infection prevention practices and the related challenges in home healthcare in Switzerland. Home healthcare workers describe various challenges related to infection prevention practices as largely manageable in their work routine, and generally show satisfaction with the support provided by their organisations regarding IPC precautions. Key findings regarding challenges amenable to interventions include uncertainty and inconsistency regarding the management of MDRO colonisation and acute illnesses, and gaps in information transfer. Those challenges may benefit from both organisational interventions and further research into the level of precautions that are appropriate to the home healthcare setting.

Barriers and facilitators to infection prevention practices in home healthcare: a scoping review and proposed implementation framework

Infection prevention and control (IPC) research has focused on the hospital setting, neglecting the rapidly expanding home healthcare (HHC) sector. Current infection prevention recommendations do not reflect the challenges specific to the HHC setting. This scoping review considered any original studies reporting on barriers or facilitators to infection prevention practices in the context of HHC. Study characteristics were mapped, and a descriptive content analysis was performed. Based on the findings we propose a framework of eight HHC setting characteristics relevant to infection prevention implementation. 33 studies fulfilled the eligibility criteria. A majority of studies addressed sharps injury or blood and body fluid exposure prevention (N=15) and the majority were conducted in the United States (N=23). Study methodologies employed were surveys (N=18), qualitative (N=11), direct observation (N=7), and one interventional study. The HHC setting characteristics relevant to infection prevention implementation were: the care process in the patient's immediate environment; the need to bring equipment and materials into the home; the provision and financing of equipment and materials; the use of patient space and facilities; the unique position of and the expectations towards HHC providers; working alone with little support; the intermittent nature of care; the attitudes of HHC providers formed by their work circumstances. Interventional studies generating higher-quality evidence for implementation are lacking. Furthermore, implementation of aseptic technique and the decontamination and reprocessing of equipment are poorly studied in the HHC setting and deserve more research interest. The proposed framework may guide future research and implementation work.

Barriers to infection prevention and control in patients' homes

While there is a lot of emphasis on the need for good infection prevention and control practices and acute care, the increasing complexity of patients being cared for in their own homes means that there is an increased risk for infection. Good practice is required by community nurses to minimise this risk. Patients' own homes can present particular challenges in complying with good practice and this article looks at some of the barriers to optimum infection prevention and control precautions in this setting.

Nursing care for patients carrying multi-drug resistant organisms: Experiences, intention to use protective equipment and ability to comply with measures

AIMS

The aims of the study were to explore the impact of caring for patients carrying multi-drug resistant organisms on nursing staff and identify factors predicting their intention to use personal protective equipment and their ability to comply with advised infection prevention and control measures.

BACKGROUND

Carriage of multi-drug resistant organisms and corresponding infection prevention and control measures have a major impact on patients. Limited research has been done to investigate the impact of caring for these patients on nursing staff.

DESIGN

A cross-sectional design.

METHODS

Online survey among Dutch nursing staff in various healthcare settings. Prediction analyses were conducted using random forest. The STROBE checklist was used preparing the manuscript.

RESULTS

974 respondents were included. The majority of nursing staff reported to have experience in caring for patients carrying multi-drug resistant organisms. Relevant dilemmas in daily practice were identified. Important predictors of the intention to use protective equipment were practicing hand hygiene, usable protocols, favourable attitudes and perceptions, as well as knowledge. Important predictors of the ability to comply with advised measures were usable and findable protocols, a suitable work environment and practicing hand hygiene.

CONCLUSION

We have gained comprehensive insight into experiences, attitudes, perceptions, knowledge and dilemmas in daily practice of nursing staff caring for patients carrying multi-drug resistant organisms. To enhance their intention to use protective equipment and their ability to comply with advised measures, activities should focus on improving hand hygiene and the usability of protocols. Additionally, efforts are needed to improve knowledge, provide better resources and a more supportive work environment. All of which need to be specifically tailored to each healthcare setting.

RELEVANCE TO CLINICAL PRACTICE

The results can be used in the development of interventions to improve nursing care while reducing the unfavourable impact on nursing staff and supporting adherence to advised measures.

Application of a Nursing Data-Driven Model for Continuous Improvement of PICC Care Quality

A PICC catheter maintenance network was established and managed to monitor the maintenance of catheters in placed patients throughout the process, providing homogeneous PICC catheter continuity of care for patients. Model-driven thinking is an idea for simulation system development. Model-driven architecture (MDA) is a design methodology that implements model-driven thinking and is widely used in simulation system development. Based on the requirements of nursing, the data-driven model is mainly divided into interface layer and functional service layer; this study adopts MDA technology which can detach the functions of the system from the platform, based on domain knowledge, and the metamodel adopts XSD-based data model to generate the PIM model, which is stored in the model library. The results showed that the number of nurses at maintenance sites increased from 79 to 232, the PICC placement rate for oncology patients increased from 35.0% to 76.0%, the nurse maintenance operation pass rate increased from 53.9% to 88.4%, and the maintenance default rate decreased from 40.0% to 10.9%.