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. 2015 Oct;24(10):630-6.
doi: 10.1136/bmjqs-2015-003952. Epub 2015 May 22.

Infection prevention and control in nursing homes: a qualitative study of decision-making regarding isolation-based practices

Catherine Crawford Cohen  1 , Monika Pogorzelska-Maziarz  2 , Carolyn T A Herzig  1 , Eileen J Carter  3 , Ragnhildur Bjarnadottir  1 , Patricia Semeraro  1 , Jasmine L Travers  1 , Patricia W Stone  1
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Infection prevention and control in nursing homes: a qualitative study of decision-making regarding isolation-based practices

Catherine Crawford Cohen et al. BMJ Qual Saf. 2015 Oct.

Abstract

Background: Isolation-based practices in nursing homes (NHs) differ from those in acute care. NHs must promote quality of life while preventing infection transmission. Practices used in NHs to reconcile these goals of care have not been characterised.

Purpose: To explore decision-making in isolation-based infection prevention and control practices in NHs.

Methods: A qualitative study was conducted with staff (eg, staff nurses, infection prevention directors and directors of nursing) employed in purposefully sampled US NHs. Semistructured, role-specific interview guides were developed and interviews were digitally recorded, transcribed verbatim and analysed using directed content analysis. The research team discussed emerging themes in weekly meetings to confirm consensus.

Results: We inferred from 73 interviews in 10 NHs that there was variation between NHs in practices regarding who was isolated, when isolation-based practices took place, how they were implemented, and how they were tailored for each resident. Interviewees' decision-making depended on staff perceptions of acceptable transmission risk and resident quality of life. NH resources also influenced decision-making, including availability of private rooms, extent to which staff can devote time to isolation-based practices and communication tools. A lack of understanding of key infection prevention and control concepts was also revealed.

Conclusions and implications: Current clinical guidelines are not specific enough to ensure consistent practice that meets care goals and resource constraints in NHs. However, new epidemiological research regarding effectiveness of varying isolation practices in this setting is needed to inform clinical practice. Further, additional infection prevention and control education for NH staff may be required.

Keywords: Decision making; Infection control; Nosocomial infections; Nursing homes.

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Conflict of interest statement

COMPETING INTERESTS

MPM has served as a consultant to Becton, Dickinson and Company. This consulting work was not related to the research presented in this article. The other authors have no potential conflicts of interest to report.

Figures

Figure 1
Figure 1
Emergent themes from qualitative directed content analysis regarding isolation-based infection control and prevention practices in nursing homes.
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