3034PHM Evidence Based Practice

Travers, J., Herzig, C. T., Pogorzelska-Maziarz, M., Carter, E., Cohen, C. C., Semeraro, P. K., … & Stone, P. W. (2015). Perceived barriers to infection prevention and control for nursing home certified nursing assistants: a qualitative study. Geriatric Nursing, 36(5), 355-360. doi/10.1016/j.gerinurse.2015.05.001

Introduction

It is critical to ensure that nursing assistants who work in nursing homes know about infection prevention and control. The article appraised here presents the findings of a qualitative study of perceived barriers to infection prevention and control. The paper starts with the part titled abstract which explains the titles used in the article which are an introduction, methods, results, discussion and conclusion (Ward, 2011). The purpose of the article is to assess the barriers that desist nursing homes certified nursing assistants from implementing infection protection and control practices. The journal seeks to address the strategies that can be used to overcome these perceived barriers then. The researchers conducted a qualitative study on the staff that is vital to infection control. They use audio-recorded interviews that they analyze. The interview reveals that five aspects are responsible for the barriers to infection prevention and control for certified nursing assistants. The five include language or culture, knowledge or training, per-diem or part-time staff, workload and accountability. They, therefore, conclude that they need strategies to find solutions to the barriers. The plans include empowerment of the certified nursing assistants, increasing the staff ratio, getting staff to undergo hands-on training, part-time worker to get on-the-spot whenever they come to work and finally translating in-services. The abstract highlights what the research covers (Saiman et al. 2014). It is detailed and informative in its findings, interpretations, and conclusion.

Literature Review

Although the researchers do not use a title on the literature review, the introduction gives evidence on the perceived barriers. The researchers use statistics from the Department of Health and Human Services which has provided an estimate of 1.4-5-2 infections per 1000 resident-care days in nursing homes and skilled nursing facilities. Regarding revenue allocation, the United States healthcare uses $673 million in these infections. The healthcare-associate infections are said to be avoidable through the observance of practices of infection prevention and control. They clearly state that these practices can only be implemented if the relevant staff get more skills, education, and training. The most affected staff here are the certified nursing assistants who are at the exposure of these infections from residents. The researchers note that this happens when there is a transmission from the residents to them. Their roles which include resident positioning and turning, caring for their hygiene, toileting, feeding the residents, hydrating and ambulation (Raschka, Dempster, & Bryce 2013). The researchers note that there have not been previous studies that have been done to address the challenges faced in the compliance of infection prevention and control by the nursing homes certified nursing assistants. This paper then aims to give an insight of the strategies that the nursing home staff use to address these barriers.

Methodology

The study used interviews as its study design. The samples were from nursing homes from different geographical locations, different sizes of bed and homes from varying ownership status. The interviews focused on personnel directly related to infection practice and control which included, certified nursing assistants, infection preventionists, directors and assistant directors of nursing, nursing home administrators, advanced clinicians, environmental services workers, risk managers, quality improvement coordinators, and staff nurses (Otter, Yezli, Perl, Barbut, & French 2013). The duration of workers in nursing homes were those that had stayed in their facilities for more than a year and were English speakers. The research is done between May and September where ten nursing homes were selected. Three nursing homes were from the Northeast, four from the South and three from the West and Midwest part of the country. The nursing homes had bed capacities of between 4-200 each. The interviews began with each interview having a panel of eight interviewers. The researchers ensured that they had studies different roles of the staff and tailored their questions according to those roles and it explained the structures, processes, and outcomes to be followed. The data collected was then recorded digitally, verbatim transcription was applied, and the data was eventually de-identified.  The researchers used analysis software to code the data. Cases that arose of discrepancies in the coding were reconciled during the researchers’ gatherings. All interpretation that was contentious and had emerged in the course of the research were sought consensus for, and a conclusion was achieved (Meyer & Cookson 2010). The analysis was finalized when all the researchers agreed that there was no new information arising from the collected data.

Ethical Considerations

The researchers observed ethical considerations by taking consent documents from all participants. The researchers ensured that each participant had read and signed the consent forms carefully. They gave them time and the decision to opt out if they were not comfortable with the research. They also sought permission from the nursing homes before conducting the investigation. Three bodies eventually approved the study (MacCannell, Umscheid, Agarwal, Lee, Kuntz, Stevenson, & Healthcare Infection Control Practices Advisory Committee 2011). They included the University of Pittsburgh, RAND Corporation and Institution Review Boards of Columbia University Medical Centre.  

Results

The results are based from two tables. The first table highlights the personnel had interviews of them taken from nursing homes on a national sample. The second table highlights the themes that were discovered and had created infection prevention and control barriers and the employed strategies to combat them (Hooton et al. 2010). The researchers use a total of 73 interviews that had a duration of roughly 45mins each. The researchers include the fact that some roles were overlapping.

An example is that some infection preventionists also acted as staff nurses or directors and aides of directors of nursing. Five categories classify the themes that describe the barriers. The results of the study validate how language and culture were barriers. The interviewees who were working in the nursing homes were from different cultures. Most of them were using English as their second language (Halpin, Shortell, Milstein, & Vanneman 2011). The interviewers’ highlight that these might be the reason that the certified nursing assistants could not comprehend the rules of infection practice and control.

An example is used by a risk manager who said that the nursing home number 3 had a tool that the certified nursing assistants could not apply since they could not read the words encrypted on it. The researchers also note that diverse cultures had different perspectives that personnel ascribing to those cultures believed. An example from nursing home 2 shows that there was staff who came from cultures that did not find in discussing medical issues.  They were in a position to understand diagrams, pictures or color-codes (Edwards et al. 2012). The barrier of knowledge and training of the staff that proved a problem for them to follow infection prevention and control practices.

Discussion

The education and training that the nurses acquire are considered very low comparing them to other staff in their profession. An administrator from nursing home notes that despite nurses having education implementation of the education in their routine activity is an impediment. A nurse employed in nursing home 5 confesses that nurses who were fresh from school did not adhere to the practices due to the lack of awareness that they existed. The researchers highlight the barrier caused by the part-time staff or the per-diem (De Bono, Heling, & Borg 2014). The part-time staff came to the nursing as a result of unavoidable circumstances like under-staffing, pick-offs or turnovers. It was therefore not easy to predict when they would be available at the facility.

An infection preventionist from nursing home 2 noted that some part-time staff had terrible hygiene habits like poor trash disposal habits. The barrier of the workload that the nurses are subjected to. The workload made it difficult for the nurses to follow the infection prevention and control practices because of their multitasking roles and juggling between one resident to another. An infection preventionist from nursing home 10 gives an example of a nurse who has reported to work late and finds that there are nine residents instead of eight (Anderson, Gosbee, Bessesen, & Williams 2010). This makes the nurse hurry to finish the workload. The barrier is accountability by the staff to the practices. The nurses showed no interests in making sure that their duties are done in a responsible and accountable manner. The infection preventionist from nursing home 2 notes that they had to be constantly monitored for them to be accountable entirely.

Recommendation

The study notices that the healthcare workforce has more staff from diverse cultures and language. It is increasing relatively with the increase in staff. It highlights this diversity proved to be a challenge and the American Medicals Doctors had taken steps to provide material for education and translation of in-services (American Society of Health-System Pharmacists 2010). The recommendation of the reviewing of the requirements needed for a certified nursing assistant for them to be capable of satisfying what is required of them as per their duties. Posting of messages by the administration to places where all staff can be able to notice as polite remember. Considering the different levels of education of the staff, customized education that is curtailed to assist in their workstations. In the case of part-time staff, suggestions for training and reminders of essential aspects 15mins before their shift begins deemed crucial.

References

American Society of Health-System Pharmacists. (2010). ASHP statement on the pharmacist’s role in antimicrobial stewardship and infection prevention and control. American Journal of Health-System Pharmacy, 67(7), 575-577.

Anderson, J., Gosbee, L. L., Bessesen, M., & Williams, L. (2010). Using human factors engineering to improve the effectiveness of infection prevention and control. Critical care medicine, 38, S269-S281.

De Bono, S., Heling, G., & Borg, M. A. (2014). Organizational culture and its implications for infection prevention and control in healthcare institutions. Journal of Hospital Infection, 86(1), 1-6.

Edwards, R., Charani, E., Sevdalis, N., Alexandrou, B., Sibley, E., Mullett, D., … & Holmes, A. (2012). Optimisation of infection prevention and control in acute health care by use of behaviour change: a systematic review. The Lancet infectious diseases, 12(4), 318-329.

Halpin, H., Shortell, S. M., Milstein, A., & Vanneman, M. (2011). Hospital adoption of automated surveillance technology and the implementation of infection prevention and control programs. American journal of infection control, 39(4), 270-276.

Hooton, T. M., Bradley, S. F., Cardenas, D. D., Colgan, R., Geerlings, S. E., Rice, J. C., … & Nicolle, L. E. (2010). Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clinical infectious diseases, 50(5), 625-663.

MacCannell, T., Umscheid, C. A., Agarwal, R. K., Lee, I., Kuntz, G., Stevenson, K. B., & Healthcare Infection Control Practices Advisory Committee. (2011). Guideline for the prevention and control of norovirus gastroenteritis outbreaks in healthcare settings. Infection Control & Hospital Epidemiology, 32(10), 939-969.

Meyer, B., & Cookson, B. (2010). Does microbial resistance or adaptation to biocides create a hazard in infection prevention and control?. Journal of Hospital Infection, 76(3), 200-205.

Otter, J. A., Yezli, S., Perl, T. M., Barbut, F., & French, G. L. (2013). The role of ‘no-touch’automated room disinfection systems in infection prevention and control. Journal of Hospital Infection, 83(1), 1-13.

Raschka, S., Dempster, L., & Bryce, E. (2013). Health economic evaluation of an infection prevention and control program: are quality and patient safety programs worth the investment?. American Journal of Infection Control, 41(9), 773-777.

Saiman, L., Siegel, J. D., LiPuma, J. J., Brown, R. F., Bryson, E. A., Chambers, M. J., … & Marshall, B. C. (2014). Infection prevention and control guideline for cystic fibrosis: 2013 update. Infection Control & Hospital Epidemiology, 35(S1), s1-s67.

Ward, D. J. (2011). The role of education in the prevention and control of infection: a review of the literature. Nurse Education Today, 31(1), 9-17.