Characterizing infection prevention programs and urinary tract infection prevention practices in nursing homes: A mixed-methods study.

BackgroundCritical Access Hospitals (CAH) may face challenges with limited resources in their infection prevention and control (IPC) program. As part of the Project Firstline collaborative, the University of Nebraska Medical Center and its clinical partner Nebraska Medicine sought to identify needs and develop resources to mitigate IPC program gaps in small and rural hospitals, including CAHs. Since, little is known about the resources needed by CAHs to strengthen their IPC program, a needs assessment survey was deployed to Federal Emergency Management Agency Region VII CAHs.MethodsA 49-question Research Electronic Data Capture (REDCap) survey was distributed via email to infection preventionists in Region VII CAHs. The survey had 4 sections with questions focused on IPC program infrastructure, competency-based training, audit and feedback, and identification and isolation of high-risk pathogens/serious communicable diseases. An IPC practice score was assigned to each CAH by totaling “yes” responses. A “no” or “not sure” response was considered an IPC gap. Respondents who selected “no” were asked to identify resources that would assist in mitigating identified gaps. Descriptive analyses evaluated frequency of gaps and most cited resources. Welch t-test was used to study differences in IPC practice score between states.Results50 CAHs (33 in NE, 16 in IA and 1 in KS) and 1 small NE hospital (not licensed as CAH but included in the analyses as CAH) participated in the survey. Majority (n=38) responded to all sections with IPC scores ranging from 13 to 48. There was no significant difference between IPC practice scores of CAHs in NE and IA (average score 33 vs 36; p = 0.38). Specific IPC practice gaps present in > 50% of CAHs were related to audit and feedback practices (Table 1). Additional gaps included lack of drug diversion program, absence of input from IPC team prior to purchasing equipment and failure to conduct risk assessment for the laboratory. Most CAHs cited a standardized audit tool and staff training materials as much needed resources (Table 1).Table 1. Needs/Resources for the identified Infection Prevention and Control Gaps.ConclusionMajor IPC gaps exist in CAHs with many of them related to implementing audit and feedback practices that are an essential component of a successful IPC program. Focus should be directed on developing resources to mitigate identified IPC gaps.DisclosuresM. Salman Ashraf, MBBS, Merck & Co. Inc (Grant/Research Support, I have recieved grant funding for an investigator initiated research project from Merck & Con. Inc. However, I do not see any direct conflict of interest related to the submitted abstract)

Knowing IS the Battle: Evidence-Based Infection Prevention Practices & Outcome Metrics in Nursing Homes

Infection Prevention and Control Programs in US Nursing Homes: Results of a National Survey

Urinary tract infections (UTIs) are one of the most frequently reported infections in older adults and the most common reason for antimicrobial prescribing in nursing homes (NHs). In this vulnerable population, both a good diagnosis and prevention of these infections are crucial as overuse of antibiotics can lead to a variety of negative consequences including the development of multidrug-resistant organisms. To determine infection prevention and control (IPC) and diagnostic practices for UTIs in Belgian NHs. Local staff members had to complete an institution-level questionnaire exploring the availability of IPC practices and resources and procedures for UTI surveillance, diagnosis, and urinary catheter and incontinence care. UTIs were the second most common infections in the 87 participating NHs (prevalence: 1.0%). Dipstick tests and urine cultures were routinely performed in 30.2% and 44.6% of the facilities, respectively. In non-catheterised residents, voided or midstream urine sampling was most frequently applied. Protocols/guidelines for urine sampling, urinary catheter care and incontinence care were available in 43.7%, 45.9% and 31.0% of the NHs, respectively. Indwelling catheters were uncommon (2.3% of the residents) and urinary retention (84.9%) and wound management (48.8%) were the most commonly reported indications. Only surveillance was found to significantly impact the UTI prevalence: 2.2% versus 0.8% in NHs with or without surveillance, respectively (P < 0.001). This survey identified key areas for improving the diagnosis and prevention of UTIs, such as education and training regarding the basics of urine collection and catheter care.

Transitioning an Infection Prevention and Control Program to a New Outpatient Hospital-Based Cancer Center

A Needs-Assessment Survey of Healthcare Professionals Accountable for Infection Prevention and Control in Hemodialysis Setting

BackgroundHospital infection prevention and control (IPC) depends on consistent practice to achieve its purpose. Standard precautions are embedded in modern healthcare policies, but not uniformly observed by all clinicians. Well-documented differences in attitudes to IPC, between doctors and nurses, contribute to suboptimal IPC practices and persistence of preventable healthcare-associated infections. The COVID-19 pandemic has seriously affected healthcare professionals’ work-practices, lives and health and increased awareness and observance of IPC. Successful transition of health services to a ‘post-COVID-19’ future, will depend on sustainable integration of lessons learnt into routine practice.MethodsThe aim of this pre-COVID-19 qualitative study was to investigate factors influencing doctors’ IPC attitudes and practices, whether they differ from those of nurses and, if so, how this affects interprofessional relationships. We hypothesised that better understanding would guide new strategies to achieve more effective IPC. We interviewed 26 senior clinicians (16 doctors and 10 nurses) from a range of specialties, at a large Australian tertiary hospital. Interview transcripts were reviewed iteratively, and themes identified inductively, using reflexive thematic analysis.ResultsParticipants from both professions painted clichéd portraits of ‘typical’ doctors and nurses and recounted unflattering anecdotes of their IPC behaviours. Doctors were described as self-directed and often unaware or disdainful of IPC rules; while nurses were portrayed as slavishly following rules, ostensibly to protect patients, irrespective of risk or evidence. Many participants believed that doctors object to being reminded of IPC requirements by nurses, despite many senior doctors having limited knowledge of correct IPC practice. Overall, participants’ comments suggested that the ‘doctor-nurse game’—described in the 1960s, to exemplify the complex power disparity between professions—is still in play, despite changes in both professions, in the interim.ConclusionsThe results suggest that interprofessional differences and inconsistencies constrain IPC practice improvement. IPC inconsistencies and failures can be catastrophic, but the common threat of COVID-19 has promoted focus and unity. Appropriate implementation of IPC policies should be context-specific and respect the needs and expertise of all stakeholders. We propose an ethical framework to guide interprofessional collaboration in establishing a path towards sustained improvements in IPC and bio-preparedness.

ObjectiveQuality assurance for reducing infections is a key objective of the WHO’s global action plan targeting antimicrobial resistance, yet no studies have employed a multifaceted approach to review health professional...

Objective:The study examined resources needed by Infection Preventionists (IP) to address infection prevention and control (IPC) program gaps.Design:A 49-question survey.Setting:Licensed Critical Access Hospitals (CAHs) in Federal Emergency Management Area (FEMA) Region VII.Participants:IP at licensed CAHs.Methods:The survey conducted between December 2020 and January 2021 consisted of questions focusing on four categories including IPC program infrastructure, competency-based training, audit and feedback, and identification of high-risk pathogens/serious communicable diseases (HRP/SCD). An IPC score was calculated for each facility by totaling “Yes” responses (which indicate best practices) to 49 main survey questions. Follow-up questions explored the resources needed by the CAHs to implement or further strengthen best practices and mitigate IPC practice gaps. Welch t-test was used to study differences in IPC practice scores between states.Results:50 of 259 (19.3%) CAHs participated in the survey with 37 (14.3%) answering all 49 questions. CAHs responding to all questions had a median IPC score of 35. There was no significant difference between IPC practice scores of CAHs in NE and IA. The top three IPC gaps were absence of drug diversion program (77%), lack of audits and feedback for insertion and maintenance of central venous catheters (76%), and missing laboratory risk assessments to identify tests that can be offered safely for patients under investigation for HRP/SCD (76%). Standardized audit tools, educational resources, and staff training materials were cited as much-needed resources.Conclusion:IPC practice gaps exist in CAHs. Various resources are needed for gap mitigation.

OBJECTIVE The impact of healthcare system integration on infection prevention programs is unknown. Using catheter-associated urinary tract infection (CAUTI) prevention as an example, we hypothesize that US Department of Veterans Affairs (VA) nursing homes have a more robust infection prevention infrastructure due to integration and centralization compared with non-VA nursing homes. SETTING VA and non-VA nursing homes participating in the AHRQ Safety Program for Long-Term Care collaborative. METHODS Nursing homes provided baseline information about their infection prevention programs to assess strengths and gaps related to CAUTI prevention via a needs assessment questionnaire. RESULTS A total of 353 of 494 nursing homes from 41 states (71%; 47 VA and 306 non-VA facilities) responded. VA nursing homes reported more hours per week devoted to infection prevention-related activities (31 vs 12 hours; P<.001) and were more likely to have committees that reviewed healthcare-associated infections. Compared with non-VA facilities, a higher percentage of VA nursing homes reported tracking CAUTI rates (94% vs 66%; P<.001), sharing CAUTI data with leadership (94% vs 70%; P=.014) and with nursing personnel (85% vs 56%, P=.003). However, fewer VA nursing homes reported having policies for appropriate catheter use (64% vs 81%; P=.004) and catheter insertion (83% vs 94%; P=.004). CONCLUSIONS Among nursing homes participating in an AHRQ-funded collaborative, VA and non-VA nursing homes differed in their approach to CAUTI prevention. Best practices from both settings should be applied universally to create an optimal infection prevention program within emerging integrated healthcare systems. Infect Control Hosp Epidemiol 2017;38:287-293.

Enhancing infection prevention and control practices among nurses: The mediating role of resilience and the moderating effect of training participation.

Infection prevention and control in nursing homes during COVID-19: An environmental scan

Antimicrobial Stewardship and Infection Prevention and Control in Low- and Middle-income Countries: Current Status and Best Practices.

Infection prevention and control (IPC) is critical in neonatal units to prevent healthcare-associated infections, yet research on IPC has primarily focused on healthcare workers, overlooking the role of family caregivers. In low-resource settings, mothers often take on essential caregiving responsibilities including IPC-related tasks, both a logistic necessity and a cultural norm, but their perspectives and experiences remain underexplored. This qualitative descriptive study aimed to explore mothers' experiences and perceptions of IPC in a neonatal unit in Gaborone, Botswana. Understanding maternal involvement in IPC is essential for developing effective interventions, particularly in settings where health systems face workforce shortages and resource constraints. Fifteen semi-structured interviews were conducted with mothers of infants admitted to the neonatal unit between June and December 2022. Data were analysed using thematic analysis. Six themes were identified. Major themes related to (1) mothers' strong sense of responsibility for IPC and concerns about infection risks, (2) health system constraints (including supply shortages) that limited consistent IPC practice, (3) competing demands within restricted visiting times that required mothers to balance IPC with feeding and bonding, (4) variable communication with health care workers (HCWs) and limited comfort reminding staff about IPC, and (5) peer dynamics between mothers, including mutual reminders as well as tensions arising from shared feeding equipment. A minor theme that emerged was (6) mothers' emotional distress and its perceived impact on remembering and enacting IPC behaviours. Overall, mothers described high motivation to protect their infants but reported that time pressures, insufficient communication with HCWs, and resource limitations constrained IPC adherence, underscoring the need for structured IPC orientation and ongoing support for families in neonatal care. Mothers in this neonatal unit viewed themselves as key partners in IPC and were highly motivated to protect their infants, but their ability to consistently follow IPC practices was constrained by limited supplies, staffing pressures, restricted time for caregiving and bonding, and variable communication with HCWs. Mothers also expressed concerns about HCW adherence to IPC and described how emotional distress and peer dynamics could shape IPC behaviour. These findings underscore the need for structured IPC education and support for mothers in neonatal units, and the importance of integrating family-centred IPC policies into neonatal care. Future research should evaluate interventions that strengthen caregiver support, improve communication, and address contextual barriers and constraints to sustained IPC practice.

Background: Hospital infection prevention and control (IPC) ethics are an important yet neglected component of patient safety and wellbeing. The IPC program in a hospital is mainly focused to prevent the transmission of drug resistant organisms. Poor compliance of such program can lead to nosocomial infections and impaired patient’s safety, which is against the moral principles of ethics. Material and Methods: This qualitative study was conducted in a tertiary care hospital Rawalpindi affiliated with National University of Medical Sciences Rawalpindi. Semi structured, informal interviews were taken from health care workers, recorded and analyzed based on thematic analysis. Results: A total of 20 health care workers were selected and interviewed belonging to different specialties including two nurses. Majority of the participants had fairly good knowledge of hospital IPC but poor knowledge of ethical issues related to poor IPC practices. Autonomy was the dominant factor in compromised IPC practices. Conclusion: Ethics of hospital IPC is an important subject of patient safety and hospital success. It should be taught and incorporated in training at all the levels of medical education. Keywords: Autonomy, Consequentialism, Deontology, Infection prevention and control, Leadership, Nosocomial infections