医疗机构人员在具备通气条件的熟练护理设施中实施耐碳青霉烯类肠杆菌科感染控制措施的经验：一项定性分析。
Healthcare personnel experiences implementing carbapenem-resistant Enterobacterales infection control measures at a ventilator-capable skilled nursing facility-A qualitative analysis.
机构信息
Case Western Reserve University, Cleveland, Ohio.
Rush University Medical Center, Chicago, Illinois.
出版信息
Infect Control Hosp Epidemiol. 2022 Aug;43(8):1010-1016. doi: 10.1017/ice.2021.265. Epub 2021 Jun 21.
OBJECTIVE
Ventilator-capable skilled nursing facilities (vSNFs) are critical to the epidemiology and control of antibiotic-resistant organisms. During an infection prevention intervention to control carbapenem-resistant (CRE), we conducted a qualitative study to characterize vSNF healthcare personnel beliefs and experiences regarding infection control measures.
DESIGN
A qualitative study involving semistructured interviews.
SETTING
One vSNF in the Chicago, Illinois, metropolitan region.
PARTICIPANTS
The study included 17 healthcare personnel representing management, nursing, and nursing assistants.
METHODS
We used face-to-face, semistructured interviews to measure healthcare personnel experiences with infection control measures at the midpoint of a 2-year quality improvement project.
RESULTS
Healthcare personnel characterized their facility as a home-like environment, yet they recognized that it is a setting where germs were 'invisible' and potentially 'threatening.' Healthcare personnel described elaborate self-protection measures to avoid acquisition or transfer of germs to their own household. Healthcare personnel were motivated to implement infection control measures to protect residents, but many identified structural barriers such as understaffing and time constraints, and some reported persistent preference for soap and water.
CONCLUSIONS
Healthcare personnel in vSNFs, from management to frontline staff, understood germ theory and the significance of multidrug-resistant organism transmission. However, their ability to implement infection control measures was hampered by resource limitations and mixed beliefs regarding the effectiveness of infection control measures. Self-protection from acquiring multidrug-resistant organisms was a strong motivator for healthcare personnel both outside and inside the workplace, and it could explain variation in adherence to infection control measures such as a higher hand hygiene adherence after resident care than before resident care.
目的
有能力使用呼吸机的熟练护理设施（vSNF）对控制抗生素耐药生物体的流行病学具有重要意义。在一项预防感染干预措施以控制碳青霉烯类耐药菌（CRE）的过程中，我们进行了一项定性研究，以描述 vSNF 医疗保健人员对感染控制措施的信念和经验。
设计
一项涉及半结构化访谈的定性研究。
地点
芝加哥，伊利诺伊州，大都市区的一个 vSNF。
参与者
该研究包括 17 名医疗保健人员，代表管理层、护理人员和护理助理。
方法
我们在为期两年的质量改进项目的中点，使用面对面的半结构化访谈来衡量医疗保健人员对感染控制措施的经验。
结果
医疗保健人员将他们的设施描述为一个家庭式的环境，但他们认识到这是一个看不见的、潜在威胁的细菌环境。医疗保健人员描述了精心的自我保护措施，以避免在自己家中获得或传播细菌。医疗保健人员有动力实施感染控制措施来保护居民，但许多人指出了人员配备不足和时间限制等结构性障碍，一些人报告说他们仍然更喜欢使用肥皂和水。
结论
vSNF 中的医疗保健人员，从管理层到一线工作人员，都理解细菌理论和多药耐药生物体传播的重要性。然而，他们实施感染控制措施的能力受到资源限制和对感染控制措施有效性的混合信念的阻碍。防止获得多药耐药生物体的自我保护是医疗保健人员在工作场所内外的一个强大动力，这可以解释他们对感染控制措施的遵守情况的差异，例如在照顾居民后比照顾居民前更高的手部卫生遵守率。
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