Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, The Netherlands.
Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
PLoS One. 2021 Oct 29;16(10):e0258701. doi: 10.1371/journal.pone.0258701. eCollection 2021.
Care institutions are recognised to be a high-risk setting for the emergence and spread of infections and antimicrobial-resistant organisms, which stresses the importance of infection prevention and control (IPC). Accurate implementation is crucial for optimal IPC practice. Despite the wide promotion of IPC and research thereof in the hospital and nursing home setting, similar efforts are lacking in disability care settings. Therefore, this study aimed to assess perceived barriers and facilitators to IPC among professionals working at residential care facilities (RCFs) for people with intellectual and developmental disabilities (IDD), as well as to identify professional-reported recommendations to improve IPC.
This qualitative study involved semi-structured interviews (before COVID-19) with twelve professionals from five Dutch RCFs for people with IDD. An integrated theoretical approach was used to inform data collection and analysis. Thematic analysis using inductive and deductive approaches was conducted. This study followed the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines.
Our findings revealed barriers and facilitators at the guideline, client, professional, professional interaction, professional client interaction, client interaction, organisational, community, and societal level. Six main themes covering multiple barriers and facilitators were identified: (1) guidelines' applicability to (work)setting; (2) professionals' cognitions and attitude towards IPC (related to educational background); (3) organisational support and priority; (4) educational system; (5) time availability and staff capacity; and (6) task division and change coaches. The main professional-reported recommendations were the introduction of tailored and practical IPC guidelines, structural IPC education and training among all professionals, and client participation.
To promote IPC, multifaceted and multilevel strategies should be implemented, with a preliminary need for improvements on the guideline, professional, and organisational level. Given the heterogeneous character, i.e., different professionals, clients and care needs, there is a need for a tailored approach to implement IPC and sustain it successfully in disability care. Our findings can inform future IPC practice improvements.
医疗机构被认为是感染和抗微生物药物耐药生物体出现和传播的高风险场所，这强调了感染预防和控制（IPC）的重要性。准确实施对于最佳 IPC 实践至关重要。尽管在医院和养老院环境中广泛推广了 IPC 及其研究，但在残疾护理环境中缺乏类似的努力。因此，本研究旨在评估从事智障和发育障碍人士（IDD）居住护理设施（RCF）工作的专业人员对 IPC 的感知障碍和促进因素，以及确定专业人员报告的改善 IPC 的建议。
本定性研究采用了在 COVID-19 之前对来自荷兰五个 RCF 的 12 名专业人员进行的半结构化访谈。使用综合理论方法来告知数据收集和分析。采用归纳和演绎方法进行主题分析。本研究遵循 COnsolidated criteria for REporting Qualitative research（COREQ）指南。
我们的研究结果揭示了指南、客户、专业人员、专业人员互动、专业人员与客户互动、客户互动、组织、社区和社会层面的障碍和促进因素。确定了六个涵盖多个障碍和促进因素的主要主题：（1）指南对（工作）环境的适用性；（2）专业人员对 IPC 的认知和态度（与教育背景有关）；（3）组织支持和优先级；（4）教育系统；（5）时间可用性和员工能力；以及（6）任务分工和变更教练。主要的专业人员报告的建议是引入针对性强和实用的 IPC 指南，在所有专业人员中进行结构性 IPC 教育和培训，以及客户参与。
为了促进 IPC，应实施多方面和多层次的策略，初步需要改进指南、专业人员和组织层面。鉴于异质性特征，即不同的专业人员、客户和护理需求，需要采取有针对性的方法来实施 IPC，并在残疾护理中成功维持它。我们的研究结果可以为未来的 IPC 实践改进提供信息。
