Healthcare-associated infections, while preventable, result in increased morbidity and mortality in nursing home (NH) residents. Frontline personnel, such as certified nursing assistants (CNAs), are crucial to successful implementation of infection prevention and control (IPC) practices. The purpose of this study was to explore barriers to implementing and maintaining IPC practices for NH CNAs as well as to describe strategies used to overcome these barriers. We conducted a multi-site qualitative study of NH personnel important to infection control. Audio-recorded interviews were transcribed verbatim and transcripts were analyzed using conventional content analysis. Five key themes emerged as perceived barriers to effective IPC for CNAs: 1) language/culture; 2) knowledge/training; 3) per-diem/part-time staff; 4) workload; and 5) accountability. Strategies used to overcome these barriers included: translating in-services, hands on training, on-the-spot training for per-diem/part-time staff, increased staffing ratios, and inclusion/empowerment of CNAs. Understanding IPC barriers and strategies to overcome these barriers may better enable NHs to achieve infection reduction goals.

Infections have been identified as a priority issue in nursing homes (NHs). We conducted a qualitative study purposively sampling 10 NHs across the country where 6 to 8 employees were recruited (N = 73). Semi-structured, open-ended guides were used to conduct in-depth interviews. Data were audio-taped, transcribed and a content analysis was performed. Five themes emerged: ‘Residents’ Needs’, ‘Roles and Training’ ‘Using Infection Data’, ‘External Resources’ and ‘Focus on Hand Hygiene’. Infection prevention was a priority in the NHs visited. While all sites had hand hygiene programs, other recommended areas were not a focus and many sites were not aware of available resources. Developing ways to ensure effective, efficient and standardized infection prevention and control in NHs continues to be a national priority.

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 characterized. Purpose To explore decision-making regarding isolation-based infection prevention and control practices in NHs. Methods A qualitative study was conducted with staff (e.g., staff nurses, infection prevention directors and directors of nursing) employed in purposefully sampled U.S. NHs. Semi-structured, role-specific interview guides were developed and interviews were digitally recorded, transcribed verbatim and analyzed 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.

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The purpose of this study was to explore how Minimum Data Set (MDS) coordinators perceive their role and the assessment process. Eleven MDS coordinators from ten geographically dispersed nursing homes (NH) were interviewed between May and September 2013. Four broad themes emerged from the content analysis: 1) information gathering, 2) interdisciplinary coordination, 3) role challenges and 4) resources. The first two themes referred to key components and competencies in the MDS coordinators’ role, the third theme dealt with certain challenges inherent in that role and the fourth theme highlighted resources that helped address these challenges. This study provides insight into how MDS coordinators perceive their role, as well as some of the challenges they face to successfully enact that role. Findings from this study can help inform NH management staff, such as directors of nursing and NH administrators and policy makers on how best to support MDS coordinators’ work to enable efficient and accurate resident assessment processes.