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Infection Prevention and Antimicrobial Stewardship Knowledge for Selected Infections Among Nursing Home Personnel

Published online by Cambridge University Press:  04 October 2016

Barbara W. Trautner ,
M. Todd Greene ,
Sarah L. Krein ,
Heidi L. Wald ,
Sanjay Saint ,
Andrew J. Rolle ,
Sara McNamara ,
Barbara S. Edson  and
Lona Mody
Barbara W. Trautner*
Affiliation:
Houston Veterans Affairs (VA) Health Services R&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas Department of Medicine, Baylor College of Medicine, Houston, Texas
M. Todd Greene
Affiliation:
VA Ann Arbor Healthcare System, Ann Arbor, Michigan Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Sarah L. Krein
Affiliation:
VA Ann Arbor Healthcare System, Ann Arbor, Michigan Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Heidi L. Wald
Affiliation:
Division of Health Care Policy Research, University of Colorado School of Medicine, Aurora, Colorado
Sanjay Saint
Affiliation:
VA Ann Arbor Healthcare System, Ann Arbor, Michigan Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Andrew J. Rolle
Affiliation:
Health Research & Educational Trust, American Hospital Association
Sara McNamara
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Barbara S. Edson
Affiliation:
Health Research & Educational Trust, American Hospital Association
Lona Mody
Affiliation:
VA Ann Arbor Healthcare System, Ann Arbor, Michigan Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
*
Address correspondence to Barbara W. Trautner, MD, PhD, Center for Innovations in Quality, Effectiveness, and Safety (151), 2002 Holcombe Blvd, Houston, TX 77030 ([email protected]).
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Abstract

OBJECTIVE

To assess knowledge about infection prevention among nursing home personnel and identify gaps potentially addressable through a quality improvement collaborative.

DESIGN

Baseline knowledge assessment of catheter-associated urinary tract infection, asymptomatic bacteriuria, antimicrobial stewardship, and general infection prevention practices for healthcare-associated infections.

SETTING

Nursing homes across 14 states participating in the national “Agency for Healthcare Research and Quality Safety Program for Long-Term Care: Healthcare-Associated Infections/Catheter-Associated Urinary Tract Infection.”

PARTICIPANTS

Licensed (RNs, LPNs, APRNs, MDs) and unlicensed (clinical nursing assistants) healthcare personnel.

METHODS

Each facility aimed to obtain responses from at least 10 employees (5 licensed and 5 unlicensed). We assessed the percentage of correct responses.

RESULTS

A total of 184 (78%) of 236 participating facilities provided 1 response or more. Of the 1,626 respondents, 822 (50.6%) were licensed; 117 facilities (63.6%) were for-profit. While 99.1% of licensed personnel recognized the definition of asymptomatic bacteriuria, only 36.1% knew that pyuria could not distinguish a urinary tract infection from asymptomatic bacteriuria. Among unlicensed personnel, 99.6% knew to notify a nurse if a resident developed fever or confusion, but only 27.7% knew that cloudy, smelly urine should not routinely be cultured. Although 100% of respondents reported receiving training in hand hygiene, less than 30% knew how long to rub hands (28.5% licensed, 25.2% unlicensed) or the most effective agent to use (11.7% licensed, 10.6% unlicensed).

CONCLUSIONS

This national assessment demonstrates an important need to enhance infection prevention knowledge among healthcare personnel working in nursing homes to improve resident safety and quality of care.

Infect. Control Hosp. Epidemiol. 2016;1–6

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 1 , January 2017 , pp. 83 - 88
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Harris-Kojetin, L, Sengupta, M, Park-Lee, E, Valverde, R. Long-term care services in the United States: 2013 overview. Vital Health Stat 2013;3:1–107.Google Scholar
2. Strausbaugh, LJ, Joseph, CL. The burden of infection in long-term care. Infect Control Hosp Epidemiol 2000;21:674–679.Google Scholar
3. Centers for Disease Control and Prevention (CDC). Nursing homes and assisted living (long-term care facilities [LTCFs]). US Department of Health and Human Services. CDC website. http://www.cdc.gov/longtermcare/index.html. Accessed April 7, 2016.Google Scholar
4. Rhee, SM, Stone, ND. Antimicrobial stewardship in long-term care facilities. Infect Dis Clin North Am 2014;28:237–246.Google Scholar
5. Dwyer, LL, Harris-Kojetin, LD, Valverde, RH, et al. Infections in long-term care populations in the United States. J Am Geriatr Soc 2013;61:342–349.CrossRefGoogle ScholarPubMed
6. Peron, EP, Hirsch, AA, July, LA, Jump, RL, Donskey, CJ. Another setting for stewardship: high rate of unnecessary antimicrobial use in a Veterans Affairs long-term care facility. J Am Geriatr Soc 2013;61:289–290.Google Scholar
7. Reform of requirements for long-term care facilities (CMS-3260-P). A proposed rule by the Centers for Medicare and Medicaid Services. Fed Regist 2015;80:42167–42269; https://www.federalregister.gov/articles/2015/07/16/2015-17207/medicare-and-medicaid-programs-reform-of-requirements-for-long-term-care-facilities#h-13. Accessed April 7, 2016.Google Scholar
8. Travers, J, Herzig, CT, Pogorzelska-Maziarz, M, et al. Perceived barriers to infection prevention and control for nursing home certified nursing assistants: a qualitative study. Geriatr Nurs 2015;36:355–360.Google Scholar
9. Mody, L, Meddings, J, Edson, BS, et al. Enhancing resident safety by preventing healthcare-associated infection: a national initiative to reduce catheter-associated urinary tract infections in nursing homes. Clin Infect Dis 2015;61:86–94.Google Scholar
10. Mody, L, Krein, SL, Saint, S, et al. A targeted infection prevention intervention in nursing home residents with indwelling devices: a randomized clinical trial. JAMA Intern Med 2015;175:714–723.Google Scholar
11. Koo, E, McNamara, S, Lansing, B, et al. Making infection prevention education interactive can enhance knowledge and improve outcomes: results from the Targeted Infection Prevention (TIP) study [published online August 20, 2016]. Am J Infect Control .Google Scholar
12. Herzig, CT, Stone, PW, Castle, N, Pogorzelska-Maziarz, M, Larson, EL, Dick, AW. Infection prevention and control programs in US nursing homes: results of a national survey. J Am Med Dir Assoc 2016;17:85–88.Google Scholar
13. Trautner, BW, Petersen, NJ, Hysong, SJ, Horwitz, D, Kelly, PA, Naik, AD. Overtreatment of asymptomatic bacteriuria: identifying provider barriers to evidence-based care. Am J Infect Control 2014;42:653–658.Google Scholar
14. Knowles, MS, Holton, EF, Swanson, RA. The Adult Learner: The Definitive Classic in Adult Education and Human Resource Development. New York: Butterworth-Heinemann (Elsevier); 2012.Google Scholar
15. Jump, RL, Heath, B, Crnich, CJ, et al. Knowledge, beliefs, and confidence regarding infections and antimicrobial stewardship: a survey of Veterans Affairs providers who care for older adults. Am J Infect Control 2015;43:298–300.Google Scholar
16. Jump, RL, Olds, DM, Jury, LA, et al. Specialty care delivery: bringing infectious disease expertise to the residents of a Veterans Affairs long-term care facility. J Am Geriatr Soc 2013;61:782–787.Google Scholar
17. Fleming, A, Bradley, C, Cullinan, S, Bryne, S. Antibiotic prescribing in long-term care facilities: a meta-synthesis of qualitative research. Drugs Aging 2015;32:295–303.Google Scholar
18. Grein, JD, Kahn, KL, Eells, SJ, et al. Treatment for positive urine cultures in hospitalized adults: a survey of prevalence and risk factors in 3 medical centers. Infect Control Hosp Epidemiol 2016;37:319–326.CrossRefGoogle ScholarPubMed
19. Lee, MJ, Kim, M, Kim, NH, et al. Why is asymptomatic bacteriuria overtreated?: A tertiary care institutional survey of resident physicians. BMC Infect Dis 2015;15:289.Google Scholar
20. Drekonja, DM, Abbo, LM, Kuskowski, MA, Gnadt, C, Shukla, B, Johnson, JR. A survey of resident physicians’ knowledge regarding urine testing and subsequent antimicrobial treatment. Am J Infect Control 2013;41:892–896.Google Scholar
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