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Understanding Staff Perceptions about Klebsiella pneumoniae Carbapenemase–Producing Enterobacteriaceae Control Efforts in Chicago Long-Term Acute Care Hospitals

Published online by Cambridge University Press:  10 May 2016

Rosie D. Lyles ,
Nicholas M. Moore ,
Shayna B. Weiner ,
Monica Sikka ,
Michael Y. Lin ,
Robert A. Weinstein ,
Mary K. Hayden ,
Ronda L. Sinkowitz-Cochran  and
CDC Prevention Epicenters Program
Rosie D. Lyles*
Affiliation:
Division of Infectious Diseases, John H. Stroger Hospital of Cook County, Chicago, Illinois
Nicholas M. Moore
Affiliation:
Department of Medical Laboratory Sciences, Rush University Medical Center, Chicago, Illinois
Shayna B. Weiner
Affiliation:
Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Monica Sikka
Affiliation:
Section of Infectious Diseases, University of Illinois at Chicago, Chicago, Illinois
Michael Y. Lin
Affiliation:
Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Robert A. Weinstein
Affiliation:
Division of Infectious Diseases, John H. Stroger Hospital of Cook County, Chicago, Illinois Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Mary K. Hayden
Affiliation:
Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois Department of Pathology, Rush University Medical Center, Chicago, Illinois
Ronda L. Sinkowitz-Cochran
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
1900 West Polk Street, Suite 1256, Chicago, IL 60612 ([email protected])
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Abstract

Objective.

To identify differences in organizational culture and better understand motivators to implementation of abundle intervention to control Klebsiella pneumoniae carbapenemase–producing Enterobacteriaceae (KPC).

Design.

Mixed-methods study.

Setting.

Four long-term acute care hospitals (LTACHs) in Chicago.

Participants.

LTACH staff across 3 strata of employees (administration, midlevel management, and frontline clinical workers).

Methods.

Qualitative interviews or focus groups and completion of a quantitative questionnaire.

Results.

Eighty employees (frontline, 72.5%; midlevel, 17.5%; administration, 10%) completed surveys and participated in qualitative discussions in August 2012. Although 82.3% of respondents felt that quality improvement was a priority at their LTACH, there were statistically significant differences in organizational culture between staff strata, with administrative-level having higher organizational culture scores (ie, more favorable responses) than midlevel or frontline staff. When asked to rank the success of the KPC control program, mean response was 8.0 (95% confidence interval, 7.6–8.5), indicating a high level of agreement with the perception that the program was a success. Patient safety and personal safety were reported most often as personal motivators for intervention adherence. The most convergent theme related to prevention across groups was that proper hand hygiene is vital to prevention of KPC transmission.

Conclusions.

Despite differences in organizational culture across 3 strata of LTACH employees, the high degree of convergence in motivation, understanding, and beliefs related to implementation of a KPC control bundle suggests that all levels of staff may be able to align perspectives when faced with a key infection control problem and quality improvement initiative.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 4: Special Topic Issue: Carbapenem-Resistant Enterobacteriaceae and Multidrug-Resistant Organisms , April 2014 , pp. 367 - 374
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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References

1. Bratu, S, Landman, D, Haag, R, et al. Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City: a new threat to our antibiotic armamentarium. Arch Intern Med 2005;165:1430–1435.Google Scholar
2. Smith Moland, E, Hanson, N, Herrera, V, et al. Plasmid-mediated, carbapenem-hydrolysing beta-lactamase, KPC-2, in Klebsiella pneumoniae isolates. J Antimicrob Chemother 2003;51:711–714.Google Scholar
3. Bradford, P, Bratu, S, Urban, C, et al. Emergence of carbapenem-resistant Klebsiella species possessing the class A carbapenem-hydrolyzing KPC-2 and inhibitor-resistant TEM-30 beta-lactamases in New York City. Clin Infect Dis 2004;39:55–60.Google Scholar
4. Yigit, H, Queenan, A, Anderson, G, et al. Novel carbapenem-hydrolyzing beta-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae . Antimicrob Agents Chemother 2008;52(2):809.CrossRefGoogle Scholar
5. Won, S, Munoz-Price, L, Lolans, K, et al. Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis 2011;53:532–540.Google Scholar
6. Patel, G, Huprikar, S, Factor, S, Jenkins, S, Calfee, D. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol 2008;29:1099–1106.Google Scholar
7. Centers for Disease Control and Prevention (CDC). Guidance for Control of Carbapenem-Resistant Enterobacteriaceae (CRE): 2012 CRE Toolkit. Atlanta: CDC, 2012. http://www.cdc.gov/hai/pdfs/cre/CRE-guidance-508.pdf. Accessed July 27, 2013.Google Scholar
8. Thurlow, CJ, Prabaker, K, Lin, MY, et al. Anatomic sites of patient colonization and environmental contamination with Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae at long-term acute care hospitals. Infect Control Hosp Epidemiol 2013;34:56–61.Google Scholar
9. Lin, MY, Lyles-Banks, RD, Lolans, K, et al. The importance of long-term acute care hospitals in the regional epidemiology of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis 2013;57:1246–1252.CrossRefGoogle ScholarPubMed
10. Munoz-Price, L, Hayden, MK, Lolans, K, et al. Successful control of an outbreak of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae at a long-term acute care hospital. Infect Control Hosp Epidemiol 2010;31:341–347.Google Scholar
11. Chitnis, A, Caruthers, P, Rao, A, et al. Outbreak of carbapenem-resistant Enterobacteriaceae at a long-term acute care hospital: sustained reductions in transmission through active surveillance and targeted interventions. Infect Control Hosp Epidemiol 2012;33:984–992.Google Scholar
12. Blake, SC, Kohler, S, Rask, K, Davis, A, Naylor, DV. Facilitators and barriers to 10 National Quality Forum safe practices. Am J Med Qual 2006;21(5):323–334.Google Scholar
13. Davies, HT, Nutley, SM, Mannion, R. Organisational culture and quality of health care. Qual Health Care 2000;9:111–119.Google Scholar
14. Garcia-Williams, AG, Miller, LJ, Burkitt, KH, et al. Beyond beta: lessons learned from implementation of the Department of Veterans Affairs Methicillin-Resistant Staphylococcus aureus Prevention Initiative. Infect Control Hosp Epidemiol. 2010;31:763–765.CrossRefGoogle ScholarPubMed
15. Griffiths, P, Renz, A, Hughes, J, Rafferty, AM. Impact of organisation and management factors on infection control in hospitals: a scoping review. J Hosp Infect 2009;73:1–14.Google Scholar
16. Keroack, MA, Youngberg, BJ, Cerese, JL, Krsek, C, Prellwitz, LW, Trevelyan, EW. Organizational factors associated with high performance in quality and safety in academic medical centers. Acad Med 2007;82:1178–1186.Google Scholar
17. Krein, SL, Damschroder, LJ, Kowalski, CP, Forman, J, Hofer, TP, Saint, S. The influence of organizational context on quality improvement and patient safety efforts in infection prevention: a multi-center qualitative study. Soc Sci Med 2010;71:1692–1701.Google Scholar
18. Jain, M, Miller, L, Belt, D, King, D, Berwick, DM. Decline in ICU adverse events, nosocomial infections and cost through a quality improvement initiative focusing on teamwork and culture change. Qual Saf Health Care 2006;15:235–239.Google Scholar
19. Saint, S, Kowalski, CP, Banaszak-Holl, J, Forman, J, Damschroder, L, Krein, SL. The importance of leadership in preventing health-care-associated infection: results of a multisite qualitative study. Infect Control Hosp Epidemiol 2010;31:901–907.CrossRefGoogle ScholarPubMed
20. Sinkowitz-Cochran, R, Burkitt, K, Cuerdon, T, et al. The associations between organizational culture and knowledge, attitudes, and practices in a multicenter Veterans Affairs quality improvement initiative to prevent methicillin-resistant Staphylococcus aureus . Am J Infect Control 2012;40:138–143.Google Scholar
21. Sinkowitz-Cochran, R, Garcia-Williams, A, Hackberth, A, et al. Evaluation of organizational culture among different levels of healthcare staff participating in the Institute for Healthcare Improvement's 100,000 Lives Campaign. Infect Control Hosp Epidemiol 2012;33:135–143.Google Scholar
22. Baker, K. Chapter 11: Organizational Culture, http://www.au.af.mil/au/awc/awcgate/doe/benchmark/ch11.pdf. Accessed June 5, 2013.Google Scholar
23. Shortell, S, Bennett, C, Byck, G. Assessing the impact of continuous quality improvement on clinical practice: what it will take to accelerate progress. Milbank Q 1998;76:593–624.Google Scholar
24. Leape, L. Errors in medicine. Clin Chim Acta 2009;104:2–5.Google Scholar
25. Ohman-Strickland, P, Orzano, J, Nutting, P, Dickinson, W, Scott-Cawiezell, J, Hahn, K. Measuring organizational attributes of primary care practices: development of a new instrument. Health Serv Res 2007;42:1257–1273.Google Scholar
26. Wise, ME, Weber, SG, Schneider, A, et al. Hospital staff perceptions of a legislative mandate for methicillin-resistant Staphylococcus aureus screening. Infect Control Hosp Epidemiol 2011;32:573–578.Google Scholar
27. Borkan, J. Immersion/crystallization. In: Crabtree, B, Miller, W, eds. Doing Qualitative Research. 2nd ed. Thousand Oaks, CA: Sage, 1999:179–194.Google Scholar