Skip to main content Accessibility help
×
Home

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

  • Barbara W. Trautner (a1) (a2), M. Todd Greene (a3) (a4), Sarah L. Krein (a3) (a4), Heidi L. Wald (a5), Sanjay Saint (a3) (a4), Andrew J. Rolle (a6), Sara McNamara (a4), Barbara S. Edson (a6) and Lona Mody (a3) (a4)...

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

Copyright

Corresponding author

Address correspondence to Barbara W. Trautner, MD, PhD, Center for Innovations in Quality, Effectiveness, and Safety (151), 2002 Holcombe Blvd, Houston, TX 77030 (trautner@bcm.edu).

References

Hide All
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;3:1107.
2. Strausbaugh, LJ, Joseph, CL. The burden of infection in long-term care. Infect Control Hosp Epidemiol 2000;21:674679.
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.
4. Rhee, SM, Stone, ND. Antimicrobial stewardship in long-term care facilities. Infect Dis Clin North Am 2014;28:237246.
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;61:342349.
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;61:289290.
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;80:4216742269; 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.
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;36:355360.
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;61:8694.
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;175:714723.
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 .
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;17:8588.
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;42:653658.
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.
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;43:298300.
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;61:782787.
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;32:295303.
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;37:319326.
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.
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;41:892896.
Type Description Title
PDF
Supplementary materials

Trautner supplementary material
Trautner supplementary material 1

 PDF (424 KB)
424 KB
PDF
Supplementary materials

Trautner supplementary material
Trautner supplementary material 2

 PDF (467 KB)
467 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed