Korean J Adult Nurs.  2018 Dec;30(6):634-642. 10.7475/kjan.2018.30.6.634.

Nurses' Views on Infection Control in Long-Term Care Facilities in South Korea: A Focus Group Study

• Lee CY
• Lee MH
• Lee SH
• Park YH

• KMID: 2429770
• DOI: http://doi.org/10.7475/kjan.2018.30.6.634

Abstract

PURPOSE
Nurses' infection prevention and control responsibilities have been emphasized owing to the increasing infection rate in long-term care facilities in South Korea. The aim of this study was to explore nurses' perspectives on challenging situations and the areas of improvement related to their role in infection management.
METHODS
An exploratory descriptive qualitative study was conducted with a purposive sample of 15 nursing staff from five long-term care facilities. A focus group interview with semi-structured questions was conducted between January and May 2017. The study participants' discussions were analyzed using conventional content analysis with line-by-line coding.
RESULTS
The participants discussed the breadth of challenges interfering with their ability to provide optimal infection care, from practical human resource management issues to organizational and environmental barriers, and laid a foundation based on which lacking areas can be improved. The analysis produced key themes centered on healthcare personnel-related professionalism, professional role boundaries, daily workflow and management, interdisciplinary collaboration, standards and protocols, and technological infrastructure.
CONCLUSION
Although participants expressed negative feelings toward the constraints in long-term care facilities, they demonstrated the willingness to create a positive change and offered suggestions for improvement and support to improve resident safety and care management. Therefore, special attention should be paid to nurses' perspectives on their work and roles regarding infection control practices and supporting them with available sources.

MeSH Terms

Clinical Coding
Cooperative Behavior
Delivery of Health Care
Focus Groups*
Humans
Infection Control*
Korea*
Long-Term Care*
Nursing Staff
Professional Role
Professionalism

Reference

1. Eriksen HM, Koch AM, Elstrom P, Nilsen RM, Harthug S, Aavitsland P. Healthcare-associated infection among residents of long-term care facilities: a cohort and nested case-control study. The Journal of Hospital Infection. 2007; 65(4):334–340. DOI: 10.1016/j.jhin.2006.11.011.

2. Hwang I, Kim H, Son Y, Jeong H, Kim M, Lee S, et al. Rate of antimicrobial resistant urinary pathogens and associated risk factor in older adults living in long-term care facilities in Seoul. Korean Journal of Family Practice. 2017; 7(6):864–869. DOI: 10.21215/kjfp.2017.7.6.864.

3. Healthy People.gov. Healthcare-associated infections [Internet]. Washington: Healthy People.gov;2018. cited 2018 September 22. Available from: https://www.healthypeople.gov/2020/topics-objectives/topic/healthcare-associated-infections.

4. Yang M, Vleck K, Bellantoni M, Sood G. Telephone survey of infection-control and antibiotic stewardship practices in long-term care facilities in Maryland. Journal of the American Medical Directors Association. 2016; 17(6):491–494. DOI: 10.1016/j.jamda.2015.12.018.

5. Shah N, Castro-Sánchez E, Charani E, Drumright LN, Holmes AH. Towards changing healthcare workers' behaviour: a qualitative study exploring non-compliance through appraisals of infection prevention and control practices. The Journal of Hospital Infection. 2015; 90(2):126–134. DOI: 10.1016/j.jhin.2015.01.023.

6. Park YH, Bang HL, Kim GH, Oh S, Jung YI, Kim H. Current status and barriers to health care services for nursing home residents: perspectives of staffs in Korean nursing homes. Korean Journal of Adult Nursing. 2015; 27(4):418–427. DOI: 10.7475/kjan.2015.27.4.418.

7. Cole M. Qualitative research: a challenging paradigm for infection control. Br J Infect Control. 2006; 7(6):25–30.

8. Cohen CC, Pogorzelska-Maziarz M, Herzig CTA, Carter EJ, Bjarnadottir R, Semeraro P, et al. Infection prevention and control in nursing homes: a qualitative study of decision-making regarding isolation-based practices. BMJ Qual Saf. 2015; 24(10):630–636. DOI: 10.1136/bmjqs-2015-003952.

9. Travers J, Herzig CTA, Pogorzelska-Maziarz M, Carter E, Cohen CC, Semeraro PK, et al. Perceived barriers to infection prevention and control for nursing home certified nursing assistants: a qualitative study. Geriatric Nursing. 2015; 36(5):355–360. DOI: 10.1016/j.gerinurse.2015.05.001.

10. Ngam C, Hundt AS, Haun N, Carayon P, Stevens L, Safdar N. Barriers and facilitators to Clostridium difficile infection prevention: a nursing perspective. American Journal of Infection Control. 2017; 45(12):1363–1368. DOI: 10.1016/j.ajic.2017.07.009.

11. Seibert DJ, Speroni KG, Oh KM, DeVoe MC, Jacobsen KH. Preventing transmission of MRSA: a qualitative study of health care workers' attitudes and suggestions. American Journal of Infection Control. 2014; 42(4):405–411. DOI: 10.1016/j.ajic.2013.10.008.

12. Lee JS, Hwang R, Lim MK. A study on working conditions and factors related to job satisfaction of nurses in the long-term care facilities for the elderly. Journal of Korean Public Health Nursing. 2015; 29(3):551–564. DOI: 10.5932/JKPHN.2015.29.3.551.

13. Choi H. A concept mapping study of good service experience among the elderly residents of long-term care facilities. Korean Journal of Adult Nursing. 2016; 28(6):669–679. DOI: 10.7475/kjan.2016.28.6.669.

14. Hsieh HF, Sarah ES. Three approaches to qualitative content analysis. Qualitative Health Research. 2005; 15(9):1277–1288. DOI: 10.1177/1049732305276687.

15. Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Educ Inf. 2004; 22(2):63–75. DOI: 10.3233/EFI-2004-22201.

16. 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. Social Science & Medicine. 2010; 71(9):1692–1701. DOI: 10.1016/j.socscimed.2010.07.041.

17. Jump RL, Heath B, Crnich CJ, Moehring R, Schmader KE, Olds D, et al. Knowledge, beliefs, and confidence regarding infections and antimicrobial stewardship: a survey of Veterans Affairs providers who care for older adults. American Journal of Infection Control. 2015; 43(3):298–300. DOI: 10.1016/j.ajic.2014.11.017.

18. Trautner BW, Greene MT, Krein SL, Wald HL, Saint S, Rolle AJ, et al. Infection prevention and antimicrobial stewardship knowledge for selected infections among nursing home personnel. Infection Control & Hospital Epidemiology. 2017; 38(1):83–88. DOI: 10.1017/ice.2016.228.

19. Saint S, Kowalski CP, Banaszak-Holl J, Forman J, Damschroder L, Krein SL. The importance of leadership in preventing healthcare-associated infection: results of a multisite qualitative study. Infection Control & Hospital Epidemiology. 2010; 31(9):901–907. DOI: 10.1086/655459.

20. Spires SS, Talbot HK, Pope CA, Talbot TR. Paramyxovirus outbreak in a long-term care facility: the challenges of implementing infection control practices in a congregate setting. Infection Control & Hospital Epidemiology. 2017; 38(4):399–404. DOI: 10.1017/ice.2016.316.

21. Kim HJ, Kim HY. Emotional labor, job stress and professional quality of life among nurses in long-term care hospital. Korean Journal of Adult Nursing. 2017; 29(3):290–301. DOI: 10.7475/kjan.2017.29.3.290.

22. Alexander GL, Rantz M, Galambos C, Vogelsmeier A, Flesner M, Popejoy L, et al. Preparing nursing homes for the future of health information exchange. Applied Clinical Informatics. 2015; 6(2):248–266. DOI: 10.4338/ACI-2014-12-RA-0113.

23. Smith PW, Bennett G, Bradley S, Drinka P, Lautenbach E, Marx J, et al. Shea/Apic guideline: infection prevention and control in the long-term care facility. Infection Control & Hospital Epidemiology. 2008; 29(9):785–814. DOI: 10.1086/592416.

24. Park EJ, Lim YJ, Cho BH, Sin IJ, Kim SO. A survey on performance of infection control by workers in nursing homes for the elderly. Journal of Korean Gerontological Nursing. 2011; 13(2):79–90.

25. Kim HJ, Kim HY. Experience of job stress among nurses working in long-term care hospital: a phenomenological approach. Korean Journal of Adult Nursing. 2016; 28(5):572–584. DOI: 10.7475/kjan.2016.28.5.572.

26. Park YH, Lee SH, Lee YM, Lee CY, Lee MH. Development of evidence-based guidelines for nursing home's infection control in Korea. J Muscle Joint Health. 2018; 25(2):135–147. DOI: 10.5953/JMJH.2018.25.2.135.

27. Kreman T, Hu J, Pottinger J, Herwaldt LA. Survey of long-term-care facilities in Iowa for policies and practices regarding residents with methicillin-resistant staphylococcus aureus or vancomycin-resistant enterococci. Infection Control & Hospital Epidemiology. 2005; 26(10):811–815. DOI: 10.1086/502498.

28. Choi HW. An analysis of the current conditions of the patient rooms of the long-term care facilities in Seoul city. Asia-pacific Journal of Multimedia Services Convergent with Art, Humanities, and Sociology. 2017; 7(8):751–762. DOI: 10.14257/ajmahs.2017.08.18.

29. Centers for Disease Control and Prevention. Tracking infections in long-term care facilities [Internet]. USA: Centers for Disease Control and Prevention;2012. cited 2018 September 28. Available from: https://www.cdc.gov/nhsn/ltc/index.html.

30. Herzig CTA, Dick AW, Sorbero M, Pogorzelska-Maziarz M, Cohen CC, Larson EL, et al. Infection trends in US nursing homes, 2006–2013. J Am Med Dir Assoc. 2017; 18(7):635.e9–635.e20. DOI: 10.1016/j.jamda.2017.04.003.

31. Alexander GL, Madsen RW. A report of information technology and health deficiencies in US nursing homes. J Patient Saf. 2017; DOI: 10.1097/PTS.0000000000000390.