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Environmental service workers as potential designers of infection control policy in long-term care settings

  • Jennifer M. Van Tiem
    Correspondence
    Address correspondence to Jennifer M. Van Tiem, PhD, Department of Veterans Affairs Health Services Research & Delivery Service (HSR&D), Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System (152), 601 Highway 6 West, Iowa City, IA 52246.
    Affiliations
    Department of Veterans Affairs Health Services Research & Delivery Service (HSR&D), Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA

    Department of Veterans Affairs Health Services Research & Delivery Service (HSR&D), Primary Care Analytics Team-Iowa City, Iowa City VA Health Care System, Iowa City, IA
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  • Julia E. Friberg
    Affiliations
    Department of Veterans Affairs Health Services Research & Delivery Service (HSR&D), Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA
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  • Cassie Cunningham Goedken
    Affiliations
    Department of Veterans Affairs Health Services Research & Delivery Service (HSR&D), Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA
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  • Lisa Pineles
    Affiliations
    Department of Infection Control, Veterans Affairs Maryland Health Care System, Baltimore, MD

    Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
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  • Heather Schacht Reisinger
    Affiliations
    Department of Veterans Affairs Health Services Research & Delivery Service (HSR&D), Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA

    Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA

    Community and Patient Engagement, Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA
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  • Daniel J. Morgan
    Affiliations
    Department of Infection Control, Veterans Affairs Maryland Health Care System, Baltimore, MD

    Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
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  • Samantha L. Solimeo
    Affiliations
    Department of Veterans Affairs Health Services Research & Delivery Service (HSR&D), Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA

    Department of Veterans Affairs Health Services Research & Delivery Service (HSR&D), Primary Care Analytics Team-Iowa City, Iowa City VA Health Care System, Iowa City, IA

    Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA

    Community and Patient Engagement, Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA

    Department of Veterans Affairs, Office of Rural Health, Veterans Rural Health Resource Center- Iowa City, Iowa City VA Health Care System, Iowa City, IA
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Published:February 19, 2020DOI:https://doi.org/10.1016/j.ajic.2020.01.014

      Highlights

      • Designing infection prevention policies in long-term care is logistically complex.
      • Use of private and public space impact how staff engage in infection control.
      • Environmental service workers contribute unique perspectives on infection control.

      Background

      Long-term care facility residents are at higher risk of methicillin-resistant Staphylococcus aureus infection and colonization than the general population. In 2009, the Department of Veterans Affairs (VA) implemented the “methicillin-resistant S. aureus prevention initiative” in long-term care facilities (ie, Community Living Centers or “CLCs”).

      Methods

      Over 4 months, 40 semistructured interviews were conducted with staff in medicine, nursing, and environmental services at 5 geographically dispersed CLCs. Interviews addressed knowledge, attitudes, and beliefs concerning infection prevention and resident-centered care. A modified constant comparative approach was used for data analysis.

      Results

      In CLCs, staff work to prevent and control infections in spaces where residents live. Nurses and Environmental Service Workers daily balance infection prevention conventions with the CLC setting. Infection control team members, who are accustomed to working in acute care settings, struggle to reconcile the CLC context with infection prevention.

      Discussion

      The focus on the resident's room as the locus of care, and thus the main target of infection control, misses opportunities for addressing infection prevention in the spaces beyond the residents’ rooms.

      Conclusions

      Environmental Service Workers’ daily work inside the rooms and within the wider facility produces a unique perspective that might help in the design of workable infection control policies in CLCs.

      Key Words

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      References

        • Evans ME
        • Kralovic SM
        • Simbartl LA
        • et al.
        Nationwide reduction of health care-associated methicillin-resistant Staphylococcus aureus infections in Veterans Affairs long-term care facilities.
        Am J Infect Control. 2014; 42: 60-62
        • Grigg C
        • Palms D
        • Stone ND
        • et al.
        Burden of invasive methicillin-resistant Staphylococcus aureus infections in nursing home residents.
        J Am Geriatr Soc. 2018; 66: 1581-1586
        • Gu FF
        • Zhang J
        • Zhao SY
        • et al.
        Risk factors for methicillin-resistant Staphylococcus aureus carriage among residents in 7 nursing homes in Shanghai, China.
        Am J Infect Control. 2016; 44: 805-808
        • McKinnell JA
        • Miller LG
        • Singh R
        • et al.
        Prevalence of and factors associated with multidrug resistant organism (MDRO) colonization in 3 nursing homes.
        Infect Control Hosp Epidemiol. 2016; 37: 1485-1488
        • Albrecht JS
        • Croft L
        • Morgan DJ
        • Roghmann MC
        Perceptions of gown and glove use to prevent methicillin-resistant Staphylococcus aureus transmission in nursing homes.
        J Am Med Dir Assoc. 2017; 18: 158-161
        • Dumyati G
        • Stone ND
        • Nace DA
        • Crnich CJ
        • Jump RL
        Challenges and strategies for prevention of multidrug-resistant organism transmission in nursing homes.
        Curr Infect Dis Rep. 2017; 19: 18
        • 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
        • Schweon SJ
        • Kirk J
        A realistic approach towards hand hygiene for long-term care residents and health care personnel.
        Am J Infect Control. 2011; 39: 336-338
        • Morgan DJ
        • Wenzel RP
        • Bearman G
        Contact precautions for endemic MRSA and VRE: time to retire legal mandates.
        JAMA. 2017; 318: 329-330
        • Morgan DJ
        • Diekema DJ
        • Sepkowitz K
        • Perencevich EN
        Adverse outcomes associated with contact precautions: a review of the literature.
        Am J Infect Control. 2009; 37: 85-93
        • Harris AD
        • Morgan DJ
        • Pineles L
        • Perencevich EN
        • Barnes SL
        Deconstructing the relative benefits of a universal glove and gown intervention on MRSA acquisition.
        J Hosp Infect. 2017; 96: 49-53
        • Pineles L
        • Morgan FJ
        • Lydecker A
        • et al.
        Transmission of methicillin-resistant Staphylococcus aureus to health care worker gowns and gloves during care of residents in Veterans Affairs nursing homes.
        Am J Infect Control. 2017; 45: 947-953
        • Jain R
        • Kralovic SM
        • Evans ME
        • et al.
        Veterans affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections.
        N Engl J Med. 2011; 364: 1419-1430
        • Rahman AN
        • Schnelle JF
        The nursing home culture-change movement: recent past, present, and future directions for research.
        The Gerontologist. 2008; 48: 142-148
        • Pineles L
        • Petruccelli C
        • Perencevich EN
        • et al.
        The impact of isolation on healthcare worker contact and compliance with infection control practices in nursing homes.
        Infect Control Hosp Epidemiol. 2018; 39: 683-687
        • Ellard-Gray A
        • Jeffrey NK
        • Choubak M
        • Crann SE
        Finding the hidden particiapnt: solutions for recruiting hidden, hard-to-reach, and vulnerable populations.
        Int J Qual Methods. 2015; 14: 1-10
        • Perlow LA
        • Gittell JH
        • Katz N
        Contextualizing patterns of work group interaction: towards a nested theory of structuration.
        Organ Sci. 2004; 15: 520-536
        • Glaser BG
        The constant comparative method of qualitative analysis.
        Soc Probl. 1965; 12: 436-445
        • Smyth F
        Medical geography: therapeutic places, spaces and networks.
        Prog Hum Geogr. 2005; 29: 488-495
        • DeLyser D
        • Sui D
        Crossing the qualitative- quantitative divide II.
        Prog Hum Geogr. 2012; 37: 293-305
        • Müller B
        • Armstrong P
        • Lowndes R
        Cleaning and caring: contributions in long-term residential care.
        Ageing Int. 2018; 43: 53-73
        • Mitchell BG
        • White N
        • Farrington A
        • et al.
        Changes in knowledge and attitudes of hospital environmental services staff: the researching effective approaches to cleaning in hospitals (REACH) study.
        Am J Infect Control. 2018; 46: 980-985
        • Pedersen L
        • Masroor N
        • Cooper K
        • et al.
        Barriers and perceptions of environmental cleaning: an environmental services perspective.
        Am J Infect Control. 2018; 46: 1406-1407
        • Bernstein DA
        • Salsgiver E
        • Simon MS
        • et al.
        Understanding barriers to optimal cleaning and disinfection in hospitals: a knowledge, attitudes, and practices survey of environmental services workers.
        Infect Cont Hosp Epidemiol. 2016; 37: 1492-1495