title: Understanding staff perceptions about Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae control efforts in Chicago long-term acute care hospitals.
abstract: OBJECTIVE
  To identify differences in organizational culture and better understand motivators to implementation of a bundle intervention to control Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (KPC).
  
  
  METHODS
  Mixed-methods study.
  
  
  METHODS
  Four long-term acute care hospitals (LTACHs) in Chicago.
  
  
  METHODS
  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.
authors.affiliation: Division of Infectious Diseases, John H. Stroger Hospital of Cook County, Chicago, Illinois.
authors.forename: Rosie D
authors.initials: RD
authors.lastname: Lyles
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Moore
authors.forename: Shayna B
authors.initials: SB
authors.lastname: Weiner
authors.forename: Monica
authors.initials: M
authors.lastname: Sikka
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Lin
authors.forename: Robert A
authors.initials: RA
authors.lastname: Weinstein
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hayden
authors.forename: Ronda L
authors.initials: RL
authors.lastname: Sinkowitz-Cochran
mesh_terms: D001291:Attitude of Health Personnel; D001426:Bacterial Proteins / Q000096:biosynthesis*; D002641:Chicago; D003428:Cross Infection / Q000517:prevention & control*; D004196:Disease Outbreaks / Q000517:prevention & control; D017144:Focus Groups; D019538:Health Care Surveys; D006739:Hospital Administration; D006801:Humans; D017053:Infection Control; D007710:Klebsiella Infections / Q000517:prevention & control*; D007711:Klebsiella pneumoniae / Q000201:enzymology / Q000302:isolation & purification; D008505:Medical Staff, Hospital / Q000523:psychology*; D015279:Organizational Culture; D036301:Qualitative Research; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase