Infectious disease outbreaks and increased complexity of care.
OBJECTIVE
This study examined the effects of healthcare-associated infectious disease outbreaks on nurses' work in a large acute care hospital in Ontario, Canada.


BACKGROUND
The incidence of healthcare-associated infections has increased. Previous research focuses on epidemiology, healthcare systems, and the economic burden of outbreaks. Few published studies focus on the impact of outbreaks on nurses' work in acute care facilities.


BACKGROUND
Since the severe acute respiratory syndrome epidemic in 2003, combating infectious diseases has become a key issue. Hospitals have implemented measures related to healthcare-associated infections. However, nurses experience challenges in preventing, controlling, and contending with outbreaks.


METHODS
A retrospective exploratory case study approach was used. Data were collected over a 4-month period in 2012. The incidence rates of site-specific HAIs were analysed, and individual interviews were held with 23 bedside nurses and five nurse managers.


RESULTS
Five themes emerged from the interviews: comparison of healthcare-associated infections outbreaks; the nature of nurses' work; impact of outbreaks on patient care; innovation and quality control in clinical practice; and increased and expanded IPAC measures. The incidence rates of methicillin-resistant Staphylococcus aureus, Clostridium difficile and vancomycin-resistant enterococci at the study site decreased, but remained above provincial benchmarks. Nurses experienced workload challenges, time pressures and psychological effects stemming from outbreaks and developed various innovations in response. Patient care was also affected.


CONCLUSIONS
Nurses' work has been impacted by healthcare-associated infectious disease outbreaks. Nursing workloads should be quantified to facilitate the development of guidelines for optimum nurse-patient ratio during outbreaks.


CONCLUSIONS
A strong evidence-based policy framework is required to address healthcare-associated infectious disease outbreaks. Infection prevention and control guidelines and procedures should be established provincially and nationally. An interdisciplinary approach is essential for the creation of comprehensive and innovative strategies. Nursing research has increased understanding of the implications of infectious diseases in hospitals. Building on the literature, findings from this study can be used to influence policies on the care of patients who have secondary infections. Nurse-driven protocols are important and can lead to the creation of best practice guidelines that can be implemented across settings.
School of Nursing and Midwifery, Nairobi, Kenya.
J
J
Musau
Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.|Nursing Health Services Research Unit, McMaster University, Hamilton, ON, Canada.
A
A
Baumann
Nursing Health Services Research Unit, McMaster University, Hamilton, ON, Canada.
C
C
Kolotylo
Department of Medicine, Division of Infectious Diseases, McMaster University, Hamilton, ON, Canada.
T
T
O'Shea
St. Joseph's Healthcare, Hamilton, ON, Canada.
A
A
Bialachowski
D000328:Adult; D003428:Cross Infection / Q000453:epidemiology* / Q000451:nursing*; D004196:Disease Outbreaks / Q000517:prevention & control* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D009741:Nursing Staff, Hospital / Q000523:psychology*; D009864:Ontario / Q000453:epidemiology; D009936:Organizational Innovation; D012189:Retrospective Studies; D016526:Workload
Canada; Healthcare-Associated Infections; Hospital Infections; Infection Control Policies and Procedures; Nurses; Nurses' Work; Nursing Protocols; Outbreaks