title: Infection prevention and control in nursing homes: a qualitative study of decision-making regarding isolation-based practices.
abstract: BACKGROUND
  Isolation-based practices in nursing homes (NHs) differ from those in acute care. NHs must promote quality of life while preventing infection transmission. Practices used in NHs to reconcile these goals of care have not been characterised.
  
  
  OBJECTIVE
  To explore decision-making in isolation-based infection prevention and control practices in NHs.
  
  
  METHODS
  A qualitative study was conducted with staff (eg, staff nurses, infection prevention directors and directors of nursing) employed in purposefully sampled US NHs. Semistructured, role-specific interview guides were developed and interviews were digitally recorded, transcribed verbatim and analysed using directed content analysis. The research team discussed emerging themes in weekly meetings to confirm consensus.
  
  
  RESULTS
  We inferred from 73 interviews in 10 NHs that there was variation between NHs in practices regarding who was isolated, when isolation-based practices took place, how they were implemented, and how they were tailored for each resident. Interviewees' decision-making depended on staff perceptions of acceptable transmission risk and resident quality of life. NH resources also influenced decision-making, including availability of private rooms, extent to which staff can devote time to isolation-based practices and communication tools. A lack of understanding of key infection prevention and control concepts was also revealed.
  
  
  CONCLUSIONS
  Current clinical guidelines are not specific enough to ensure consistent practice that meets care goals and resource constraints in NHs. However, new epidemiological research regarding effectiveness of varying isolation practices in this setting is needed to inform clinical practice. Further, additional infection prevention and control education for NH staff may be required.
authors.affiliation: Center for Health Policy, Columbia University School of Nursing, New York, New York, USA.
authors.forename: Catherine Crawford
authors.identifier: http://orcid.org/0000-0001-7100-1535
authors.initials: CC
authors.lastname: Cohen
authors.affiliation: Jefferson School of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Monika
authors.initials: M
authors.lastname: Pogorzelska-Maziarz
authors.affiliation: Center for Health Policy, Columbia University School of Nursing, New York, New York, USA.
authors.forename: Carolyn T A
authors.initials: CT
authors.lastname: Herzig
authors.affiliation: Center for Health Policy, Columbia University School of Nursing, New York, New York, USA NewYork-Presbyterian Hospital, New York, New York, USA.
authors.forename: Eileen J
authors.initials: EJ
authors.lastname: Carter
authors.affiliation: Center for Health Policy, Columbia University School of Nursing, New York, New York, USA.
authors.forename: Ragnhildur
authors.initials: R
authors.lastname: Bjarnadottir
authors.affiliation: Center for Health Policy, Columbia University School of Nursing, New York, New York, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Semeraro
authors.affiliation: Center for Health Policy, Columbia University School of Nursing, New York, New York, USA.
authors.forename: Jasmine L
authors.initials: JL
authors.lastname: Travers
authors.affiliation: Center for Health Policy, Columbia University School of Nursing, New York, New York, USA.
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Stone
mesh_terms: D003142:Communication; D003657:Decision Making; D006801:Humans; D017053:Infection Control / Q000458:organization & administration; D009735:Nursing Homes / Q000458:organization & administration*; D009740:Nursing Staff; D010356:Patient Isolation / Q000458:organization & administration*; D010362:Patients' Rooms; D036301:Qualitative Research; D011788:Quality of Life; D018570:Risk Assessment; D013997:Time Factors; D014481:United States
keywords: Decision making; Infection control; Nosocomial infections; Nursing homes