title: Carbapenem-resistant Enterobacteriaceae carriers in acute care hospitals and postacute-care facilities: The effect of organizational culture on staff attitudes, knowledge, practices, and infection acquisition rates.
abstract: Carbapenem-resistant Enterobacteriaceae (CRE) carriers are frequently transferred between acute care hospitals (ACHs) and postacute-care facilities (PACFs). Compliance of health care workers with infection prevention guidelines in both care settings may be influenced by the institution's organizational culture.
  
  
  
  To assess the association between organizational culture and health care workers' attitudes, knowledge, practices, and CRE acquisition rate and to identify differences between different care settings and health care workers' sectors.
  
  
  
  Cross-sectional descriptive design. Self-administered questionnaires were distributed to a sample of 420 health care workers from 1 ACH and 1 PACF belonging to the same health maintenance organization located in central Israel.
  
  
  
  The organizational culture factor known as staff engagement was positively correlated with infection prevention attitudes and compliance with contact precaution protocols and negatively correlated with CRE acquisition rate. In the 2 care settings, health care workers' attitudes, knowledge, and practices were found to be similar, but CRE acquisition rate was lower in PACFs. Compliance with contact precaution protocols by physicians was lower than compliance reported by other health care workers. Auxiliary staff reported lower knowledge.
  
  
  
  In a setting of endemic CRE where a multifaceted intervention is already being implemented, organizational culture variables can predict health care workers' attitudes, knowledge, and practices and in turn can affect CRE acquisition rates.
authors.affiliation: Infection Control Unit, Rabin Medical Center, Hasharon Hospital, Clalit Health Services, Petakh Tikva, Israel. Electronic address: rinap@clalit.org.il.
authors.forename: Rina
authors.initials: R
authors.lastname: Fedorowsky
authors.affiliation: Nursing Department, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Anat
authors.initials: A
authors.lastname: Peles-Bortz
authors.affiliation: National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel.
authors.forename: Samira
authors.initials: S
authors.lastname: Masarwa
authors.affiliation: Department of Sociology of Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel.
authors.forename: Dvora
authors.initials: D
authors.lastname: Liberman
authors.affiliation: Infection Control Unit, Rabin Medical Center, Clalit Health Services, Petakh Tikva, Israel.
authors.forename: Bina
authors.initials: B
authors.lastname: Rubinovitch
authors.affiliation: Nursing Management Department, Beit Rivka Geriatric Rehabilitation Hospital, Clalit Health Services, Petakh Tikva, Israel.
authors.forename: Valentina
authors.initials: V
authors.lastname: Lipkin
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001291:Attitude of Health Personnel; D000073182:Carbapenem-Resistant Enterobacteriaceae / Q000302:isolation & purification*; D015780:Carbapenems / Q000494:pharmacology; D003428:Cross Infection / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D019983:Guideline Adherence; D006268:Health Facilities; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000458:organization & administration*; D007557:Israel / Q000453:epidemiology; D015279:Organizational Culture
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: CRE carriers; Endemic setting; Healthcare worker; Infection prevention