title: Staff Knowledge, Awareness, Perceptions, and Beliefs About Infection Prevention in Pediatric Long-term Care Facilities.
abstract: BACKGROUND
  The burden of healthcare-associated infection worldwide is considerable, and there is a need to improve surveillance and infection control practices such as hand hygiene.
  
  
  OBJECTIVE
  The aims of this study were to explore direct care providers' knowledge about infection prevention and hand hygiene, their attitudes regarding their own and others' hand hygiene practices, and their ideas and advice for improving infection prevention efforts.
  
  
  METHODS
  This exploratory study included interviews with direct care providers in three pediatric long-term care facilities. Two trained nurse interviewers conducted semistructured interviews using an interview guide with open-ended questions. Two other nurse researchers independently transcribed the audio recordings and conducted a thematic analysis using a strategy adapted from the systematic text condensation approach.
  
  
  RESULTS
  From 31 interviews, four major thematic categories with subthemes emerged from the analysis: (a) hand hygiene products; (b) knowledge, awareness, perceptions, and beliefs; (c) barriers to infection prevention practices; and (d) suggested improvements. There was confusion regarding hand hygiene recommendations, use of soap or sanitizer, and isolation precaution policies. There was a robust "us" and "them" mentality between professionals.
  
  
  CONCLUSIONS
  One essential driver of staff behavior change is having expectations that are meaningful to staff, and many staff members stated that they wanted more in-person staff meetings with education and hands-on, practical advice. Workflow patterns and/or the physical environment need to be carefully evaluated to identify systems and methods to minimize cross-contamination. Further studies need to evaluate if personal sized containers of hand sanitizer (e.g., for the pocket, attached to a belt or lanyard) would facilitate improvement of hand hygiene in these facilities.
authors.affiliation: Borghild Løyland, PhD, RN, is Associate Professor, Department of Nursing and Health Promotion, Oslo and Akershus University College, Norway. Sibyl Wilmont, BSN, RN, is Research Assistant; and Amanda J. Hessels, PhD, RN, is Postdoctoral Research Fellow, School of Nursing, Columbia University, New York. Elaine Larson, PhD, RN, FAAN, CIC, is Anna C. Maxwell Professor of Nursing Research, Associate Dean for Nursing Research, School of Nursing, and Professor of Epidemiology, the Mailman School of Public Health, Columbia University, New York, and Editor, American Journal of Infection Control.
authors.forename: Borghild
authors.initials: B
authors.lastname: Løyland
authors.forename: Sibyl
authors.initials: S
authors.lastname: Wilmont
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Hessels
authors.forename: Elaine
authors.initials: E
authors.lastname: Larson
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D002983:Clinical Competence; D003428:Cross Infection / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D063373:Hand Hygiene; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017053:Infection Control; D008134:Long-Term Care; D008503:Medical Staff; D009740:Nursing Staff