Survey of C. difficile-Specific Infection Control Policies in Local Long-Term Care Facilities.
Survey of C. difficile-Specific Infection Control Policies in Local Long-Term Care Facilities.
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DOI：
10.4236/ijcm.2014.57056
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发表时间：
2014-04-01
期刊：
影响因子：
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通讯作者：
Archbald-Pannone L
中科院分区：
文献类型：
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作者：
Archbald-Pannone L
艰难梭菌感染（CDI）的发病率和严重程度一直在增加，长期护理机构（LTCF）的居民由于年龄、合并症和高抗生素暴露而处于高风险中。感染控制政策对于控制CDI至关重要，但美国目前没有监管指南。因此，我们评估了当地LTCF的感染控制政策，以确定CDI特定的政策以及管理和工作人员对CDI的理解，从而确定合规的感知障碍。寻求IRB批准并获得豁免，要求所有8家当地LTCF参与。研究人员访问了每个机构，并以不同的调查格式采访了管理感染控制从业人员（ICP）和3 - 4名执业护士（LPN）。然后将感染控制政策与SHEA对LTCF中CDI的建议进行比较。在符合条件的机构中，75%（n = 6）参与了研究。对ICP（n = 6）和LPN（n = 21）进行了访谈。所有设施都接受有活跃CDI的居民，2个有书面的CDI特异性感染控制政策。所有设施都有手部卫生或手套使用政策，2个设施有使用杀孢子环境清洁的政策。无机构限制抗生素使用。每个机构都有一项政策，通过在职培训指导其员工，无论是每年还是在新雇用时，但33%（n = 7）的LPN报告没有基于机构的CDI培训。虽然80%（n = 17）的LPN对机构CDI政策感到满意，但只有11人准确地重申了这一点。ICP认为员工合规的最相关障碍是时间限制（n = 4，67%），然而，LPN认为这是知识有限（n = 10，48%）和沟通不畅（n = 2，10%）。随着LCTF中CDI的发病率和严重程度的增加，很少有被调查的设施有CDI特定的政策。尽管CDI的具体培训，有一个感知的知识和沟通差距的工作人员照顾居民与CDI。
The incidence and severity of Clostridium difficile infection (CDI) has been increasing and long-term care facility (LTCF) residents are at high risk given their age, co-morbidities, and high antibiotic exposure. Infection control policies are crucial for controlling CDI, but there are currently no regulatory guidelines in the United States. Therefore, we evaluated infection control policies in local LTCFs to define the CDI-specific policies and the administrative and staff understanding of CDI, so as to identify perceived barriers for compliance. IRB approval was sought and exemption granted, all 8 local LTCFs were asked to participate. Each facility was visited by study personnel who interviewed the administrative Infection Control Practitioner (ICP) and 3 - 4 Licensed Practical Nurses (LPNs) with distinct survey format. Infection control policies were then compared to the SHEA recommendations for CDI in LTCFs. Of the eligible facilities, 75% (n = 6) participated. ICP (n = 6) and LPNs (n = 21) were interviewed. All facilities accept residents with active CDI and 2 had written CDI-specific infection control policies. All facilities had hand hygiene or glove use policies and 2 had policies for the use of sporicidal environmental cleaning. No facility restricted antibiotic use. Each facility has a policy to instruct their staff through in-services, either annually or upon new hire, but 33% (n = 7) LPNs reported no facility-based CDI training. While 80% (n = 17) of LPNs felt comfortable with the facility CDI policies, only 11 accurately restated it. ICPs felt the most relevant barrier to staff compliance was time constraints (n = 4, 67%), however, LPNs felt it was limited knowledge (n = 10, 48%) and poor communication (n = 2, 10%). With the increasing incidence and severity of CDI in LCTF, few of the facilities surveyed had CDI-specific policies. Despite CDI-specific training, there is a perceived knowledge and communication gap for staff caring for residents with CDI.