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Jemere DM, Ratcliffe J, Khadka J, Lay K, Milte R. Are quality of care instruments inclusive of older people living with dementia? A scoping review in long-term care settings. DEMENTIA 2024; 23:1212-1237. [PMID: 39121362 DOI: 10.1177/14713012241270758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2024]
Abstract
More than half of older people in long-term care facilities have dementia. Little is currently known about the methods and instruments which can be used to capture the perspectives of older people, including those with dementia, regarding the quality of care provided in such facilities. The main aims of this scoping review were two-fold. Firstly, to identify quality of care instruments that have been applied in long-term care settings. Secondly, to evaluate how these instruments have been developed and validated, particularly in terms of their applicability among older people with dementia. Seven databases (Medline, Web of Science, Scopus, ProQuest, Ageline, CINHAL and google scholar) were searched for relevant literature without any date limit. We used quality criteria adapted from COSMIN (Consensus-based Standards for the selection of health status Measurement Instruments) guidelines to assess the psychometric properties of the instruments. The search identified 16 quality of care instruments which had been used in long-term care settings. Of which, two (12.5%) were specifically designed for older people with dementia, and three instruments (18.7%) were modified for use with older people with mild to moderate dementia. A variety of methods were used to develop the identified instruments including literature reviews, qualitative interviews, expert panel reviews, pre-testing and piloting with older people. None of the identified instruments had been subjected to comprehensive psychometric assessment. Most instruments for assessing quality of care in long term care settings lack alternative communication techniques tailored to people with dementia. This review highlights the need for more rigorous psychometric testing of existing instruments for assessing quality of care in long-term care settings. Several existing measures show promise and may be taken forward for further testing and development for widespread application with older people, including those living with dementia, in long term care settings.
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Affiliation(s)
| | | | - Jyoti Khadka
- Caring Futures Institute, Flinders University, Australia
| | - Kiri Lay
- Caring Futures Institute, Flinders University, Australia
| | - Rachel Milte
- Caring Futures Institute, Flinders University, Australia
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Tropea J, Francis JJ, Bennett N, Lim LL, Fetherstonhaugh D, Buising KL, Marshall C, Flynn M, Lim WK, Peters S. Assessing infection prevention and control programs in residential aged care in Australia: A multi-methods cross-sectional study. Geriatr Gerontol Int 2024; 24 Suppl 1:358-363. [PMID: 38171346 DOI: 10.1111/ggi.14791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/22/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Abstract
AIM To assess infection prevention and control programs in residential aged care facilities. METHODS A cross-sectional survey and structured interviews from 10 residential aged care facilities in Victoria, Australia, were used. Infection prevention and control nurse leads from each facility completed a purpose-built survey based on best practice infection prevention control program core components, including staff training, policies and procedures, governance, and surveillance. Follow-up interviews with residential aged care staff, residents and family visitors were carried out to elaborate and verify survey data. RESULTS Surveys from all 10 facilities were received and 75 interviews carried out. All facilities had an infection prevention and control lead nurse who had undergone additional training, and 60% of facilities had an infection prevention and control lead position description. All facilities had a committee to oversee their infection prevention and control program, and all had policies and procedures for standard and transmission-based precautions. One facility did not have a policy on healthcare-associated infection surveillance, and two facilities did not have an antimicrobial stewardship policy. All facilities provided staff training in hand hygiene and personal protective equipment use, but not all routinely assessed competency in these. CONCLUSIONS The residential aged care facilities' infection prevention and control programs were generally in a strong position, although there were some areas that require improvement. Further assessment of the quality of infection prevention and control program components, such as content of education and training, and policies and procedures, and ongoing evaluation of programs is recommended. Geriatr Gerontol Int 2024; 24: 358-363.
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Affiliation(s)
- Joanne Tropea
- Department of Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, RMH, University of Melbourne, Melbourne, Victoria, Australia
| | - Jill J Francis
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Department of Health Services Research, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Melbourne, Victoria, Australia
- Ottawa Hospital Research Institute, Center for Implementation Research, Ottawa, Ontario, Canada
| | - Noleen Bennett
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Center, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- National Center for Antimicrobial Stewardship, University of Melbourne, Melbourne, Victoria, Australia
- Department of Nursing, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Lyn-Li Lim
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Center, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Deirdre Fetherstonhaugh
- Australian Center for Evidence Based Aged Care (ACEBAC), La Trobe University, Melbourne, Victoria, Australia
| | - Kirsty L Buising
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Caroline Marshall
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Madelaine Flynn
- Infection Prevention, Northern Health, Melbourne, Victoria, Australia
| | - Wen K Lim
- Department of Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, RMH, University of Melbourne, Melbourne, Victoria, Australia
| | - Sanne Peters
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Department of Public Health and Primary Care, University of Leuven, KU Leuven, Louvain, Belgium
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Exploring what matters to residents of Australian aged care facilities with the Happy Life Index: comparison of qualitative responses between pre- and mid-Covid-19 pandemic time points. Qual Life Res 2023:10.1007/s11136-023-03387-0. [PMID: 36928652 PMCID: PMC10019411 DOI: 10.1007/s11136-023-03387-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE This study analysed data from a national survey of people living in Australian Residential Aged Care Facilities (RACFs) reporting on what is the best thing about where they live and suggestions for improvement. Data from prior to the Covid-19 pandemic were compared with data during the Covid-19 pandemic. METHODS Qualitative data from the Happy Life Index Survey were analysed using summative content analysis to code the responses in the data sets and then organise them into categories. Once categorised, the pre-Covid-19 and mid-Covid-19 data sets were compared using descriptive statistics. RESULTS A total of 4745 residents, from over 100 RACFs, provided 8512 open-text responses to at least one of the two survey questions. Pre-Covid-19 responses were compared with mid-Covid-19 responses and those trending towards relevance (5-10% change) were identified. There were both positive and negative relevant percent changes for staff number, food (general comments), and friendliness. A trending positive percentage change was observed for staff quality and the internal environment. There was a trending negative relevant percentage change for lifestyle activities, staff generally, level of contentedness, the general environment, general choice, and general views about the service. CONCLUSION People living in RACFs notice the changes in staffing levels and visitors during restrictions imposed during infectious outbreaks. During these times, they appreciate the quality of the staff attending to their needs and the quality of their food. Further exploration is needed of the value of lifestyle activities and strategies to promote feelings of contentedness and general wellbeing during times of restriction.
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Tropea J, Peters S, Francis JJ, Bennett N, Fetherstonhaugh D, Buising K, Lim LL, Marshall C, Flynn M, Murray M, Yates P, Aboltins C, Johnson D, Kwong J, Long K, McCahon J, Lim WK. IMpleMenting Effective infection prevention and control in ReSidential aged carE (IMMERSE): protocol for a multi-level mixed methods implementation study. BMC Geriatr 2023; 23:109. [PMID: 36823588 PMCID: PMC9948775 DOI: 10.1186/s12877-023-03766-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/19/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Older people living in residential aged care facilities are at high risk of acquiring infections such as influenza, gastroenteritis, and more recently COVID-19. These infections are a major cause of morbidity and mortality among this cohort. Quality infection prevention and control practice in residential aged care is therefore imperative. Although appointment of a dedicated infection prevention and control (IPC) lead in every Australian residential aged care facility is now mandated, all people working in this setting have a role to play in IPC. The COVID-19 pandemic revealed inadequacies in IPC in this sector and highlighted the need for interventions to improve implementation of best practice. METHODS Using mixed methods, this four-phase implementation study will use theory-informed approaches to: (1) assess residential aged care facilities' readiness for IPC practice change, (2) explore current practice using scenario-based assessments, (3) investigate barriers to best practice IPC, and (4) determine and evaluate feasible and locally tailored solutions to overcome the identified barriers. IPC leads will be upskilled and supported to operationalise the selected solutions. Staff working in residential aged care facilities, residents and their families will be recruited for participation in surveys and semi-structured interviews. Data will be analysed and triangulated at each phase, with findings informing the subsequent phases. Stakeholder groups at each facility and the IMMERSE project's Reference Group will contribute to the interpretation of findings at each phase of the project. DISCUSSION This multi-site study will comprehensively explore infection prevention and control practices in residential aged care. It will inform and support locally appropriate evidence-based strategies for enhancing infection prevention and control practice.
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Affiliation(s)
- Joanne Tropea
- Department of Aged Care, Royal Melbourne Hospital, Level 8 CRM, 300 Grattan Street, Parkville, VIC, 3050, Australia. .,Department of Medicine - Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Sanne Peters
- grid.1008.90000 0001 2179 088XSchool of Health Sciences, University of Melbourne, Parkville, VIC 3010 Australia ,grid.5596.f0000 0001 0668 7884Department of Public Health and Primary Care, University of Leuven, KU Leuven, Louvain, Belgium
| | - Jill J. Francis
- grid.1008.90000 0001 2179 088XSchool of Health Sciences, University of Melbourne, Parkville, VIC 3010 Australia ,grid.1055.10000000403978434Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XDepartment of Oncology, Sir Peter MacCallum, University of Melbourne, Parkville, VIC 3010 Australia ,grid.412687.e0000 0000 9606 5108Ottawa Hospital Research Institute – General Campus, Centre for Implementation Research, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Noleen Bennett
- grid.1008.90000 0001 2179 088XVictorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre and Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC 3000, Australia ,grid.1008.90000 0001 2179 088XDepartment of Infectious Diseases, National Centre for Antimicrobial Stewardship, University of Melbourne, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XDepartment of Nursing, School of Health Sciences, University of Melbourne, Parkville, VIC 3010 Australia
| | - Deirdre Fetherstonhaugh
- grid.1018.80000 0001 2342 0938Australian Centre for Evidence Based Aged Care (ACEBAC), La Trobe University, Bundoora, VIC 3086 Australia
| | - Kirsty Buising
- grid.416153.40000 0004 0624 1200Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC 3050 Australia ,grid.1008.90000 0001 2179 088XDepartment of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC 3000, Australia
| | - Lyn-li Lim
- grid.1008.90000 0001 2179 088XVictorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre and Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC 3000, Australia
| | - Caroline Marshall
- grid.1008.90000 0001 2179 088XDepartment of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC 3000, Australia ,grid.416153.40000 0004 0624 1200Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Parkville, VIC 3050 Australia
| | - Madelaine Flynn
- Director of Infection Prevention, Northern Health, Epping, VIC 3076 Australia ,Victorian Aged Care Response Centre, Australian Department of Health, Melbourne VIC 3000, Australia
| | - Michael Murray
- grid.1018.80000 0001 2342 0938Australian Centre for Evidence Based Aged Care (ACEBAC), La Trobe University, Bundoora, VIC 3086 Australia ,grid.410678.c0000 0000 9374 3516Department of Geriatric Medicine, Austin Health, Heidelberg, VIC 3084 Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine – Austin Health, University of Melbourne, Heidelberg, VIC 3084 Australia
| | - Paul Yates
- grid.410678.c0000 0000 9374 3516Department of Geriatric Medicine, Austin Health, Heidelberg, VIC 3084 Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine – Austin Health, University of Melbourne, Heidelberg, VIC 3084 Australia
| | - Craig Aboltins
- grid.410684.f0000 0004 0456 4276Department of Infectious Diseases, Northern Health, Epping, Vic 3076 Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine, Northern Clinical School, University of Melbourne, Epping VIC 3076, Australia
| | - Douglas Johnson
- grid.1008.90000 0001 2179 088XDepartment of Medicine – Royal Melbourne Hospital, University of Melbourne, Parkville, VIC 3010 Australia ,grid.416153.40000 0004 0624 1200Departments of General Medicine and Infectious Diseases, Royal Melbourne Hospital, Parkville VIC 3050, Australia
| | - Jason Kwong
- grid.1008.90000 0001 2179 088XDepartment of Medicine – Austin Health, University of Melbourne, Heidelberg, VIC 3084 Australia ,grid.410678.c0000 0000 9374 3516Department of Infectious Diseases, Austin Health, Heidelberg VIC 3084, Australia ,grid.1008.90000 0001 2179 088XDepartment of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne VIC 3000, Australia
| | - Karrie Long
- grid.416153.40000 0004 0624 1200Director Nursing Research Hub, Royal Melbourne Hospital, Parkville VIC 3050, Australia
| | - Judy McCahon
- Consumer Representative of the IMMERSE Research Team, and Melbourne Academic Centre for Health, Parkville VIC 3050, Australia
| | - Wen K. Lim
- grid.416153.40000 0004 0624 1200Department of Aged Care, Royal Melbourne Hospital, Level 8 CRM, 300 Grattan Street, Parkville, VIC 3050 Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine – Royal Melbourne Hospital, University of Melbourne, Parkville, VIC 3010 Australia
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Usher K, Hickman LD, Jackson D. Put 'nursing' back into aged care: Nursing care is essential to aged care homes beyond the COVID-19 pandemic. Contemp Nurse 2021; 57:1-3. [PMID: 34112058 DOI: 10.1080/10376178.2020.1843511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Kim Usher
- School of Health, Armidale, Australia
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Barratt R, Gilbert GL. Education and training in infection prevention and control: Exploring support for national standards. Infect Dis Health 2021; 26:139-144. [PMID: 33461891 PMCID: PMC7816900 DOI: 10.1016/j.idh.2020.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/05/2020] [Accepted: 12/06/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Effective infection prevention and control (IPC) programmes comprise a hierarchy of preventive measures, one of which is appropriate use of personal protective equipment (PPE). A poor understanding of the role of PPE and sub-optimal use may fail to prevent or even increase pathogen transmission during routine care or an infectious disease outbreak. Variability in delivery and content of IPC and PPE education and training across organisations can lead to confusion, unsafe practice, and lack of confidence among clinicians. In a national survey we explored the perspectives of Australian and New Zealand IPC professionals on the value and feasibility of a national IPC training and monitoring programme to improve and standardise PPE practice and raise the profile of IPC. METHODS A population-based online survey that examined hospital PPE training programmes was distributed to members of three major Australasian organisations representing IPC professionals. Quantitative results of the survey have been reported previously. This paper is a qualitative analysis of responses to two open-ended questions about a national approach to training in IPC and the use of PPE. RESULTS Most respondents agreed that standardising IPC and PPE training could achieve more consistent practice nationally, supported through the provision of educational resources. Including competency in the use of PPE in mandatory IPC standards would assist in improving the practice and raising the profile of IPC more generally. CONCLUSION The results of this study suggest that that there is support for national programmes and standards for use of PPE in Australia and New Zealand.
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Affiliation(s)
- Ruth Barratt
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, Australia; The University of Sydney, Westmead Clinical School, Faculty of Medicine and Health, NSW, Australia.
| | - Gwendolyn L Gilbert
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, Australia; The University of Sydney, Westmead Clinical School, Faculty of Medicine and Health, NSW, Australia.
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Shaban RZ, Sotomayor-Castillo C, Macbeth D, Russo PL, Mitchell BG. Scope of practice and educational needs of infection prevention and control professionals in Australian residential aged care facilities. Infect Dis Health 2020; 25:286-293. [PMID: 32711966 DOI: 10.1016/j.idh.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/04/2020] [Accepted: 06/11/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Healthcare-associated infections are serious and significant complications present across healthcare services, including residential aged care facilities. Although ensuring high quality personal and clinical care delivered to older people residing in these facilities is a high national priority, there is a paucity of evidence published about outbreaks, governance and education programs held for healthcare workers within Australian residential aged care facilities. The aim of this study is to examine the scope of practice of Infection Prevention and Control professionals within Australian residential aged care facilities and the types of infection prevention and control education and training delivered. METHODS A cross-sectional study was conducted inviting all Australian residential aged care facilities to participate in an online survey. RESULTS A total of 134 residential aged care facilities completed the survey. The majority (88.1%) reported having a designated Infection Prevention and Control professional responsible for surveillance and educational activities. Hand hygiene (94%), personal protective equipment (PPE) (79.9%) and environmental cleaning (70.1%) were some of the available Infection Prevention and Control programs. The lack of access to Infection Prevention and Control education (69.5%) and lack of Infection Prevention and Control expert advice (67.2%) were also reported by some Residential aged care facilities. CONCLUSION Australian residential aged care facilities recognise the importance of Infection Prevention and Control training programs to manage infection surveillance and outbreaks. Considerable activities are carried out to increase knowledge on breaking the chain of infection. Yet, more support and resources are needed to assist these efforts.
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Affiliation(s)
- Ramon Z Shaban
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW, Australia; Department of Infection Prevention and Control, Division of Infectious Diseases and Sexual Health, Westmead Hospital and the Directorate of Nursing, Midwifery and Clinical Governance, Western Sydney Local Health District, Westmead, NSW, Australia.
| | - Cristina Sotomayor-Castillo
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW, Australia; Department of Infection Prevention and Control, Division of Infectious Diseases and Sexual Health, Westmead Hospital and the Directorate of Nursing, Midwifery and Clinical Governance, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Deborough Macbeth
- Infection Control Department, Infectious Diseases and Immunology, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Philip L Russo
- Department of Nursing Research, Cabrini Institute, Malvern, VIC, Australia; Nursing and Midwifery, Monash University, Clayton, Frankston, VIC, Australia
| | - Brett G Mitchell
- School of Nursing and Midwifery, Faculty of Health and Medicine, Newcastle University, NSW, Australia; School of Nursing, Avondale University College, Wahroonga, NSW, Australia
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