Perceptions of patients' and healthcare workers' experiences in cohort isolation units: a qualitative study

Treating the disease and meeting the person with the illness-patient perspectives of needs during infective endocarditis, a qualitative study

BACKGROUND

Infective endocarditis (IE) is a rare but severe infectious disease. Patients with IE are treated for weeks in the hospital and have profound impairments to their health. New treatment modalities increase options for outpatient care. Little is known about how patients perceive their disease and hospitalisation. We aimed to explore the needs of patients with IE during hospitalisation and the first few months after discharge.

METHODS

In this qualitative study, 20 patients (45-86 years of age) hospitalised due to IE in Swedish hospitals were interviewed a median of 112 (67-221) days after hospitalisation. Data were analysed with qualitative content analysis, identifying eight subcategories, two categories, and an overall theme.

RESULTS

The overall theme illuminated a spectrum of needs of patients suffering from IE, between treating the disease and meeting the person with the illness. The needs encompassed eight axes with dual focus on both medical excellence and person-centred care. Medical excellence was needed to optimally treat, supervise, and offer follow-up on this rare and severe disease; patients longed to come home, and there were issues of reliability in the healthcare system. Person-centred care was requested, including individualised information leading to knowledge, reorientation, the beginning of health restoration, and being met as a unique person. Symptoms of fatigue, wasting, and cognitive and mental distress were often neglected by the caregiver.

CONCLUSIONS

This explorative study shows the patient's needs as important areas in a spectrum between medical excellence and person-centred care. Care in specialised units secure quality. Early discharge is requested by patients. Multiprofessional individualizing outpatient care needs to develop with preserved safety and medical excellence. The disease trajectory after discharge progresses slowly, and the possibility of mitigating its progress is still unclear. Person-centred care, screening for delayed restoration and rehabilitation after endocarditis are important fields for future studies.

Infection prevention and control policy implementation for CPE: a cross-sectional national survey of healthcare workers reveals knowledge gaps and suboptimal practices

BACKGROUND

In 2017, Ireland pioneered a unique response to the worsening epidemiology of carbapenemase-producing Enterobacterales (CPE), declaring a national public health emergency. Subsequently, CPE mitigation guidelines and policies were implemented in acute hospitals, focused on patient screening and outbreak management, often by healthcare workers (HCWs) with limited background in infection prevention and control (IPC). CPE risks from sinks and drains remain inadequately controlled.

AIMS

To compare CPE awareness, perceptions of the role of the environment in CPE transmission, and disposal practices of liquid waste from clinical handwashing sinks between IPC HCWs and non-IPC HCWs in Ireland.

METHODS

Between December 2022 and March 2023, HCWs employed in acute hospitals in Ireland between 2017 and 2022 were invited to participate anonymously in a 30-question digital survey.

FINDINGS

Responses (N=283) were received across several clinical disciplines. In total, 21.6% of respondents were working or had previously worked in IPC roles, 84.1% of whom reported no IPC-related learning needs. In comparison with non-IPC HCWs, more IPC HCWs perceived a risk of pathogen transmission from clean water plumbing (68.9% vs 39.2%; P<0.001) and waste/drainage plumbing (81.2% vs 43.7%; P<0.001). Among nursing and medical staff, only 5.6% of IPC HCWs used clinical handwashing sinks for disposal of liquid waste, compared with 60% of non-IPC HCWs (P<0.001). In comparison with non-IPC HCWs, a greater proportion of IPC HCWs reported that they had witnessed colleagues routinely discarding liquid waste (including nutritional products, antimicrobials and patient body fluids) via clinical handwashing sinks (88.9% vs 77.9%) CONCLUSIONS: Although there is general awareness of the role of the built environment in pathogen transmission, including CPE, familiarity with sink/water-related transmission is greater among IPC HCWs. There may be opportunities to improve disposal practices for liquid waste through education targeting non-IPC HCWs.

Healthcare workers experiences of caring for patients colonized with Carbapenemase-Producing Enterobacterale (CPE) in an acute hospital setting - A qualitative descriptive study

BACKGROUND

Carbapenemase-Producing Enterobacterale (CPE) is a multi-drug resistant organism, that is of growing concern within hospitals worldwide. This leads to an increased workload on healthcare workers.

PURPOSE

To explore the experiences of healthcare workers who care for patients colonized with CPE.

METHODS

A qualitative descriptive research design. Semi-structured interviews undertaken and analysed using a thematic analysis framework resulting in the identification of four main themes.

RESULTS

This study explores the barriers and facilitators healthcare workers encounter when caring for patients colonized with CPE and their experience of the effect that a CPE diagnosis has on the provision of patient care across four themes: education, the COVID effect, fear, and staffing/resource issues. The study is reported utilising the COREQ checklist.

CONCLUSION

Healthcare workers were aware of the IPC guidance and education was the main facilitator to knowledge and practice. Barriers such as poor staffing levels and the impact of COVID-19 were highlighted in relation to care provision and reducing fear associated with CPE. Healthcare workers priority is to provide safe and effective care for their patients and barriers that impact their ability to provide such care need to be addressed to ensure an optimal experience for both healthcare workers and patients.

Comparing the impact of two contact isolation modes for hospitalised patients with Clostridioides difficile infection on the quality of care

BACKGROUND

Clostridioides difficile causes healthcare-associated infections. Environmental spore acquisition is a major mode of transmission. Patient cohorting to prevent cross-transmission in healthcare-institutions is a reasonable component of an enhanced infection control strategy.

OBJECTIVE

The purpose of the study was to assess the effect of two different contact isolation modes on the quality of care of hospitalised patients with Clostridioides difficile infection (CDI).

METHODS

A retrospective cohort-study of patients with CDI hospitalised under one of two contact isolation modes: contact isolation in a multi-patient room without a dedicated nursing team vs. contact isolation in a permanent cohort isolation unit with a dedicated nursing team. Patients' files were reviewed for demographics, clinical characteristics, risk-assessment scores, clinical quality measures including the number of blood tests collected per day, the number of radiological tests applied per day and the time at which a radiological test was conducted, as process measurements, along with the length of stay and mortality, as outcome measures. The STROBE checklist for reporting observational studies was followed.

RESULTS

One hundred and seventy-eight patients with CDI were included; 100 in a permanent cohort isolation unit and 78 under contact isolation in a multi-patient room. No difference was found in all clinical quality process measures and in all outcome measures. Multivariable logistic regression showed that nursing home residence was associated with in-hospital mortality (OR, 2.51; CI, 1.29-4.97; p = .007), whereas the mode of hospitalisation was not.

CONCLUSIONS

The different contact isolation modes of hospitalisation did not compromise the quality of care of patients with CDI.

RELEVANCE TO CLINICAL PRACTICE

Cohorting of patients with CDI is used to prevent cross-transmission, though it raises a major concern regarding quality of care. In this study we show there was no compromise in patient care, therefore it is a reasonable component of an enhanced infection control strategy in a hospital setting.

Healthcare workers' experiences of caring for patients colonized with carbapenemase-producing Enterobacterales (CPE) in an acute hospital setting - a scoping review

Carbapenemase-producing Enterobacterales (CPE) is an increasing public health concern; these bacteria are highly transmissible in hospital environments and the number of patients with these multidrug-resistant bacteria is rising. Healthcare workers caring for patients colonized with CPE offer insight into care delivery and processes in the hospital setting. The aim of this review was to explore healthcare workers' experiences of caring for patients colonized with CPE. A scoping review method was employed and seven electronic databases (CINAHL, Academic Search Complete, Cochrane, Embase, Medline, Web of Science and Scopus) and four grey literature databases (Open Grey, Grey Literature Report, Clinical trials. gov and WHO International Clinical Trials Registry Platform) were searched using specific search terms and inclusion/exclusion criteria. A PRISMA flow diagram was used to illustrate the process of article selection and thematic analysis used to form themes. Three studies met the criteria to be included in this review. Two main themes were identified from analysing the articles: 'Safeguarding' and 'Power of Knowledge'. The desire to protect themselves, their families and patients was evident from the studies. Healthcare workers were aware of the importance on infection prevention and control measures such as hand hygiene, in preventing the transmission of CPE, however barriers to these were identified, such as time constraints. In conclusion, healthcare workers have negative associations when it comes to caring for patients with CPE. Very little research has been conducted in the area and there is an opportunity to further explore the experience of healthcare workers caring for patients with CPE to identify opportunities for improvement and support of staff.

Autonomy and isolation experienced by patients and primary caregivers during COVID-19 hospitalization in Barcelona (Spain)

This study aims to describe patients' and family caregivers' hospitalization experiences during the COVID-19 pandemic. Using qualitative exploratory descriptive methods, 13 patients admitted to the largest hospital in Barcelona (Spain) due to COVID-19 were interviewed by telephone once discharged, as were eight primary caregivers. Data were analyzed using the content analysis method proposed by Krippendorff. Two main themes were identified: (i) Acceptance of mandatory isolation for patients and family caregivers, which refers to the verbalization of a feeling that justifies the imposed isolation and the need for the use of personal protective equipment by the health team for everyone's safety; and (ii) Limited autonomy during hospitalization for patients and family caregivers, which describes participants' perceptions of autonomy during hospitalization. Patients and caregivers experienced feelings of loneliness, which negatively affected their emotional health. In addition, they experienced reduced autonomy due to new habits and routines intended to control the pandemic for the benefit of public and global health.

Difficulties of healthcare workers encountered under cohort isolation in a psychiatric hospital during the COVID-19 pandemic: A qualitative study

This study examined the experiences of healthcare workers who were quarantined within the psychiatric wards due to COVID-19 and analyzed those experiences with a consensual qualitative research method. Participants experienced (a) difficulties due to the specificity of a mental hospital, including a lack of protocols, noncompliance with quarantine guidelines among patients with severe mental illness, and a shortage of institutions capable of containing confirmed COVID-19 patients with severe mental illness. Furthermore, (b) difficulties related to isolation of the cohort itself included a workforce shortage, physical problems, fear of infection, limited facilities, guilt toward newly confirmed cases, exhaustion, and distress caused by separation from family. The participants also described (c) difficulties related to external factors, including administrative orders and the perceived stigma, and (d) positive experiences. Appropriate support is needed during the COVID-19 pandemic to reduce the difficulties among healthcare workers in psychiatric hospitals. This includes preparation for future scenarios, facilities, and workers in response to outbreaks of infection in psychiatric hospitals that cause unique risks and challenges among those workers.

Patient perspectives of healthcare associated infection: "You don't know what impacts it will have on your life"

BACKGROUND

Healthcare associated infections (HAIs) are not present on admission but contracted while a patient is undergoing hospital treatment. While the prevalence of HAIs, their causes and treatments have been researched in varied contexts to date, the patients' perspectives of contracting and living with the consequences of HAI remains under-researched.

OBJECTIVE

To explore the patients' experience of having an HAI.

METHODS

We conducted a qualitative phenomenological study which drew on data from semi-structured interviews to explore the lived experiences of patients who had recently contracted an HAI while in hospital. Participants were recruited from two Australian hospitals during 2019 and 2021. Telephone interviews were conducted with ten participants by two research team members and transcripts from these interviews were qualitatively analysed using a thematic coding process to identify the patients' perspectives of contracting an HAI.

RESULTS

The participants had a range of different HAIs. The participants described how the experience of having an HAI can be very isolating and distressing from the patient perspective, with life-long implications. This contributes to our understanding of the way in which patients are impacted emotionally and mentally as a result of contracting an HAI.

CONCLUSION

There is a need for improved, person-centred communication about the source, treatment, and prognosis of HAIs. The findings from our study indicate the importance of considering patients' voices in their own health care.