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Hall A, Aguilera-Muñoz J, McGarrigle L, Eost-Telling C, Denison-Day J, Cabral C, Willcox M, Todd C. Adapting the Germ Defence Web-Based Intervention to Improve Infection Prevention and Control in Care Homes: Interview Study Among Care Home Staff. JMIR Form Res 2025; 9:e66706. [PMID: 39970434 DOI: 10.2196/66706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 09/23/2024] [Revised: 11/28/2024] [Accepted: 11/29/2024] [Indexed: 02/21/2025] Open
Abstract
BACKGROUND Infection prevention and control (IPC) is vital in care homes as it can reduce morbidity and mortality by 30%. Ensuring good IPC practice is a perennial challenge in the varied and complex context of care homes. Behavior change interventions delivered via digital technology may be effective in improving IPC among care home staff. OBJECTIVE This study aimed to evaluate how an evidence-based, digital behavior change intervention called Germ Defence can be rapidly adapted to meet the needs of care homes. METHODS This study applied the person-based approach, which emphasizes iterative approaches to optimizing interventions via individual user feedback. Phase 1 involved initial edits to the website by the research team to create Germ Defence for Care Homes (GDCH) version 1. Phase 2 consisted of stakeholder consultation on GDCH version 1 followed by edits to create GDCH version 2. The formal research (phases 3 and 4) involved individual think-aloud interviews with 21 staff members from management, care, and ancillary positions in 4 care homes providing real-time feedback as they worked through GDCH. Edits were made to create GDCH version 3 between phases 3 and 4. During the development of GDCH versions 2 and 3, it became clear that the intervention would need more fundamental changes beyond the pragmatic, incremental changes that would be possible within the scope of this study. Analysis was completed via a rapid, qualitative descriptive approach to develop a high-level summary of key findings from the interview data. RESULTS There were mixed results about the attractiveness of GDCH and its suitability to the care home context. Participants felt that the images needed to be aligned much more closely with the meaning of adjacent text. Many participants felt that they would not have time to read a text-based website, and some suggested that more engaging content, including audio and video, may be preferable. Most participants felt that the overall concept of Germ Defence was clearly relevant to their context. Some felt that it might be a useful introduction for new staff members or a refresher for current staff, but others felt that it did not add anything to their existing IPC training. There were mixed opinions about the level of detail provided in the information offered by the site. While the goal-setting behavior change mechanism may have potential, the findings suggested that it may be unsuitable for care homes and more work is needed to refine it. CONCLUSIONS Much more work needs to be done to make Germ Defence more engaging, accessible, and relevant to the care home workforce. Our study highlights the challenges of rapidly adapting an existing intervention to a new context. Future research in this area will require a pragmatic methodological approach with a focus on implementation.
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Affiliation(s)
- Alex Hall
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Johanna Aguilera-Muñoz
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, United Kingdom
| | - Lisa McGarrigle
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Charlotte Eost-Telling
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, United Kingdom
| | - James Denison-Day
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Christie Cabral
- Centre for Academic Primary Care, University of Bristol, Bristol, United Kingdom
| | - Merlin Willcox
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Chris Todd
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, United Kingdom
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Bertini L, Schmidt-Renfree N, Blackstone J, Stirrup O, Adams N, Cullen-Stephenson I, Krutikov M, Leiser R, Goscé L, Henderson C, Flowers P, Shallcross L, Cassell JA, Cadar D. VIVALDI ASCOT and Ethnography Study: protocol for a mixed-methods longitudinal study to evaluate the impact of COVID-19 and other respiratory infection outbreaks on care home residents' quality of life and psychosocial well-being. BMJ Open 2024; 14:e088685. [PMID: 39117401 PMCID: PMC11404191 DOI: 10.1136/bmjopen-2024-088685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 05/12/2024] [Accepted: 07/24/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION Older adults in care homes experienced some of the highest rates of mortality from SARS-CoV-2 globally and were subjected to strict and lengthy non-pharmaceutical interventions, which severely impacted their daily lives. The VIVALDI ASCOT and Ethnography Study aims to assess the impact of respiratory outbreaks on care home residents' quality of life, psychological well-being, loneliness, functional ability and use of space. This study is linked to the VIVALDI-CT, a randomised controlled trial of staff's asymptomatic testing and sickness payment support in care homes (ISRCTN13296529). METHODS AND ANALYSIS This is a mixed-methods, longitudinal study of care home residents (65+) in Southeast England. Group 1-exposed includes residents from care homes with a recent COVID-19 or other respiratory infection outbreak. Group 2-non-exposed includes residents from care homes without a recent outbreak. The study has two components: (a) a mixed-methods longitudinal face-to-face interviews with 100 residents (n=50 from group 1 and n=50 from group 2) to assess the impact of outbreaks on residents' quality of life, psychological well-being, loneliness, functional ability and use of space at time 1 (study baseline) and time 2 (at 3-4 weeks after the first visit); (b) ethnographic observations in communal spaces of up to 10 care homes to understand how outbreaks and related restrictions to the use of space and social activities impact residents' well-being. The study will interview only care home residents who have the mental capacity to consent. Data will be compared and integrated to gain a more comprehensive understanding of the impact of outbreaks on residents' quality of life and well-being. ETHICS AND DISSEMINATION The VIVALDI ASCOT and Ethnography Study obtained ethical approval from the Health Research Authority (HRA) Social Care REC (24/IEC08/0001). Only residents with the capacity to consent will be included in the study. Findings will be published in scientific journals.
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Affiliation(s)
- Lavinia Bertini
- Department of Clinical Neuroscience, Brighton and Sussex Medical School, Brighton, UK
- Department of Primary Care, Brighton and Sussex Medical School, Brighton, UK
| | - Nicola Schmidt-Renfree
- Department of Clinical Neuroscience, Brighton and Sussex Medical School, Brighton, UK
- Department of Primary Care, Brighton and Sussex Medical School, Brighton, UK
| | - James Blackstone
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Oliver Stirrup
- Institute for Global Health, University College London, London, UK
| | - Natalie Adams
- Royal Free London NHS Foundation Trust, London, UK
- UCL Institute of Health Informatics, London, UK
| | | | - Maria Krutikov
- Institute of Health informatics, University College London, London, UK
| | - Ruth Leiser
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Lara Goscé
- Institute for Global Health, University College London, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine Henderson
- Care Policy and Evaluation Centre, The London School of Economics and Political Science, London, UK
| | | | - Laura Shallcross
- Institute of Health informatics, University College London, London, UK
| | - Jackie A Cassell
- Department of Primary Care, Brighton and Sussex Medical School, Brighton, UK
- UK Health Security Agency, London, UK
| | - Dorina Cadar
- Department of Clinical Neuroscience, Brighton and Sussex Medical School, Brighton, UK
- Behavioural Scince and Health, University College London, London, UK
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Marschall J, Snyders RE, Sax H, Newland JG, Guimarães T, Kwon JH. Perspectives on research needs in healthcare epidemiology, infection prevention, and antimicrobial stewardship: what's on the horizon-Part II. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e212. [PMID: 38156221 PMCID: PMC10753481 DOI: 10.1017/ash.2023.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Academic Contribution Register] [Received: 06/05/2023] [Indexed: 12/30/2023]
Abstract
In this overview, we articulate research needs and opportunities in the field of infection prevention that have been identified from insights gained during operative infection prevention work, our own research in healthcare epidemiology, and from reviewing the literature. The 10 areas of research need are: 1) Transmissions and interruptions, 2) personal protective equipment and other safety issues in occupational health, 3) climate change and other crises, 4) device, diagnostic, and antimicrobial stewardship, 5) implementation and deimplementation, 6) healthcare outside the acute care hospital, 7) low- and middle-income countries, 8) networking with the "neighbors," 9) novel research methodologies, and 10) the future state of surveillance. An introduction and chapters 1-5 are presented in part I of the article and chapters 6-10 and the discussion in part II. There are many barriers to advancing the field, such as finding and motivating the future IP workforce including professionals interested in conducting research, a constant confrontation with challenges and crises, the difficulty of performing studies in a complex environment, the relative lack of adequate incentives and funding streams, and how to disseminate and validate the often very local quality improvement projects. Addressing research gaps now (i.e., in the post-pandemic phase) will make healthcare systems more resilient when facing future crises.
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Affiliation(s)
- Jonas Marschall
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
- BJC Healthcare, St. Louis, MO, USA
| | | | - Hugo Sax
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jason G. Newland
- Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Thais Guimarães
- Infection Control Department, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Jennie H. Kwon
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
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Watson E, Dowson L, Dunt D, Thursky K, Worth LJ, Sluggett JK, Appathurai A, Bennett N. Identifying barriers and enablers to participation in infection surveillance in Australian residential aged care facilities. BMC Public Health 2023; 23:2160. [PMID: 37924023 PMCID: PMC10625226 DOI: 10.1186/s12889-023-16891-2] [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] [Academic Contribution Register] [Received: 07/16/2023] [Accepted: 10/04/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Infection surveillance is a vital part of infection prevention and control activities for the aged care sector. In Australia there are two currently available infection and antimicrobial use surveillance programs for residential aged care facilities. These programs are not mandated nor available to all facilities. Development of a new surveillance program will provide standardised surveillance for all facilities in Australia. METHODS This study aimed to assess barriers and enablers to participation in the two existing infection and antimicrobial use surveillance programs, to improve development and implementation of a new program. A mixed-methods study was performed. Aged Care staff involved in infection surveillance were invited to participate in focus groups and complete an online survey comprising 17 items. Interviews were transcribed and analysed using the COM-B framework. RESULTS Twenty-nine staff took part in the focus groups and two hundred took part in the survey. Barriers to participating in aged care infection surveillance programs were the time needed to collect and enter data, competing priority tasks, limited understanding of surveillance from some staff, difficulty engaging clinicians, and staff fatigue after the COVID-19 pandemic. Factors that enabled participation were previous experience with surveillance, and sharing responsibilities, educational materials and using data for benchmarking and to improve practice. CONCLUSION Streamlined and simple data entry methods will reduce the burden of surveillance on staff. Education materials will be vital for the implementation of a new surveillance program. These materials must be tailored to different aged care workers, specific to the aged care context and provide guidance on how to use surveillance results to improve practice.
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Affiliation(s)
- Eliza Watson
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, VIC, 3000, Australia
| | - Leslie Dowson
- National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - David Dunt
- Professor Emeritus, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Karin Thursky
- National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Parkville, VIC, 3010, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010 , Australia
- The Royal Melbourne Hospital Guidance Group, Melbourne, VIC, 3000, Australia
| | - Leon J Worth
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, VIC, 3000, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010 , Australia
- Department of Medicine, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Janet K Sluggett
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, SA, 5001, Australia
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, SA, 5001, Australia
| | - Amanda Appathurai
- National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Noleen Bennett
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, VIC, 3000, Australia.
- National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Parkville, VIC, 3010, Australia.
- Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia.
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Burton JK, Drummond M, Gallacher KI, Quinn TJ. Listening and learning: a qualitative study of Scottish care home staff experiences of managing COVID-19 between March 2020-August 2022. BMC Geriatr 2023; 23:544. [PMID: 37679720 PMCID: PMC10485989 DOI: 10.1186/s12877-023-04251-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 05/04/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND The serious outcomes of outbreaks of COVID-19 in care homes have been described internationally. The experiences of professionals working through outbreaks has received less attention, missing opportunities to acknowledge and learn lessons. Our aim was to explore the experiences of care home staff in Scotland of managing COVID-19 within their homes to help inform understanding and future practice. METHODS From April to August 2022, 34 individual semi-structured interviews were conducted with care home staff working in homes which experienced an outbreak(s) of COVID-19. Reflexive thematic methods were used to analyse verbatim deidentified transcripts. FINDINGS There was no singular experience of COVID-19 outbreaks within care homes. We identified four broad groupings of homes with outbreaks (significant outbreaks, managed outbreaks, outbreaks in remote/rural homes & outbreaks in homes supporting younger adults), with overlaps in timing and severity and variation in the support received and impact. The national response to the COVID-19 pandemic resulted in fundamental change to care home relationships. Staff responded by adaptation in uncertainty. However, they were challenged by emerging inequalities influencing residents' care. There were tensions between staff experience and evolving external approaches to regulation and oversight. All this change resulted in psychological impacts on staff. However, there was also widespread evidence of compassionate leadership and teamwork in their responses. Effective sources of support were underpinned by respectful relationships and continuity, tailored to individual contexts. CONCLUSIONS The lived experiences of care home staff during the COVID-19 pandemic provide valuable insights applicable beyond the pandemic context. This includes: recognition of the specialism, complexity and diversity of care home practice; the value afforded by embedding genuine representation and involvement in planning, policy-making and research; the need for individualising to people in their contexts and the value of fostering respectful relationships across professional groups to support residents.
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Affiliation(s)
- Jennifer Kirsty Burton
- Academic Geriatric Medicine, School of Cardiovascular & Metabolic Health, College of Medicine, Veterinary & Life Sciences, University of Glasgow, Glasgow, G12 8TA, Scotland.
- School of Cardiovascular & Metabolic Health, New Lister Building, University of Glasgow, Glasgow Royal Infirmary, Room 2.42 Level 2, Alexandra Parade, G31 2ER, Glasgow, Scotland.
| | - Maria Drummond
- Nursing & Health Care, School of Medicine, Dentistry & Nursing, College of Medicine, Veterinary & Life Sciences, University of Glasgow, Glasgow, G12 8LW, Scotland
| | - Katie I Gallacher
- General Practice & Primary Care, School of Health and Wellbeing, College of Medicine, Veterinary & Life Sciences, University of Glasgow, Glasgow, G12 8TB, Scotland
| | - Terence J Quinn
- Academic Geriatric Medicine, School of Cardiovascular & Metabolic Health, College of Medicine, Veterinary & Life Sciences, University of Glasgow, Glasgow, G12 8TA, Scotland
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MacFarlane A, LeMaster J. Disrupting patterns of exclusion in participatory spaces: Involving people from vulnerable populations. Health Expect 2022; 25:2031-2033. [PMID: 35983897 DOI: 10.1111/hex.13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Anne MacFarlane
- Public and Patient Involvement Reserach Unit, School of Medicine & Health Research Institute, University of Limerick, Limerick, Ireland
| | - Joseph LeMaster
- Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City, Kansas, USA
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