Infection prevention and control practices in long-term residential care settings: A multiple methods approach

Abstract

Background. Despite the relatively high risk of infection in long-term residential care settings, few studies have provided a complete evaluation of infection prevention and control (IPC) practices. Therefore, we aimed to evaluate IPC practices in two nursing homes in Hong Kong in order to inform care providers and enhance the overall quality of care. Methods. This study was conducted between August 2015 and March 2016. The IPC practices of two nursing homes were evaluated using a multiple-methods design that includes field observations, focus group interviews of staff (administrators, nurses, allied health professionals, health workers, and personal care workers), and document reviews of residents’ records and relevant practice guidelines of the Social Welfare Department and the Department of Health of Hong Kong. Results. Based on field observations, the two nursing homes met the IPC guidelines 80.4% and 75.0% of the time, respectively. The cleansing and disinfection of the environment and facilities were satisfactory. For focus group interviews of staff, 22 women and one man aged 35 to 59 years participated. The staff could describe the IPC measures satisfactorily. Yet what was described was not always observed to be done. No specific infection incident of interest was reported between January and December 2014. Overall, there are five areas of practice that deserve attention: long-term indwelling catheter care, naso-gastric feeding, respiratory care, hand hygiene, and care of residents and equipment on oxygen therapy. Conclusion. Areas in need of improvement included observance of the practice of handwashing, the provision of better handwashing facilities, the proper use of gloves, and the maintenance of the residents’ respiratory hygiene when dining, the prevention of myiasis, and the use of better bedside alert signage. We recommend that nursing homes establish an IPC committee and assign an IPC officer to oversee IPC practices. The findings enable residential home operators to identify and prioritise the areas of care that need to be addressed in the context of IPC.