Skip to main content
×
×
Home

Understanding Staff Perceptions about Klebsiella pneumoniae Carbapenemase–Producing Enterobacteriaceae Control Efforts in Chicago Long-Term Acute Care Hospitals

  • Rosie D. Lyles (a1), Nicholas M. Moore (a2), Shayna B. Weiner (a3), Monica Sikka (a4), Michael Y. Lin (a3), Robert A. Weinstein (a1) (a3), Mary K. Hayden (a3) (a5), Ronda L. Sinkowitz-Cochran (a6) and CDC Prevention Epicenters Program...
Abstract
Objective.

To identify differences in organizational culture and better understand motivators to implementation of abundle intervention to control Klebsiella pneumoniae carbapenemase–producing Enterobacteriaceae (KPC).

Design.

Mixed-methods study.

Setting.

Four long-term acute care hospitals (LTACHs) in Chicago.

Participants.

LTACH staff across 3 strata of employees (administration, midlevel management, and frontline clinical workers).

Methods.

Qualitative interviews or focus groups and completion of a quantitative questionnaire.

Results.

Eighty employees (frontline, 72.5%; midlevel, 17.5%; administration, 10%) completed surveys and participated in qualitative discussions in August 2012. Although 82.3% of respondents felt that quality improvement was a priority at their LTACH, there were statistically significant differences in organizational culture between staff strata, with administrative-level having higher organizational culture scores (ie, more favorable responses) than midlevel or frontline staff. When asked to rank the success of the KPC control program, mean response was 8.0 (95% confidence interval, 7.6–8.5), indicating a high level of agreement with the perception that the program was a success. Patient safety and personal safety were reported most often as personal motivators for intervention adherence. The most convergent theme related to prevention across groups was that proper hand hygiene is vital to prevention of KPC transmission.

Conclusions.

Despite differences in organizational culture across 3 strata of LTACH employees, the high degree of convergence in motivation, understanding, and beliefs related to implementation of a KPC control bundle suggests that all levels of staff may be able to align perspectives when faced with a key infection control problem and quality improvement initiative.

Copyright
Corresponding author
1900 West Polk Street, Suite 1256, Chicago, IL 60612 (rlyles@cookcountyhhs.org)
References
Hide All
1. Bratu, S, Landman, D, Haag, R, et al. Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City: a new threat to our antibiotic armamentarium. Arch Intern Med 2005;165:14301435.
2. Smith Moland, E, Hanson, N, Herrera, V, et al. Plasmid-mediated, carbapenem-hydrolysing beta-lactamase, KPC-2, in Klebsiella pneumoniae isolates. J Antimicrob Chemother 2003;51:711714.
3. Bradford, P, Bratu, S, Urban, C, et al. Emergence of carbapenem-resistant Klebsiella species possessing the class A carbapenem-hydrolyzing KPC-2 and inhibitor-resistant TEM-30 beta-lactamases in New York City. Clin Infect Dis 2004;39:5560.
4. Yigit, H, Queenan, A, Anderson, G, et al. Novel carbapenem-hydrolyzing beta-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae . Antimicrob Agents Chemother 2008;52(2):809.
5. Won, S, Munoz-Price, L, Lolans, K, et al. Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis 2011;53:532540.
6. Patel, G, Huprikar, S, Factor, S, Jenkins, S, Calfee, D. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol 2008;29:10991106.
7. Centers for Disease Control and Prevention (CDC). Guidance for Control of Carbapenem-Resistant Enterobacteriaceae (CRE): 2012 CRE Toolkit. Atlanta: CDC, 2012. http://www.cdc.gov/hai/pdfs/cre/CRE-guidance-508.pdf. Accessed July 27, 2013.
8. Thurlow, CJ, Prabaker, K, Lin, MY, et al. Anatomic sites of patient colonization and environmental contamination with Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae at long-term acute care hospitals. Infect Control Hosp Epidemiol 2013;34:5661.
9. Lin, MY, Lyles-Banks, RD, Lolans, K, et al. The importance of long-term acute care hospitals in the regional epidemiology of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis 2013;57:12461252.
10. Munoz-Price, L, Hayden, MK, Lolans, K, et al. Successful control of an outbreak of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae at a long-term acute care hospital. Infect Control Hosp Epidemiol 2010;31:341347.
11. Chitnis, A, Caruthers, P, Rao, A, et al. Outbreak of carbapenem-resistant Enterobacteriaceae at a long-term acute care hospital: sustained reductions in transmission through active surveillance and targeted interventions. Infect Control Hosp Epidemiol 2012;33:984992.
12. Blake, SC, Kohler, S, Rask, K, Davis, A, Naylor, DV. Facilitators and barriers to 10 National Quality Forum safe practices. Am J Med Qual 2006;21(5):323334.
13. Davies, HT, Nutley, SM, Mannion, R. Organisational culture and quality of health care. Qual Health Care 2000;9:111119.
14. Garcia-Williams, AG, Miller, LJ, Burkitt, KH, et al. Beyond beta: lessons learned from implementation of the Department of Veterans Affairs Methicillin-Resistant Staphylococcus aureus Prevention Initiative. Infect Control Hosp Epidemiol. 2010;31:763765.
15. Griffiths, P, Renz, A, Hughes, J, Rafferty, AM. Impact of organisation and management factors on infection control in hospitals: a scoping review. J Hosp Infect 2009;73:114.
16. Keroack, MA, Youngberg, BJ, Cerese, JL, Krsek, C, Prellwitz, LW, Trevelyan, EW. Organizational factors associated with high performance in quality and safety in academic medical centers. Acad Med 2007;82:11781186.
17. Krein, SL, Damschroder, LJ, Kowalski, CP, Forman, J, Hofer, TP, Saint, S. The influence of organizational context on quality improvement and patient safety efforts in infection prevention: a multi-center qualitative study. Soc Sci Med 2010;71:16921701.
18. Jain, M, Miller, L, Belt, D, King, D, Berwick, DM. Decline in ICU adverse events, nosocomial infections and cost through a quality improvement initiative focusing on teamwork and culture change. Qual Saf Health Care 2006;15:235239.
19. Saint, S, Kowalski, CP, Banaszak-Holl, J, Forman, J, Damschroder, L, Krein, SL. The importance of leadership in preventing health-care-associated infection: results of a multisite qualitative study. Infect Control Hosp Epidemiol 2010;31:901907.
20. Sinkowitz-Cochran, R, Burkitt, K, Cuerdon, T, et al. The associations between organizational culture and knowledge, attitudes, and practices in a multicenter Veterans Affairs quality improvement initiative to prevent methicillin-resistant Staphylococcus aureus . Am J Infect Control 2012;40:138143.
21. Sinkowitz-Cochran, R, Garcia-Williams, A, Hackberth, A, et al. Evaluation of organizational culture among different levels of healthcare staff participating in the Institute for Healthcare Improvement's 100,000 Lives Campaign. Infect Control Hosp Epidemiol 2012;33:135143.
22. Baker, K. Chapter 11: Organizational Culture, http://www.au.af.mil/au/awc/awcgate/doe/benchmark/ch11.pdf. Accessed June 5, 2013.
23. Shortell, S, Bennett, C, Byck, G. Assessing the impact of continuous quality improvement on clinical practice: what it will take to accelerate progress. Milbank Q 1998;76:593624.
24. Leape, L. Errors in medicine. Clin Chim Acta 2009;104:25.
25. Ohman-Strickland, P, Orzano, J, Nutting, P, Dickinson, W, Scott-Cawiezell, J, Hahn, K. Measuring organizational attributes of primary care practices: development of a new instrument. Health Serv Res 2007;42:12571273.
26. Wise, ME, Weber, SG, Schneider, A, et al. Hospital staff perceptions of a legislative mandate for methicillin-resistant Staphylococcus aureus screening. Infect Control Hosp Epidemiol 2011;32:573578.
27. Borkan, J. Immersion/crystallization. In: Crabtree, B, Miller, W, eds. Doing Qualitative Research. 2nd ed. Thousand Oaks, CA: Sage, 1999:179194.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed