A Qualitative Study of Infection Prevention Perceptions, Beliefs, and Practices in the Emergency Department

Background: Emergency departments (ED) present unique challenges to infection prevention. Little qualitative data exists to guide development of infection prevention strategies tailored to the unique environment of emergency care, particularly with relation to hand hygiene and contact precaution use.

Methods: 11 semi-structured focus groups comprised of 54 emergency physicians, emergency medicine residents, mid-level providers, nurses, patient care technicians, and environmental services staff were conducted in a large urban, academic ED averaging over 90,000 patient visits annually and a small community academic-affiliated ED averaging 10,000 patient visits annually. Focus groups were stratified by job role and covered domains related to infection prevention awareness, perceptions, barriers, and potential solutions. An inductive open-coding approach was used to identify major themes.

Results: Analysis highlighted several themes relating to infection prevention including awareness of patients colonized with multidrug-resistant organisms (MDRO), variable perception of risks posed by MDROs, a distinct ED culture towards infection prevention practices when patients are known to be colonized with a MDRO, environmental barriers to adherence to hand hygiene and contact precaution adherence, and solutions to improve infection prevention in the ED.

Conclusion: Incomplete awareness of patient MDRO status and perceived risk to other patients and healthcare providers, unit-specific cultural attitudes and accepted norms deemphasizing certain aspects of infection prevention (e.g., contact precautions), competing clinical demands, high patient acuity, and lack of time, resources, and support are obstacles to infection prevention practices in the ED. Successful ED-specific infection prevention initiatives are greatly needed to improve hand hygiene and contact precaution adherence.