Healthcare Worker (HCW) Perceptions of Healthcare-associated Respiratory Infection in Pediatric Clinics: A Qualitative Study

Background: The success of infection prevention and control (IPC) interventions in pediatric ambulatory settings relies on engaged key stakeholders: healthcare workers, patients and parents. We aimed to explore HCW perceptions about the risk for healthcare-associated respiratory infection (HA-RI) and the acceptability of IPC interventions in the pediatric ambulatory setting.

Methods: We conducted focus groups with physicians, nurse practitioners (NPs), nurses, front-desk staff, and clinic managers from 14 clinics within a large pediatric ambulatory network. HCWs were asked about the risk of HA-RI in the clinic, whom is responsible for IPC, acceptability of different types of IPC interventions and suggestions to prevent HA-RI. Data were analyzed using thematic analysis.

Results: Participants (N=181) included: 42 physicians and NPs, 77 nurses, 56 front desk staff, and 6 clinic managers. While virtually all HCWs acknowledge that respiratory virus transmission occurs in clinics, many consider the risk of a child acquiring a respiratory tract infection to be greater from other exposures outside of the clinic. Second, although HCWs recognized that specific roles differ, they believed that clinic staff and parents share responsibility for preventing HA-RI transmission. Third, the acceptability of IPC interventions is dependent on clinician and child comfort, the perceived efficacy of the intervention in reducing HA-RI, and clear policies to promote adherence. HCW suggestions to prevent HA-RI included: parent-, child-, and clinician-directed education, larger clinic space, improved ventilation systems, complete separation of sick and well children, methods to identify child with HA-RI before appointments, and increased staffing to encourage sick healthcare workers to stay home.

Conclusion: HCWs acknowledge that spending time in a pediatric clinic can lead to HA-RI. While they may consider the risk to be higher in other settings, they also acknowledge the importance of IPC interventions to prevent transmission. HCWs endorse a shared responsibility to prevent HA-RI and seek educational and physical resources to promote effective IPC practice.