Barriers and Facilitators to Successful Outbreak Management of Viral Respiratory Tract Infections in Long-Term Care Facilities: A Qualitative Interview Study.

Abstract

Objectives: Effective management of COVID-19 and influenza outbreaks in nursing homes (NHs) depends on preparation by the NH organization and the rightful execution of infection prevention and control (IPC) measures by NH staff. To be better prepared for future outbreaks and pandemics, we need a better understanding of barriers and facilitators to the execution of measures. This study aims to investigate which barriers and facilitators were perceived by Dutch NH staff during the execution of IPC measures to control outbreaks of COVID-19 and influenza in the COVID-19 pandemic end stage.

Design: Qualitative interview study.

Setting: Nursing homes where COVID-19 and/or influenza outbreaks (defined as at least 2 confirmed cases on an NH unit) occurred between February 2023 and April 2023.

Methods: We monitored 24 COVID-19 and influenza outbreaks in 14 Dutch NH organizations in the pandemic end stage. Purposive sampling was used to select a variety of outbreaks for more extensive monitoring, including qualitative interviews with NH staff involved in the management of the outbreak. During the interviews, participants reflected on the management of monitored outbreaks as well as previous outbreaks. Interview transcripts were thematically analyzed to identify determinants of IPC strategy execution.

Results: Determinants of IPC execution were clustered according to themes: motivations and attitudes; appropriateness of measures; guidance and cooperation of NH staff; communication; knowledge and skills; architectural features of the NH location; and availability of resources.

Conclusions and implications: The current study provides in-depth insight into which determinants facilitated and impeded IPC execution during COVID-19 and influenza outbreaks pandemic end stage. These findings may help NHs to better prepare for the management of future outbreaks and pandemics, and provide insights into what determinants to consider for developing IPC strategies.