Beneath the Personal Protective Equipment: Perspectives on Infection Prevention and Control From Emergency Department Health Care Personnel.

Abstract

Introduction: Optimally following infection prevention and control practices in the emergency department can be challenging owing to patient crowding, high acuity of illness, and the presentation of patients with a wide range of undifferentiated illnesses, among other factors. Understanding how health care personnel in the emergency department perceive infection prevention and control challenges may help inform improvements in infection prevention and control practices.

Methods: Between August and November 2023, interviews focused on infection prevention and control were conducted with ED health care personnel. Sites were identified using a convenience sample from a larger group of United States emergency departments selected for variety in geography, volume, and practice type. Interviews solicited voluntary participation from health care personnel and were recorded, transcribed, and coded by 2 raters. Codes were categorized as either facilitators or barriers to effective infection prevention and control practice. Content analysis was used to quantify the frequency of the identified codes, and responses were stratified by role group.

Results: A total of 25 interviews across 4 role groups and 9 facilities were conducted. Barriers identified to effective infection prevention and control practice included constraints on time (25 of 25; 100%), attention (23 of 25; 92%), and environment of care (23 of 25; 92%), as well as perceptions of infection prevention and control importance, including risk (23 of 25; 92%). Promoters included culture supporting infection prevention and control (24 of 25; 96%) and interpersonal dynamics (23 of 25; 92%). Stratified analyses demonstrated variations among roles, with nursing and nonclinical health care personnel emphasizing communication concerns, whereas providers emphasized competing priorities.

Discussion: The main barriers to effective infection prevention and control perceived by ED health care personnel included limited time and personal perceptions of risk and safety. A strong culture that promotes infection prevention and control practices and cohesive team dynamics were the primary infection prevention and control facilitators reported, suggesting potential targets for future interventions.