Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: Zeitschrift für Gerontologie und Geriatrie 3/2019

16.03.2018 | Original Contributions

Perspectives on multidrug-resistant organisms at the end of life

A focus group study of staff members and institutional stakeholders

verfasst von: Dr. phil. Franziska A. Herbst, Maria Heckel, Johanna M. Tiedtke, Thomas Adelhardt, Alexander Sturm, Stephanie Stiel, Christoph Ostgathe

Erschienen in: Zeitschrift für Gerontologie und Geriatrie | Ausgabe 3/2019

Einloggen, um Zugang zu erhalten

Abstract

Background

There is a lack of research into how hospital staff and institutional stakeholders (i. e. institutional representatives from public health authorities, hospital hygiene, and the departments of microbiology, palliative care, and geriatrics) engage with patients who are carriers of multidrug-resistant organisms and receiving end-of-life care. Knowledge of their experiences, workload, and needs should be considered in dealing with hospitalized carriers of multidrug-resistant organisms as well as staff education.

Objective

This study explored and compared staff members’ and stakeholders’ perspectives on multidrug-resistant organisms and on provision of end-of-life care to carrier patients.

Methods

In this study four focus groups consisting of hospital staff members and institutional stakeholders were formed within a mixed-methods parent study in a palliative care unit at a university clinic and a geriatric ward of a Catholic and academic teaching hospital. Participants discussed results from staff and stakeholder interviews from a former study phase. Data were analyzed according to Grounded Theory and perspectives of staff members and institutional stakeholders were compared and contrasted.

Results

Key issues debated by staff members (N = 19) and institutional stakeholders (N = 10) were 1) the additional workload, 2) reasons for uncertainty about handling carrier patients, 3) the format of continuing education, and 4) the preferred management approach for dealing with multidrug-resistant organism carrier patients. Although similar barriers (e. g. colleagues’ ambiguous opinions) were identified, both groups drew different conclusions concerning the management of these barriers. While institutional stakeholders recommended making decisions on hygiene measures under consideration of the specific patient situation, staff members preferred the use of standardized hygiene measures which should be applied uniformly to all patients.

Discussion

Staff members and institutional stakeholders perceived similar barriers to practice caused by multidrug-resistant organisms and similar needs for continuing education. The staff members’ preferred management approach might originate from an uncertainty about the multidrug-resistant organism infection risk. Experiences and visions of both groups should be included in a specific recommendation for end-of-life care to ensure behavioral confidence.
Literatur
1.
Zurück zum Zitat Allen S, Cronin SN (2012) Improving staff compliance with isolation precautions through use of an educational intervention and behavioral contract. Dimens Crit Care Nurs 31:290–294 CrossRefPubMed Allen S, Cronin SN (2012) Improving staff compliance with isolation precautions through use of an educational intervention and behavioral contract. Dimens Crit Care Nurs 31:290–294 CrossRefPubMed
2.
Zurück zum Zitat Bükki J, Klein J, But L et al (2012) Methicillin-resistant Staphylococcus aureus (MRSA) management in palliative care units and hospices in Germany: a nationwide survey on patient isolation policies and quality of life. Palliat Med 27:84–90 CrossRef Bükki J, Klein J, But L et al (2012) Methicillin-resistant Staphylococcus aureus (MRSA) management in palliative care units and hospices in Germany: a nationwide survey on patient isolation policies and quality of life. Palliat Med 27:84–90 CrossRef
3.
Zurück zum Zitat Chen LF (2013) The changing epidemiology of methicillin-resistant staphylococcus aureus: 50 years of a superbug. Am J Infect Control 41:448–451 CrossRefPubMed Chen LF (2013) The changing epidemiology of methicillin-resistant staphylococcus aureus: 50 years of a superbug. Am J Infect Control 41:448–451 CrossRefPubMed
4.
Zurück zum Zitat Coia JE, Duckworth GJ, Edwards DI et al (2006) Guidelines for the control and prevention of meticillin-resistant staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect 63:S1–S44 CrossRefPubMed Coia JE, Duckworth GJ, Edwards DI et al (2006) Guidelines for the control and prevention of meticillin-resistant staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect 63:S1–S44 CrossRefPubMed
5.
Zurück zum Zitat Cooper BS, Stone SP, Kibbler CC et al (2004) Isolation measures in the hospital management of methicillin resistant staphylococcus aureus (MRSA): systematic review of the literature. BMJ 329:533 CrossRefPubMedPubMedCentral Cooper BS, Stone SP, Kibbler CC et al (2004) Isolation measures in the hospital management of methicillin resistant staphylococcus aureus (MRSA): systematic review of the literature. BMJ 329:533 CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Dand P, Fyvie J, Yee A et al (2005) A survey of methicillin-resistant staphylococcus aureus (MRSA) management in hospices/palliative care units. Palliat Med 19:185–187 CrossRefPubMed Dand P, Fyvie J, Yee A et al (2005) A survey of methicillin-resistant staphylococcus aureus (MRSA) management in hospices/palliative care units. Palliat Med 19:185–187 CrossRefPubMed
8.
Zurück zum Zitat Easton PM, Sarma A, Williams FL et al (2007) Infection control and management of MRSA: assessing the knowledge of staff in an acute hospital setting. J Hosp Infect 66:29–33 CrossRefPubMed Easton PM, Sarma A, Williams FL et al (2007) Infection control and management of MRSA: assessing the knowledge of staff in an acute hospital setting. J Hosp Infect 66:29–33 CrossRefPubMed
9.
Zurück zum Zitat Evans HL, Shaffer MM, Hughes MG et al (2003) Contact isolation in surgical patients: a barrier to care? Surgery 134:180–188 CrossRefPubMed Evans HL, Shaffer MM, Hughes MG et al (2003) Contact isolation in surgical patients: a barrier to care? Surgery 134:180–188 CrossRefPubMed
10.
Zurück zum Zitat Godsell MR, Shaban RZ, Gamble J (2013) “Recognizing rapport”: health professionals’ lived experience of caring for patients under transmission-based precautions in an Australian health care setting. Am J Infect Control 41:971–975 CrossRefPubMed Godsell MR, Shaban RZ, Gamble J (2013) “Recognizing rapport”: health professionals’ lived experience of caring for patients under transmission-based precautions in an Australian health care setting. Am J Infect Control 41:971–975 CrossRefPubMed
11.
Zurück zum Zitat Kirkland KB, Weinstein JM (1999) Adverse effects of contact isolation. Lancet 354:1177–1178 CrossRefPubMed Kirkland KB, Weinstein JM (1999) Adverse effects of contact isolation. Lancet 354:1177–1178 CrossRefPubMed
12.
Zurück zum Zitat Köck R, Mellmann A, Schaumburg F et al (2011) The epidemiology of methicillin-resistant staphylococcus aureus (MRSA) in Germany. Dtsch Arztebl Int 108:761–767 PubMedPubMedCentral Köck R, Mellmann A, Schaumburg F et al (2011) The epidemiology of methicillin-resistant staphylococcus aureus (MRSA) in Germany. Dtsch Arztebl Int 108:761–767 PubMedPubMedCentral
13.
Zurück zum Zitat Lines L (2006) A study of senior staff nurses’ perceptions about MRSA. Nurs Times 102:32–35 PubMed Lines L (2006) A study of senior staff nurses’ perceptions about MRSA. Nurs Times 102:32–35 PubMed
14.
Zurück zum Zitat Lupión-Mendoza C, Antúnez-Dominguez MJ, González-Fernández C et al (2015) Effects of isolation on patients and staff. Am J Infect Control 43:397–399 CrossRefPubMed Lupión-Mendoza C, Antúnez-Dominguez MJ, González-Fernández C et al (2015) Effects of isolation on patients and staff. Am J Infect Control 43:397–399 CrossRefPubMed
15.
Zurück zum Zitat MAXQDA (2015) Software für qualitative Datenanalyse. VERBI Software Consult Sozialforschung GmbH, Berlin MAXQDA (2015) Software für qualitative Datenanalyse. VERBI Software Consult Sozialforschung GmbH, Berlin
16.
Zurück zum Zitat Morgan DJ, Pineles L, Shardell M et al (2013) The effect of contact precautions on healthcare worker activity in acute care hospitals. Infect Control Hosp Epidemiol 34:69–73 CrossRefPubMed Morgan DJ, Pineles L, Shardell M et al (2013) The effect of contact precautions on healthcare worker activity in acute care hospitals. Infect Control Hosp Epidemiol 34:69–73 CrossRefPubMed
17.
Zurück zum Zitat Robert Koch-Institut (2005) Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut (RKI). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 48:1061–1080 CrossRef Robert Koch-Institut (2005) Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut (RKI). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 48:1061–1080 CrossRef
18.
Zurück zum Zitat Ruscher C (2014) Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus-aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen. Empfehlungen der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch Institut. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 57:696–732 CrossRef Ruscher C (2014) Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus-aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen. Empfehlungen der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch Institut. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 57:696–732 CrossRef
19.
Zurück zum Zitat Schröppel K, Riessen R (2013) Multiresistant gram-negative bacteria. A bacterial challenge of the twenty-first century. Med Klin Intensivmed Notfmed 108:107–112 CrossRefPubMed Schröppel K, Riessen R (2013) Multiresistant gram-negative bacteria. A bacterial challenge of the twenty-first century. Med Klin Intensivmed Notfmed 108:107–112 CrossRefPubMed
20.
Zurück zum Zitat Seaton RA, Montazeri AH (2006) Medical staff knowledge about MRSA colonization and infection in acute hospitals. J Hosp Infect 64:297–299 CrossRefPubMed Seaton RA, Montazeri AH (2006) Medical staff knowledge about MRSA colonization and infection in acute hospitals. J Hosp Infect 64:297–299 CrossRefPubMed
21.
Zurück zum Zitat Statistisches Bundesamt (2015) Gesundheit: Fallpauschalenbezogene Krankenhausstatistik (DRG-Statistik) Operationen und Prozeduren der vollstationären Patientinnen und Patienten in Krankenhäusern—Ausführliche Darstellung—2014. DeStatis, Wiesbaden Statistisches Bundesamt (2015) Gesundheit: Fallpauschalenbezogene Krankenhausstatistik (DRG-Statistik) Operationen und Prozeduren der vollstationären Patientinnen und Patienten in Krankenhäusern—Ausführliche Darstellung—2014. DeStatis, Wiesbaden
22.
Zurück zum Zitat Stiel S, Pestinger M, Moser A et al (2010) The use of grounded theory in palliative care: methodological challenges and strategies. J Palliat Med 13:997–1003 CrossRefPubMed Stiel S, Pestinger M, Moser A et al (2010) The use of grounded theory in palliative care: methodological challenges and strategies. J Palliat Med 13:997–1003 CrossRefPubMed
23.
Zurück zum Zitat Strauss AL, Corbin JM (1997) Grounded theory in practice. SAGE, Thousand Oaks Strauss AL, Corbin JM (1997) Grounded theory in practice. SAGE, Thousand Oaks
24.
Zurück zum Zitat Wischnewski N, Mielke M (2007) Übersicht über aktuelle Eradikationsstrategien bei Methicillinresistenten Staphylococcus aureus (MRSA) aus verschiedenen Ländern. Hyg Med 32:389–394 Wischnewski N, Mielke M (2007) Übersicht über aktuelle Eradikationsstrategien bei Methicillinresistenten Staphylococcus aureus (MRSA) aus verschiedenen Ländern. Hyg Med 32:389–394
Metadaten
Titel
Perspectives on multidrug-resistant organisms at the end of life
A focus group study of staff members and institutional stakeholders
verfasst von
Dr. phil. Franziska A. Herbst
Maria Heckel
Johanna M. Tiedtke
Thomas Adelhardt
Alexander Sturm
Stephanie Stiel
Christoph Ostgathe
Publikationsdatum
16.03.2018
Verlag
Springer Medizin
Erschienen in
Zeitschrift für Gerontologie und Geriatrie / Ausgabe 3/2019
Print ISSN: 0948-6704
Elektronische ISSN: 1435-1269
DOI
https://doi.org/10.1007/s00391-018-1378-8

Weitere Artikel der Ausgabe 3/2019

Zeitschrift für Gerontologie und Geriatrie 3/2019 Zur Ausgabe

Mitteilungen der ÖGGG

Mitteilungen der ÖGGG

Mitteilungen des BV Geriatrie

Mitteilungen des BV Geriatrie

Journal Club

Journal Club