Implementing nasal povidone-iodine decolonization to reduce infections in hemodialysis units: a qualitative assessment.

Autor:	Dukes KC; Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.; Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans Affairs (VA) Health Care System (ICVAHCS), Iowa City, IA, USA.; College of Public Health, University of Iowa, Iowa City, IA, USA., Hockett Sherlock S; Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.; Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans Affairs (VA) Health Care System (ICVAHCS), Iowa City, IA, USA., Racila AM; Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.; Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans Affairs (VA) Health Care System (ICVAHCS), Iowa City, IA, USA., Herwaldt LA; Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.; College of Public Health, University of Iowa, Iowa City, IA, USA.; University of Iowa Hospitals & Clinics, Iowa City, IA, USA., Jacob J; Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA., Vijayan A; Department of Nephrology, Intermountain Health, Salt Lake City, UT, USA., Kellogg J; Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA., Pegues D; Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.; Division of Infectious Diseases, Perelman School of Medicine, Philadelphia, PA, USA., Tolomeo PC; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, USA., Cobb J; Renal Division, Emory University School of Medicine, Atlanta, GA, USA., Fraer M; Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.; University of Iowa Hospitals & Clinics, Iowa City, IA, USA., Bleasdale SC; University of Illinois Hospital & Health Sciences System, Chicago, IL, USA.; University of Illinois at Chicago, Chicago, IL, USA., Ward MA; Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA., Lindsey B; University of Illinois at Chicago, Chicago, IL, USA., Schweizer ML; Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Jazyk:	angličtina
Zdroj:	Infection control and hospital epidemiology [Infect Control Hosp Epidemiol] 2024 May 23, pp. 1-6. Date of Electronic Publication: 2024 May 23.
DOI:	10.1017/ice.2024.83
Abstrakt:	Background: A substantial proportion of patients undergoing hemodialysis carry Staphylococcus aureus in their noses, and carriers are at increased risk of S. aureus bloodstream infections. Our pragmatic clinical trial implemented nasal povidone-iodine (PVI) decolonization for the prevention of bloodstream infections in the novel setting of hemodialysis units. Objective: We aimed to identify pragmatic strategies for implementing PVI decolonization among patients in outpatient hemodialysis units. Design: Qualitative descriptive study. Setting: Outpatient hemodialysis units affiliated with five US academic medical centers. Units varied in size, patient demographics, and geographic location. Interviewees: Sixty-six interviewees including nurses, hemodialysis technicians, research coordinators, and other personnel. Methods: We conducted interviews with personnel affiliated with all five academic medical centers and conducted thematic analysis of transcripts. Results: Hemodialysis units had varied success with patient recruitment, but interviewees reported that patients and healthcare personnel (HCP) found PVI decolonization acceptable and feasible. Leadership support, HCP engagement, and tailored patient-focused tools or strategies facilitated patient engagement and PVI implementation. Interviewees reported both patients and HCP sometimes underestimated patients' infection risks and experienced infection-prevention fatigue. Other HCP barriers included limited staffing and poor staff engagement. Patient barriers included high health burdens, language barriers, memory issues, and lack of social support. Conclusion: Our qualitative study suggests that PVI decolonization would be acceptable to patients and clinical personnel, and implementation is feasible for outpatient hemodialysis units. Hemodialysis units could facilitate implementation by engaging unit leaders, patients and personnel, and developing education for patients about their infection risk.
Databáze:	MEDLINE
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