Mixed-methods assessment of barriers to Candidozyma auris prevention among frontline healthcare providers in long-term acute care hospitals.

OBJECTIVE

Assess knowledge, attitudes, and practices for control of Candidozyma auris among healthcare providers in long-term acute care hospitals (LTACHs).

DESIGN

Mixed methods; quantitative survey, followed by qualitative focus groups.

SETTING

Two LTACHs with endemic spread of C. auris in the Chicago, Illinois region.

PARTICIPANTS

Convenience sample of frontline healthcare providers.

RESULTS

Fifty-three quantitative surveys were completed, and 21 individuals participated in qualitative focus groups. Survey participants were 92% female, 43% nurses, and 60% had >10 years of experience in their current role. They reported awareness of high-priority healthcare-associated multidrug-resistant pathogens, including C. auris (86%). Most participants agreed that C. auris is a national problem (74%), but only 56% agreed it was a problem in their own hospital. Barriers to C. auris prevention identified in the survey included understaffing (63%), lack of training (52%), lack of coworker accountability (48%), and lack of adequate time for task completion (49% for self, 48% for coworkers). Focus groups included 10 nurses, 5 patient care technicians, 3 secretaries, and 3 therapists. Focus groups highlighted the importance of enforcement and monitoring of prevention measures and the need for additional education. When asked how to improve infection prevention at their hospital, participants identified themes of education, improvements in enforcement and monitoring of prevention measures, staff support, and improvements in visual communication and healthcare design.

CONCLUSIONS

In this cohort of frontline LTACH healthcare providers, we identified multiple barriers to C. auris containment and elicited potential solutions. These insights suggest targets for future interventions to improve C. auris control.