Barriers and enablers to meticillin-resistant Staphylococcus aureus admission screening in hospitals: a mixed-methods study

K. Currie, C. King, K. McAloney-Kocaman, N. J. Roberts, J. MacDonald, A. Dickson, S. Cairns, N. Khanna, P. Flowers, J. Reilly, L. Price

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Abstract

Background: To reduce the risk of transmission of Meticillin resistant Staphylococcus aureus (MRSA), international guidelines recommend admission screening to identify hospital patients at risk of colonisation. However, routine monitoring indicates that optimum screening compliance levels are not always achieved. In order to enhance compliance, we must better understand those factors which influence staff screening behaviours. Aim: To identify factors which influence staff compliance with hospital MRSA screening policy. Methods: A sequential 2-stage mixed methods design applied constructs from Normalisation Process Theory and the Theoretical Domains Framework to guide data collection and analysis. Initial qualitative findings informed subsequent development of a national cross-sectional survey of nursing staff (n=450). Multiple regression modelling identified which barriers and enablers’ best predict staff compliance. Findings: Three factors were significant in predicting optimum (>90%) compliance with MRSA screening: having MRSA screening routinized within the admission process; category of clinical area; feedback of MRSA screening compliance within the clinical area. Integration of data-sets indicated that organizational systems which ‘Make doing the right thing easy’ influences compliance, as does local ward culture. Embedded values and beliefs regarding the relative (de)-prioritization of MRSA screening are important. Conclusion: To our knowledge, this is the first study to provide original evidence of barriers and enablers to MRSA screening, applying both sociological and psychological theory. As antimicrobial resistance is a global health concern, these findings have international relevance for screening programmes. Future policy recommendations or behaviour change interventions, based on the insights presented here, could have significant impact upon improving screening compliance.
Original languageEnglish
Pages (from-to)100-108
JournalJournal of Hospital Infection
Volume101
Issue number1
Early online date8 Aug 2018
DOIs
Publication statusPublished - Jan 2019

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Methicillin
Staphylococcus aureus
Compliance
Psychological Theory
Nursing Staff
Cross-Sectional Studies
Guidelines

Keywords

  • MRSA
  • antimicrobial resistance

Cite this

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title = "Barriers and enablers to meticillin-resistant Staphylococcus aureus admission screening in hospitals: a mixed-methods study",
abstract = "Background: To reduce the risk of transmission of Meticillin resistant Staphylococcus aureus (MRSA), international guidelines recommend admission screening to identify hospital patients at risk of colonisation. However, routine monitoring indicates that optimum screening compliance levels are not always achieved. In order to enhance compliance, we must better understand those factors which influence staff screening behaviours. Aim: To identify factors which influence staff compliance with hospital MRSA screening policy. Methods: A sequential 2-stage mixed methods design applied constructs from Normalisation Process Theory and the Theoretical Domains Framework to guide data collection and analysis. Initial qualitative findings informed subsequent development of a national cross-sectional survey of nursing staff (n=450). Multiple regression modelling identified which barriers and enablers’ best predict staff compliance. Findings: Three factors were significant in predicting optimum (>90{\%}) compliance with MRSA screening: having MRSA screening routinized within the admission process; category of clinical area; feedback of MRSA screening compliance within the clinical area. Integration of data-sets indicated that organizational systems which ‘Make doing the right thing easy’ influences compliance, as does local ward culture. Embedded values and beliefs regarding the relative (de)-prioritization of MRSA screening are important. Conclusion: To our knowledge, this is the first study to provide original evidence of barriers and enablers to MRSA screening, applying both sociological and psychological theory. As antimicrobial resistance is a global health concern, these findings have international relevance for screening programmes. Future policy recommendations or behaviour change interventions, based on the insights presented here, could have significant impact upon improving screening compliance.",
keywords = "MRSA, antimicrobial resistance",
author = "K. Currie and C. King and K. McAloney-Kocaman and Roberts, {N. J.} and J. MacDonald and A. Dickson and S. Cairns and N. Khanna and P. Flowers and J. Reilly and L. Price",
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T1 - Barriers and enablers to meticillin-resistant Staphylococcus aureus admission screening in hospitals: a mixed-methods study

AU - Currie, K.

AU - King, C.

AU - McAloney-Kocaman, K.

AU - Roberts, N. J.

AU - MacDonald, J.

AU - Dickson, A.

AU - Cairns, S.

AU - Khanna, N.

AU - Flowers, P.

AU - Reilly, J.

AU - Price, L.

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N2 - Background: To reduce the risk of transmission of Meticillin resistant Staphylococcus aureus (MRSA), international guidelines recommend admission screening to identify hospital patients at risk of colonisation. However, routine monitoring indicates that optimum screening compliance levels are not always achieved. In order to enhance compliance, we must better understand those factors which influence staff screening behaviours. Aim: To identify factors which influence staff compliance with hospital MRSA screening policy. Methods: A sequential 2-stage mixed methods design applied constructs from Normalisation Process Theory and the Theoretical Domains Framework to guide data collection and analysis. Initial qualitative findings informed subsequent development of a national cross-sectional survey of nursing staff (n=450). Multiple regression modelling identified which barriers and enablers’ best predict staff compliance. Findings: Three factors were significant in predicting optimum (>90%) compliance with MRSA screening: having MRSA screening routinized within the admission process; category of clinical area; feedback of MRSA screening compliance within the clinical area. Integration of data-sets indicated that organizational systems which ‘Make doing the right thing easy’ influences compliance, as does local ward culture. Embedded values and beliefs regarding the relative (de)-prioritization of MRSA screening are important. Conclusion: To our knowledge, this is the first study to provide original evidence of barriers and enablers to MRSA screening, applying both sociological and psychological theory. As antimicrobial resistance is a global health concern, these findings have international relevance for screening programmes. Future policy recommendations or behaviour change interventions, based on the insights presented here, could have significant impact upon improving screening compliance.

AB - Background: To reduce the risk of transmission of Meticillin resistant Staphylococcus aureus (MRSA), international guidelines recommend admission screening to identify hospital patients at risk of colonisation. However, routine monitoring indicates that optimum screening compliance levels are not always achieved. In order to enhance compliance, we must better understand those factors which influence staff screening behaviours. Aim: To identify factors which influence staff compliance with hospital MRSA screening policy. Methods: A sequential 2-stage mixed methods design applied constructs from Normalisation Process Theory and the Theoretical Domains Framework to guide data collection and analysis. Initial qualitative findings informed subsequent development of a national cross-sectional survey of nursing staff (n=450). Multiple regression modelling identified which barriers and enablers’ best predict staff compliance. Findings: Three factors were significant in predicting optimum (>90%) compliance with MRSA screening: having MRSA screening routinized within the admission process; category of clinical area; feedback of MRSA screening compliance within the clinical area. Integration of data-sets indicated that organizational systems which ‘Make doing the right thing easy’ influences compliance, as does local ward culture. Embedded values and beliefs regarding the relative (de)-prioritization of MRSA screening are important. Conclusion: To our knowledge, this is the first study to provide original evidence of barriers and enablers to MRSA screening, applying both sociological and psychological theory. As antimicrobial resistance is a global health concern, these findings have international relevance for screening programmes. Future policy recommendations or behaviour change interventions, based on the insights presented here, could have significant impact upon improving screening compliance.

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