IMpleMenting Effective infection prevention and control in ReSidential aged carE (IMMERSE): protocol for a multi-level mixed methods implementation study

Joanne Tropea; Sanne Peters; Jill J Francis; Noleen Bennett; Deirdre Fetherstonhaugh; Kirsty Buising; Lyn-Li Lim; Caroline Marshall; Madelaine Flynn; Michael Murray; Paul Yates; Craig Aboltins; Douglas Johnson; Jason Kwong; Karrie Long; Judy McCahon; Wen K Lim

doi:10.1186/s12877-023-03766-9

IMpleMenting Effective infection prevention and control in ReSidential aged carE (IMMERSE): protocol for a multi-level mixed methods implementation study

BMC Geriatr. 2023 Feb 23;23(1):109. doi: 10.1186/s12877-023-03766-9.

Authors

Joanne Tropea^{1

2}, Sanne Peters^{3

4}, Jill J Francis^{3

5

6

7}, Noleen Bennett^{8

9

10}, Deirdre Fetherstonhaugh¹¹, Kirsty Buising^{12

13}, Lyn-Li Lim⁸, Caroline Marshall^{13

14}, Madelaine Flynn^{15

16}, Michael Murray^{11

17

18}, Paul Yates^{17

18}, Craig Aboltins^{19

20}, Douglas Johnson^{21

22}, Jason Kwong^{18

23

24}, Karrie Long²⁵, Judy McCahon²⁶, Wen K Lim^{27

21}

Affiliations

¹ Department of Aged Care, Royal Melbourne Hospital, Level 8 CRM, 300 Grattan Street, Parkville, VIC, 3050, Australia. [email protected].
² Department of Medicine - Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3010, Australia. [email protected].
³ School of Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia.
⁴ Department of Public Health and Primary Care, University of Leuven, KU Leuven, Louvain, Belgium.
⁵ Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.
⁶ Department of Oncology, Sir Peter MacCallum, University of Melbourne, Parkville, VIC, 3010, Australia.
⁷ Ottawa Hospital Research Institute - General Campus, Centre for Implementation Research, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
⁸ Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre and Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC 3000, Australia.
⁹ Department of Infectious Diseases, National Centre for Antimicrobial Stewardship, University of Melbourne, Melbourne, VIC, 3000, Australia.
¹⁰ Department of Nursing, School of Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia.
¹¹ Australian Centre for Evidence Based Aged Care (ACEBAC), La Trobe University, Bundoora, VIC, 3086, Australia.
¹² Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.
¹³ Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC 3000, Australia.
¹⁴ Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.
¹⁵ Director of Infection Prevention, Northern Health, Epping, VIC, 3076, Australia.
¹⁶ Victorian Aged Care Response Centre, Australian Department of Health, Melbourne VIC 3000, Australia.
¹⁷ Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, 3084, Australia.
¹⁸ Department of Medicine - Austin Health, University of Melbourne, Heidelberg, VIC, 3084, Australia.
¹⁹ Department of Infectious Diseases, Northern Health, Epping, Vic, 3076, Australia.
²⁰ Department of Medicine, Northern Clinical School, University of Melbourne, Epping VIC 3076, Australia.
²¹ Department of Medicine - Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3010, Australia.
²² Departments of General Medicine and Infectious Diseases, Royal Melbourne Hospital, Parkville VIC 3050, Australia.
²³ Department of Infectious Diseases, Austin Health, Heidelberg VIC 3084, Australia.
²⁴ Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne VIC 3000, Australia.
²⁵ Director Nursing Research Hub, Royal Melbourne Hospital, Parkville VIC 3050, Australia.
²⁶ Consumer Representative of the IMMERSE Research Team, and Melbourne Academic Centre for Health, Parkville VIC 3050, Australia.
²⁷ Department of Aged Care, Royal Melbourne Hospital, Level 8 CRM, 300 Grattan Street, Parkville, VIC, 3050, Australia.

Abstract

Background: Older people living in residential aged care facilities are at high risk of acquiring infections such as influenza, gastroenteritis, and more recently COVID-19. These infections are a major cause of morbidity and mortality among this cohort. Quality infection prevention and control practice in residential aged care is therefore imperative. Although appointment of a dedicated infection prevention and control (IPC) lead in every Australian residential aged care facility is now mandated, all people working in this setting have a role to play in IPC. The COVID-19 pandemic revealed inadequacies in IPC in this sector and highlighted the need for interventions to improve implementation of best practice.

Methods: Using mixed methods, this four-phase implementation study will use theory-informed approaches to: (1) assess residential aged care facilities' readiness for IPC practice change, (2) explore current practice using scenario-based assessments, (3) investigate barriers to best practice IPC, and (4) determine and evaluate feasible and locally tailored solutions to overcome the identified barriers. IPC leads will be upskilled and supported to operationalise the selected solutions. Staff working in residential aged care facilities, residents and their families will be recruited for participation in surveys and semi-structured interviews. Data will be analysed and triangulated at each phase, with findings informing the subsequent phases. Stakeholder groups at each facility and the IMMERSE project's Reference Group will contribute to the interpretation of findings at each phase of the project.

Discussion: This multi-site study will comprehensively explore infection prevention and control practices in residential aged care. It will inform and support locally appropriate evidence-based strategies for enhancing infection prevention and control practice.

Keywords: Behaviour change; Best practice; Implementation science; Infection prevention and control; Mixed methods; Nursing homes; Organisational readiness; Residential aged care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Australia / epidemiology
COVID-19* / epidemiology
COVID-19* / prevention & control
Homes for the Aged
Humans
Multicenter Studies as Topic
Nursing Homes*
Pandemics / prevention & control