Nursing staff perceptions of methicillin-resistant Staphylococcus aureus and infection control in a long-term care facility

Objectives: To assess perceptions of nursing staff regarding methicillin-resistant Staphylococcus aureus (MRSA), infection control (IC) and prevention strategies, barriers to IC, and IC resources. Design: Cross-sectional mixed methods study Setting: Atlanta Veterans Affairs (VA) long-term care facility (LTCF). Participants: Forty-two direct-care nursing staff employed at the LTCF during August 2006. Measurements: Health Belief Model (HBM) guided the development of 6 focus group discussions combined with a quantitative form assessing 5 IC practices, risk perceptions, and sources of IC information. Results: Only 59% of participants perceived that MRSA posed a risk to patients. Consistency of self-reported IC practices varied by specific behavior. Lack of supplies (26%) and lack of information/communication (24%) were reported as primary barriers to IC. All participants perceived patient behavior as a barrier, and all were interested in additional education about MRSA and IC. Comparing nurses with nursing assistants (NAs), nurses more frequently reported the IC professional as the most trusted information source (60% versus 0%, P < .005); NAs were more likely to trust the charge nurse (77% versus 4%, P < .001). Conclusion: These results suggest that the perceptions regarding the real threat of MRSA and infection transmission that would drive IC prevention behaviors in this high-risk population vary among nursing staff, as do nursing staff IC practices. This study provides insight into the complex educational and other strategies needed to implement multilevel, multidimensional IC in LTCFs.