Awareness among French healthcare workers of the transmission of multidrug resistant organisms: a large cross-sectional survey

L Vaillant, G Birgand, M Esposito-Farese, P Astagneau, C Pulcini, J Robert, J R Zahar, E Sales-Wuillemin, F Tubach, J C Lucet, PerceptR Study group, Aveline Isabelle, Bracco Christelle, Lacombe Manuelle, Colin Yolande, Poulingue Géraldine, Lesourd Fabien, Rogues Anne-Marie, Magne Béatrice, Mouzaoui Marc, Daniel Petrelli, Picot Franck, Canivet Anne, Stoeckel Vincent, Marchal Lydia, Boris Alexandre, Tiv Michel, Piriou Gilles, Lallart Dominique-Louis, Lecoq Marianne, Pina Patrick, Barege Patrice, Josso Christophe, Herbin Claire, Degallaix Dominique, Doublier Laetitia, Constantin Nicole, Ludvig-Serge Aho-Glélé, Parer Sylvie, Minchella Amandine, Romand Karine, Bentchikou Hicham, Petitfrère Manuel, Lepelletier Didier, Vaillé Jean-Louis, Houdou Sylvie, Rahal Gisèle, Miquel Chantal, Jaudinot Christel, Dehaese Olivier, Thouvenin Dominique, Pascal Eliane, Marini Hélène, Merle Véronique, Leroux Elisabeth, Laurent Oleessya, Cavarec-Cuoq Marie-Claude, Carrière Isabelle, Millet Elisabeth, Fontaine Xavier, Markiewicz Amélie, Germain Yves, Coppens Magali, Jean Sébastien Trescher, Duperrier Valérie, Paba Odile, Fanck Marie-Noëlle, Jezequel Jocelyn, Velardo Danielle, Gachot Bertrand, Lestra Bénédicte, L Vaillant, G Birgand, M Esposito-Farese, P Astagneau, C Pulcini, J Robert, J R Zahar, E Sales-Wuillemin, F Tubach, J C Lucet, PerceptR Study group, Aveline Isabelle, Bracco Christelle, Lacombe Manuelle, Colin Yolande, Poulingue Géraldine, Lesourd Fabien, Rogues Anne-Marie, Magne Béatrice, Mouzaoui Marc, Daniel Petrelli, Picot Franck, Canivet Anne, Stoeckel Vincent, Marchal Lydia, Boris Alexandre, Tiv Michel, Piriou Gilles, Lallart Dominique-Louis, Lecoq Marianne, Pina Patrick, Barege Patrice, Josso Christophe, Herbin Claire, Degallaix Dominique, Doublier Laetitia, Constantin Nicole, Ludvig-Serge Aho-Glélé, Parer Sylvie, Minchella Amandine, Romand Karine, Bentchikou Hicham, Petitfrère Manuel, Lepelletier Didier, Vaillé Jean-Louis, Houdou Sylvie, Rahal Gisèle, Miquel Chantal, Jaudinot Christel, Dehaese Olivier, Thouvenin Dominique, Pascal Eliane, Marini Hélène, Merle Véronique, Leroux Elisabeth, Laurent Oleessya, Cavarec-Cuoq Marie-Claude, Carrière Isabelle, Millet Elisabeth, Fontaine Xavier, Markiewicz Amélie, Germain Yves, Coppens Magali, Jean Sébastien Trescher, Duperrier Valérie, Paba Odile, Fanck Marie-Noëlle, Jezequel Jocelyn, Velardo Danielle, Gachot Bertrand, Lestra Bénédicte

Abstract

Background: Much effort has been made over the last two decades to educate and train healthcare professionals working on antimicrobial resistance in French hospitals. However, little has been done in France to assess perceptions, attitudes and knowledge regarding multidrug resistant organisms (MDROs) and, more globally, these have never been evaluated in a large-scale population of medical and non-medical healthcare workers (HCWs). Our aim was to explore awareness among HCWs by evaluating their knowledge of MDROs and the associated control measures, by comparing perceptions between professional categories and by studying the impact of training and health beliefs.

Methods: A multicentre cross-sectional study was conducted in 58 randomly selected French healthcare facilities with questionnaires including professional and demographic characteristics, and knowledge and perception of MDRO transmission and control. A knowledge score was calculated and used in a logistic regression analysis to identify factors associated with higher knowledge of MDROs, and the association between knowledge and perception.

Results: Between June 2014 and March 2016, 8716/11,753 (participation rate, 74%) questionnaires were completed. The mean knowledge score was 4.7/8 (SD: 1.3) and 3.6/8 (SD: 1.4) in medical and non-medical HCWs, respectively. Five variables were positively associated with higher knowledge: working in a university hospital (adjusted odds ratio, 1.41, 95% CI 1.16-1.70); age classes 26-35 years (1.43, 1.23-1.6) and 36-45 years (1.19, 1.01-1.40); medical professional status (3.7, 3.09-4.44), working in an intensive care unit (1.28, 1.06-1.55), and having been trained on control of antimicrobial resistance (1.31, 1.16-1.48). After adjustment for these variables, greater knowledge was significantly associated with four cognitive factors: perceived susceptibility, attitude toward hand hygiene, self-efficacy, and motivation.

Conclusions: We found a low level of MDRO awareness and knowledge of associated control measures among French HCWs. Training on hand hygiene and measures to control MDRO spread may be helpful in shaping beliefs and perceptions on MDRO control among other possible associated factors. Messages should be tailored to professional status and their perception. Other approaches should be designed, with more effective methods of training and cognitive interventions.

Trial registration: Clinical Trials.gov NCT02265471. Registered 16 October 2014 - Retrospectively registered.

Keywords: Cross-infection/*prevention & control; Cross-sectional studies; Drug resistance, bacterial; France; Hand disinfection; Health knowledge, attitudes, practice; Health personnel/classification/education; Healthcare workers; Surveys and questionnaires.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s). 2019.

References

    1. Tacconelli E, Cataldo MA, Dancer SJ, De Angelis G, Falcone M, Frank U, et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant gram-negative bacteria in hospitalized patients. Clin Microbiol Infect. 2014;20:1–55. doi: 10.1111/1469-0691.12427.
    1. Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol. 2003;24(5):362–386. doi: 10.1086/502213.
    1. Stewardson AJ, Sax H, Gayet-Ageron A, Touveneau S, Longtin Y, Zingg W, et al. Enhanced performance feedback and patient participation to improve hand hygiene compliance of health-care workers in the setting of established multimodal promotion: a single-Centre, cluster randomised controlled trial. Lancet Infect Dis. 2016;16(12):1345–1355. doi: 10.1016/S1473-3099(16)30256-0.
    1. Giblin TB. Clinicians’ perceptions of the problem of antimicrobial resistance in health care facilities. Arch Intern Med. 2004;164(15):1662. doi: 10.1001/archinte.164.15.1662.
    1. Burnett E, Kearney N, Johnston B, Corlett J, MacGillivray S. Understanding factors that impact on health care professionals’ risk perceptions and responses toward Clostridium difficile and meticillin-resistant Staphylococcus aureus: a structured literature review. Am J Infect Control. 2013;41(5):394–400. doi: 10.1016/j.ajic.2012.12.013.
    1. Rosenstock IM, Strecher VJ, Becker MH. Social learning theory and the health belief model. Health Educ Q. 1988;15(2):175–183. doi: 10.1177/109019818801500203.
    1. Wolf R, Lewis D, Cochran R, Richards C. Nursing staff perceptions of methicillin-resistant Staphylococcus aureus and infection control in a long-term care facility. J Am Med Dir Assoc. 2008;9(5):342–346. doi: 10.1016/j.jamda.2008.02.003.
    1. Srinivasan A, Song X, Richards A, Sinkowitz-Cochran R, Cardo D, Rand C. A survey of knowledge, attitudes, and beliefs of house staff physicians from various specialties concerning antimicrobial use and resistance. Arch Intern Med. 2004;164(13):1451–1456. doi: 10.1001/archinte.164.13.1451.
    1. Celeste C, Jolivet S, Bonneton M, Brun-Buisson C, Jansen C. Healthcare workers’ knowledge and perceptions of the risks associated with emerging extensively drug-resistant bacteria. Méd Mal Infect. 2017;47(7):459–469. doi: 10.1016/j.medmal.2017.05.014.
    1. McCullough AR, Rathbone J, Parekh S, Hoffmann TC, Del Mar CB. Not in my backyard: a systematic review of clinicians’ knowledge and beliefs about antibiotic resistance. J Antimicrob Chemother. 2015;70(9):2465–2473. doi: 10.1093/jac/dkv164.
    1. Dyar OJ, Pulcini C, Howard P, Nathwani D, on behalf of ESGAP, (the ESCMID Study Group for Antibiotic Policies) et al. European medical students: a first multicentre study of knowledge, attitudes and perceptions of antibiotic prescribing and antibiotic resistance. J Antimicrob Chemother. 2014;69(3):842–846. doi: 10.1093/jac/dkt440.
    1. Milori A, Milioria E. Antibiotic resistance and infection control: physicians aspects and beliefs. J Antimicrob Agents. 2017;03(02).
    1. Dyar O, Hills H, Seitz L-T, Perry A, Ashiru-Oredope D. Assessing the knowledge, attitudes and behaviors of human and animal health students towards antibiotic use and resistance: a pilot cross-sectional study in the UK. Antibiotics. 2018;7(1):10. doi: 10.3390/antibiotics7010010.
    1. Marschall P, Hübner N-O, Maletzki S, Wilke F, Dittmann K, Kramer A. Attitudes and perceptions of health care workers in northeastern Germany about multidrug-resistant organisms. Am J Infect Control. 2016;44(6):e91–e94. doi: 10.1016/j.ajic.2015.12.039.
    1. Lucet J-C, Nicolas-Chanoine M-H, Roy C, Riveros-Palacios O, Diamantis S, Le Grand J, et al. Antibiotic use: knowledge and perceptions in two university hospitals. J Antimicrob Chemother. 2011;66(4):936–940. doi: 10.1093/jac/dkq541.
    1. Bouadma L, Mourvillier B, Deiler V, Derennes N, Le Corre B, Lolom I, et al. Changes in knowledge, beliefs, and perceptions throughout a multifaceted behavioral program aimed at preventing ventilator-associated pneumonia. Intensive Care Med. 2010;36(8):1341–1347. doi: 10.1007/s00134-010-1890-9.
    1. Pittet D, Simon A, Hugonnet S, Pessoa-Silva CL, Sauvan V, Perneger TV. Hand hygiene among physicians: performance, beliefs, and perceptions. Ann Intern Med. 2004;141(1):1–8. doi: 10.7326/0003-4819-141-1-200407060-00008.
    1. Pessoa-Silva CL, Posfay-Barbe K, Pfister R, Touveneau S, Perneger TV, Pittet D. Attitudes and perceptions toward hand hygiene among healthcare workers caring for critically ill neonates. Infect Control Hosp Epidemiol. 2005;26(03):305–311. doi: 10.1086/502544.
    1. Jarlier V. Curbing methicillin-resistant Staphylococcus aureus in 38 French hospitals through a 15-year institutional control program. Arch Intern Med. 2010;170(6):552. doi: 10.1001/archinternmed.2010.32.
    1. Haque M, Iza A, Rahman N, Zulkifli Z, Ismail S. Antibiotic prescribing and resistance: knowledge level of medical students of clinical years of university sultan Zainal Abidin, Malaysia. Ther Clin Risk Manag. 2016;413.
    1. Suetens C, Hopkins S, Kolman J, Högberg LD. European centre for disease prevention and control. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals: 2011–2012. Luxembourg: Publications Office; 2013.
    1. Labricciosa FM, Sartelli M, Correia S, Abbo LM, Severo M, Ansaloni L, et al. Emergency surgeons’ perceptions and attitudes towards antibiotic prescribing and resistance: a worldwide cross-sectional survey. World J Emerg Surg. 2018;13(1).
    1. World Health Organization. Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities. Geneva: World Health Organization; 2017.
    1. Zingg W, Holmes A, Dettenkofer M, Goetting T, Secci F, Clack L, et al. Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus. Lancet Infect Dis. 2015;15(2):212–224. doi: 10.1016/S1473-3099(14)70854-0.
    1. Kingston L, O’Connell NH, Dunne CP. Hand hygiene-related clinical trials reported since 2010: a systematic review. J Hosp Infect. 2016;92(4):309–320. doi: 10.1016/j.jhin.2015.11.012.
    1. Cook DA, Hatala R, Brydges R, Zendejas B, Szostek JH, Wang AT, et al. Technology-enhanced simulation for health professions education: a systematic review and meta-analysis. JAMA. 2011;306(9).
    1. Alothman A, Bosaeed M, Algwizani A, Alsulaiman M, Alalwan A, Binsalih S, et al. Knowledge and attitude of physicians toward prescribing antibiotics and the risk of resistance in two reference hospitals. Infect Dis Res Treat. 2016;33.
    1. von Lengerke T, Ebadi E, Schock B, Krauth C, Lange K, Stahmeyer JT, et al. Impact of psychologically tailored hand hygiene interventions on nosocomial infections with multidrug-resistant organisms: results of the cluster-randomized controlled trial PSYGIENE. Antimicrob Resist Infect Control. 2019;8(1).
    1. Dickie R, Rasmussen S, Cain R, Williams L, MacKay W. The effects of perceived social norms on handwashing behaviour in students. Psychol Health Med. 2018;23(2):154–159. doi: 10.1080/13548506.2017.1338736.
    1. Alumran A, Hou X-Y, Hurst C. Validity and reliability of instruments designed to measure factors influencing the overuse of antibiotics. J Infect Public Health. 2012;5(3):221–232. doi: 10.1016/j.jiph.2012.03.003.

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