Barriers and facilitators to person-centred infection prevention and control: results of a survey about the Dementia Isolation Toolkit

Andrea Iaboni, Hannah Quirt, Katia Engell, Julia Kirkham, Steven Stewart, Alisa Grigorovich, Pia Kontos, Josephine McMurray, AnneMarie Levy, Kathleen Bingham, Kevin Rodrigues, Arlene Astell, Alastair J Flint, Colleen Maxwell, Andrea Iaboni, Hannah Quirt, Katia Engell, Julia Kirkham, Steven Stewart, Alisa Grigorovich, Pia Kontos, Josephine McMurray, AnneMarie Levy, Kathleen Bingham, Kevin Rodrigues, Arlene Astell, Alastair J Flint, Colleen Maxwell

Abstract

Background: People working in long-term care homes (LTCH) face difficult decisions balancing the risk of infection spread with the hardship imposed on residents by infection control and prevention (ICP) measures. The Dementia Isolation Toolkit (DIT) was developed to address the gap in ethical guidance on how to safely and effectively isolate people living with dementia while supporting their personhood. In this observational study, we report the results of a survey of LTCH staff on barriers and facilitators regarding isolating residents, and the impact of the DIT on staff moral distress.

Methods: We completed an online cross-sectional survey. Participants (n = 207) were staff working on-site in LTCH in Ontario, Canada since March 1, 2020, with direct or indirect experience with the isolation of residents. LTCH staff were recruited through provincial LTCH organizations, social media, and the DIT website. Survey results were summarized, and three groups compared, those: (1) unfamiliar with, (2) familiar with, and (3) users of the DIT.

Results: 61% of respondents identified distress of LTCH staff about the harmful effects of isolation on residents as a major barrier to effective isolation. Facilitators for isolation included delivery of 1:1 activity in the resident's room (81%) and designating essential caregivers to provide support (67%). Almost all respondents (84%) reported an increase in moral distress. DIT users were less likely to report an impact of moral distress on job satisfaction (odds ratio (OR) 0.41, 95% CI 0.19-0.87) with 48% of users reporting the DIT was helpful in reducing their level of moral distress.

Conclusions: Isolation as an ICP measure in LTCH environments creates moral distress among staff which is a barrier to its effectiveness. ICP guidance to LTCH would be strengthened by the inclusion of a dementia-specific ethical framework that addresses how to minimize the harms of isolation on both residents and staff.

Conflict of interest statement

The author A.J. Flint discloses grant support from the U.S. National Institutes of Health, Patient-Centered Outcomes Research Institute, Canadian Institutes of Health Research, Brain Canada, Ontario Brain Institute, AGE-WELL, and the Canadian Foundation for Healthcare Improvement. The remaining authors have no conflicts of interest to report.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Barriers (A) and Facilitators (B) to the isolation or quarantine of long-term care residents
Fig. 2
Fig. 2
Barriers to the use of technology to support long-term care home residents during isolation/quarantine
Fig. 3
Fig. 3
Ratings of the helpfulness of the DIT by those respondents who had used it

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