Perception Problems for Multidrug-Resistant Organisms

We’ve all seen the statistics—each year in the United States, 2 million people will get an antibiotic-resistant infection and at least 23,000 will die as a result of them. Moreover, multidrug-resistant organisms (MDROs) represent an increasing threat to global health as it’s estimated that their mortality rates will exceed those of cancer by 2050. It’s easy to see such data and focus on how to cut down the rates or how to increase antimicrobial stewardship without thinking about the perceptions or emotional impact of these infections.

How do health care workers experience MDROs? What about patients? These types of questions are rarely discussed in infection prevention or antimicrobial resistance efforts but, nonetheless, play a critical role. A new study from a research team in Germany sought to truly understand how these perceptions affect efforts such as hand hygiene, disinfection, and isolation. We all too often focus on the isolation and rapid identification of patients with MDROs but rarely discuss the social and psychological implications of such infections.

Investigators used a socio-constructivist focus and a mixed-method approach to conduct the study, which was broken into sections that included discussions, peer-assisted objective-structured clinical examination, and constructive efforts like card surveys and papers. Topics included infectious diseases and microbiology, basic hygiene procedures, communication techniques, and special protective hazardous material equipment. The research team had 51 health care workers from 13 professions across 5 hospitals participate in this training and data collection. Overall, they found that there are significant barriers both in educating clinicians and then informing patients and family members, and also in handling emotional responses in patients diagnosed and isolated with an MDRO infection.

Some of the biggest takeaways, especially for infection preventionists and educators, include recognizing that there is a substantial difference in basic hygiene education among professions in terms of depth and quality, as well as time spent. Meaning that although 1 profession gets in-depth and high-quality education on hygiene, others do not, and ultimately the disparity is noticed. Insufficient knowledge and information deficits regarding MDROs also existed in patients and in non-medical employees; it is frequently associated with “uncertainness” and “pseudo-knowledge,” which poses problems for staff.

The investigators noted several emotional impacts of MDROs, like anxiety, across all participants, especially patients. Sadness was also identified in those patients and relatives noting a feeling of helplessness.

Lastly, it is important to note that participants mentioned how the weight of an MDRO diagnosis can affect time and financial resources, for both patients and health care workers and institutions.

This is particularly interesting as hospitals discuss isolation precautions, the cost for MDRO screening in intensive care areas, and the cost-benefits of such practices for patients and hospitals alike. Ultimately, what this study shows is a significant disparity in information, not only for patients and health care workers, but also in how information is disseminated. The authors note that “with these relevant deficits, relatives, patients, trainees, and non-medical health care workers need to be and expect to be educated by other professionals for risk stratification and MDRO management.” Such findings should encourage health care facilities and their educational resources to ensure that staff and patients alike receive not only education, but a quality education that can instill knowledge and drive change while accounting for the emotional impact of MDROs.