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The lived experience of haemodialysis patients managed with transmission-based precautions for MDRO colonisation: A qualitative study

  • Nicholas A. Gray
    Correspondence
    Corresponding author. Renal Unit, Sunshine Coast University Hospital, 6 Doherty St, Birtinya, Queensland, 4575, Australia. Fax: +61 7 5202 2055.
    Affiliations
    Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia

    University of the Sunshine Coast, Sippy Downs, Queensland, Australia

    Sunshine Coast Health Institute, Birtinya, Queensland, Australia
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  • Author Footnotes
    1 Current address: Synergy Rehab Solutions, Moffat Beach, Queensland, Australia
    Lisa Toy
    Footnotes
    1 Current address: Synergy Rehab Solutions, Moffat Beach, Queensland, Australia
    Affiliations
    University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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  • Kim Dalla-Bona
    Affiliations
    Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
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  • Jennifer Broom
    Affiliations
    Infectious Diseases Research Network, Sunshine Coast University Hospital, Birtinya, Queensland, Australia

    The University of Queensland, Herston, Queensland, Australia
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  • Marion Gray
    Affiliations
    University of Southern Queensland, Ipswich, Queensland, Australia
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  • Author Footnotes
    1 Current address: Synergy Rehab Solutions, Moffat Beach, Queensland, Australia

      Highlights

      • Communication of the implications of MDRO was often insufficient and inconsistent.
      • Isolation resulted in positive (privacy) and negative (reduced interaction) effects.
      • Psychological impacts included health concern/anxiety and stigma.
      • Inconsistent management of MDRO by staff and location resulted in frustration.
      • Patient experience is important when developing and implementing MDRO policy.

      Abstract

      Background

      Patients undergoing haemodialysis colonised with multi-drug resistant organisms (MDROs) are commonly managed with transmission-based precautions (TBP) to prevent nosocomial transmission. TBP have been linked to mixed effects on patient psychological well-being and clinical care. This study was designed to report the lived experience of dialysis patients managed with TBP.

      Methods

      A qualitative study of 15 patients undergoing haemodialysis managed with TBP was performed. Participants took part in individual semi-structured interviews. Data was analysed utilising an interpretive phenomenological approach.

      Results

      Four themes were identified.
      1. Communication of what MDRO screening meant, the results, and implications of MDRO positivity was perceived by many patients as insufficient and inconsistent.
      2. Experiences of care in isolation were described, with both positive (privacy) and negative (reduced interaction) experiences identified.
      3. Psychosocial and emotional responses including concern about health implications and stigma were reported, but also screening was described by some as increasing their perception of being cared for by health care workers, as they felt all health risks were being managed.
      4. Confusion around perceived inconsistencies of management, particularly across different environments (eg hospital vs home) and staff.

      Conclusion

      TBP have complex positive and negative impacts on patients which should be considered when developing MDRO management policy and communication around such policy. Strategies to improve communication, patient and staff education, and remove (or explain) perceived inconsistencies of practice may reduce the negative consequences of TBP leading to improved delivery of quality, person-centred care.

      Keywords

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