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Category 1: Risk factors related to specific infections, health conditions and client characteristics

Nurses identified several factors that they felt put patients at a higher risk of infection. Key indicators included having a history of infections or a prescription for an antibiotic. (Dowding 2020) (U)

Wounds were a key infection risk and their assessment and management are a large part of the nurses鈥� work. (Dowding 2020) (U)

Having particular points of entry for infection, such as intravenous (IV) lines, Foley catheters and wounds were identified as factors that automatically put a patient at a higher risk of infection. (Dowding 2020) (U)

A diagnosis of chronic obstructive pulmonary disease (COPD), and a history of smoking, were specific factors related to a risk of respiratory infections such as pneumonia (Q12). (Dowding 2020) (U)

Overall, there has to be an underlying reason why an individual is at risk of infection. (Dowding 2020) (U)

Category 2: Infection as a result of multiple health issues and interaction with environment

Risk of infection was the result of a combination of factors that affected a patient鈥檚 immune system such as older age, diabetes, dehydration or having inadequate nutrition. (Dowding 2020) (U)

Patients who also had a diagnosis of diabetes were at particular risk and nurses discussed in detail their process of wound assessment to ensure they detected any infections quickly. (Dowding 2020) (U)

The risks for urinary tract infection (UTI) were complex with factors such as cognition, incontinence, availability of caregivers and environmental conditions all having a role to play. (Dowding 2020) (U)

Category 3: Clients'lack of understanding of infection risk and low adherence to infection prevention and control practices pose risk of infections

Nurses regarded patients鈥� knowledge and understanding of their illness and factors associated with infection risk and infection prevention behaviors as being closely linked to their risk of infection. This included issues such as culture and beliefs, personal hygiene practices and their understanding of how infections were spread and could be prevented. Overall nurses felt their patients lacked basic knowledge about infection prevention, including basic health and hand hygiene, or held beliefs and attitudes towards infection control that nurses perceived were not at a 鈥渉igh standard鈥�. (Dowding 2020) (U)

Patients鈥� behaviors, in relation to general health promotion such as getting vaccinations, impacted on their infection risk. (Dowding 2020) (U)

Adhering to treatment recommendations, such as following medication regimens (e.g. courses of antibiotics), managing their wounds, diabetes management and hand washing were important considerations for assessing infection risk. (Dowding 2020) (U)

Nurses faced particular challenges when talking to a patient about cleaning up their home to avoid infection, and often patients did not have a suitable family caregiver to support the nurse鈥檚 attempts at reducing infection risk. (Dowding 2020) (U)

Both patients and caregivers may show a resistance to change, may have low health literacy, and may be cognitively impaired. (Dowding 2020) (C)

Mental health 鈥揺specially stress 鈥揳lso presented a challenge to patient and caregiver education. (Dowding 2020) (C)

Home health aides (HHAs) also feared that their vulnerability to COVID-19 was greater because patients sometimes did not adhere to wearing masks. (Osakwe 2021) (C)

When patients asked for more closeness, the nurses experienced this to be difficult. (Moi 2022) (U)

A new role for caregivers was supporting their relative to follow public health measures. Wearing masks and handwashing became part of everyday life during the pandemic but supporting a person living with dementia to follow these guidelines could be challenging. (Baumbusch 2022) (U)

Changing lifelong social practices was a difficult aspect of public health measures, as was building mask wearing into their daily routines. (Baumbusch 2022) (C)