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Category 8: Staffs'nonadherence or irregular performance of hygiene, disinfection and safe procedures (Related to the Covid-19 pandemic, staffs'increased disinfection practices were observed.)

The workspace was cleaned irregularly before use. When the surface was cleaned with an alcohol- based disinfectant, it was regularly visibly wet when materials were placed on it. Sometimes communication devices or workwear touched the clean workspace. (Wendt 2022) (U)

Gloves used to put on compression stockings were regularly not cleaned before or after use, and when they were cleaned, in most cases hand disinfectants were inappropriately used. In some instances, these gloves stay behind in the house of the client to be used by different nurses, but on other occasions nurses take the gloves with them and use the same gloves to help multiple clients. (Wendt 2022) (U)

Two forms of hand hygiene were observed, one using an alcohol-based disinfectant and another washing at a washing stand or kitchen sink (with or without soap). Nurses, professional caregivers and clients then dried their hands in various ways, such as using paper tissues, cotton towels or the sides of their uniforms. [...] The observations revealed that hand hygiene was varying, inconsistent and irregular. (Wendt 2022) (U)

Sometimes single-use disposable materials –gloves, surgical masks, aprons and overshoes –were used incorrectly or irregularly, were re-used or were ‘cleaned’ with hand disinfectants. (Wendt 2022) (U)

Both the use of safety needles and regular needles were observed. (Wendt 2022) (U)

Participants went to great lengths to take COVID-19 precautions while in patients’ homes. They described engaging in elaborate cleaning routines whenever possible during their shifts. (Sterling 2020) (U)

Licensed staff said that communication about the spread of infection was lacking and that the assistant nurses did not always use face masks in a correct way and worked in private clothes. (Tavemark 2022) (C)

The protective equipment also affected the encounter with the older adult. All professionals emphasized that the care recipients commented that it was difficult not being able to see who was behind the mask. They could become anxious and had difficulty recognizing the staff. One participant described similar difficulties for care staff with hearing loss, as both the older adult and the employee’s colleagues had face masks during home visits. This employee therefore chose a visor instead of a face mask, so that lipreading was possible. (Tavemark 2022) (C)

Another facet of this issue was managing staff’s adherence to public health measures when they came into the family’s home. (Baumbusch 2022) (U)

Because the staff were employed by the local health authority, they were provided with personal protective equipment (PPE) that they were expected to wear while inside client’s home. Managing staff’s use of PPE is another additional role for caregivers during the pandemic. (Baumbush 2022) (U)

Aides’ infection prevention tasks also intensified as they took on more rigorous cleaning and sanitizing and maintained cleaning supplies and PPE for themselves and the veteran, as well as reporting on veterans’ and their own symptoms to the agency. (Franzosa 2022) (C)

Aides recognized patients’ anxieties over potential infection and took proactive steps on their own to make them feel safer. One aide agreed to wear extra PPE and two masks, while another described undergoing private COVID-19 testing every 2 weeks even though it was not required so she could reassure her client that she was not carrying the disease. (Franzosa 2022) (U)

Category 9: Staffs'irregular use of workwear, electronical devices and personal equipment

Considerable differences were found in clothing worn while providing care, from casual, day-to-day clothing to uniforms. […] Additionally, it was often up to nursing staff to clean their own workwear, but casual clothing is not cleaned at the recommended temperature, as nurses find this temperature would damage their clothing. (Wendt 2022) (U)

Nurses pay little or no attention to the bags they carry to and from different households. (Wendt 2022) (U)

A variety of electronic communication devices were used before, during and after the delivery of home-based nursing care. The most frequently used devices were (smart)phones and computer tablets, and these were often used simultaneously. Additionally, devices were constantly being carried around for consulting electronic health records or to examine nurses’ schedules. (Wendt 2022) (U)

The nurses viewed their computer/tablet as a potential vector for infection, particularly as patients were meant to use their finger or a stylus provided by the nurse to sign the tablet as a record of their care provided during the home visit. (Dowding 2020) (U)

The protective equipment contributed to a feeling of security for the staff in their work at the older adults’ homes. But the care recipients’ worry increased when the local newspaper wrote that staff did not use protective equipment correctly. (Tavemark 2022) (C)

Category 10: Staff experiences of stress and distractions during care

Participants described staffing challenges faced by home health care agencies because of the aging workforce and poor retention and recruitment. Participants explained how this impacted patient care including adherence to IPC and how it affected current staff who had to take on additional responsibilities. (Pogorzelska-Maziarz 2020) (U)

In addition to being physically present during the delivery of care, communication devices also tend to be distracting because they can interrupt nursing procedures. The latter is especially true because nurses feel pressure to answer the phone in case the call involves peer consultations or possible difficulties. (Wendt 2022) (U)

The constant teaching and reminders regarding self-protection protocols further complicated daily routines and exacerbated caregiver stress. (Baumbusch 2022) (U)