Carbapenem-resistant Enterobacteriaceae carriers in acute care hospitals and postacute-care facilities: The effect of organizational culture on staff attitudes, knowledge, practices, and infection acquisition rates

•We examine an association between Organizational Culture (OC) and staff attitudes, practices, and Carbapenem-Resistant Enterobacteriaceae (CRE) acquisition rate.•We model acute and post-acute care, two endemic settings with coordinated mandatory control plan.•OC factor-Staff Engagement was negatively correlated with CRE acquisitions rate and positively correlated with compliance of healthcare workers with infection prevention guidelines.•In acute and post-acute care, most research variables were found similar.•In post-acute care, CRE acquisition rate was significantly lower.

BackgroundCarbapenem-resistant Enterobacteriaceae (CRE) carriers are frequently transferred between acute care hospitals (ACHs) and postacute-care facilities (PACFs). Compliance of health care workers with infection prevention guidelines in both care settings may be influenced by the institution's organizational culture.ObjectivesTo assess the association between organizational culture and health care workers' attitudes, knowledge, practices, and CRE acquisition rate and to identify differences between different care settings and health care workers' sectors.MethodsCross-sectional descriptive design. Self-administered questionnaires were distributed to a sample of 420 health care workers from 1 ACH and 1 PACF belonging to the same health maintenance organization located in central Israel.ResultsThe organizational culture factor known as staff engagement was positively correlated with infection prevention attitudes and compliance with contact precaution protocols and negatively correlated with CRE acquisition rate. In the 2 care settings, health care workers' attitudes, knowledge, and practices were found to be similar, but CRE acquisition rate was lower in PACFs. Compliance with contact precaution protocols by physicians was lower than compliance reported by other health care workers. Auxiliary staff reported lower knowledge.ConclusionsIn a setting of endemic CRE where a multifaceted intervention is already being implemented, organizational culture variables can predict health care workers' attitudes, knowledge, and practices and in turn can affect CRE acquisition rates.