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

Background: Carbapenem-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. Objectives: To 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. Methods: Cross-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. Results: The 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. Conclusions: In 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.