Names	Description
1. Agency-level policies	Facts about policies in place. Specific agency policies related to infection prevention and control --- Examples: Cleanliness/sanitization; hand hygiene/bag technique; vaccinations (staff/patient)
Flu vaccination policies for agency staff	Specific policies around influenza vaccination for agency staff; wearing masks; flu vaccine clinics for staff
Flu vaccination policies for patients and families	Specific policies around influenza vaccination for patients/families; whether a flu vaccine clinic is offered, if agency staff can administer vaccines to patients/families, or if patients/families are not offered vaccines from agency staff
2. Scope of care	Facts about the range of disciplines/services offered by the agency (eg, assisted living, range of services and disciplines-phlebotomy, hospice and physical therapy)
The above are factual the below are perceptions about the processes
3. Agency priorities	Description of agency priorities in the context of infection prevention and control and quality improvement
Handwashing is our priority	Agency staff often described handwashing as a top priority/focus for the agency
4. Care coordination	The flow of information across the agency staff, patients, caregivers and other providers. Care coordination within the agency which assists, helps, motivates or is a barrier for agency staff related to infection prevention and control; How do they work as a team?; thoughts/feelings; any improvements?
Care coordination challenges	Challenges experienced by agency staff with regard to care coordination
Care coordination outside agency	Care coordination with PCP, pharmacist, hospital
Care coordination within agency	Care coordination with other disciplines at the agency (PT/OT/ST/SW)
Tools	Tools/programs used (Examples: EHR/messaging app, paper logs) to enhance communication and monitor care quality.
5. Compliance	Direct care staff, compliance with recommended/required policies/procedures. (Anecdotes, personalexperiences)
Consequences of noncompliance	What happens when someone doesn't follow the rules; Examples: “retrain/reinforce"
Monitoring compliance of staff	How does the agency management specifically monitor compliance with policies related to infection prevention and control (handwashing/bag technique); Examples: Patient survey - telephone call; bag/trunk checks; handwashing checks during staff meetings; supervisory visits (quarterly/annually). Any difficulties and reasons why or why not staff comply with infection prevention and control policies
Reasons for noncompliance	Potential reasons that agency staff may not follow infection control policies and procedures
6. Education	Education provided to staff, patients, caregivers and family members by the agency.
Patient/caregiver education	How patient and caregivers are educated.
Staff education	How staff are educated. Devoted resources/procedures to training (eg, orientation, continuing education, pamphlets…) for staff as well as retraining after outbreaks or non-compliance
Continuing staff education	Description of infection prevention and control education provided to staff members on an on-going basis at staff meetings, skills fairs, or yearly competency checks
Education after noncompliance	Description of staff education provided if policy non-compliance was observed
New staff education	Description of infection prevention and control education provided to new staff members at orientation or on-boarding
Opportunities for improvement	Thoughts about ways to improve staff education and training at the agency; includes needs and perceptions
7. Emerging themes	For codes/subcodes which may not fit under the 6 overarching themes of Agency-level Policies, Scope of Care, Communication, Compliance, Regulatory and/or other External Barriers/Facilitators, and Uniqueness of Home Health Care Environment
Agency needs	How can you be better supported in preventing infections in your current role?; also other agency needs that are mentioned throughout the interview
Importance of education	Perception of how patient and staff education about IPC impacts infections (or lack of) in the home environment (Example: “education is key")
Personal IPC priorities	Particular habits or concerns that are related to IPC (possibly like self-protection, etc); can include personal understanding/beliefs around infection prevention and control
‘Second nature'	Explanation of hand washing (and maybe sanitization too) in home environment; expectation that IPC procedures should be “second nature” to all agency staff
8. Infection prevention and monitoring	Various infection prevention processes and monitoring/tracking in place at the agency
Data collection and tracking methods	Description of how the agency collects infection data (paper log, EHR, etc) and if/how it tracks and reports (to agency staff, QI committee, hospital board, etc) infection trends that may be happening.
Infection prevention organization and operation	How are infections prevented at the agency? By whom? (ie, personnel, committees, hospital resources); supplies provided by agency
Patients with infections	Care and identification of patients with infections; how does the agency learn that a px has an infection upon admission; what happens if an existing px is suspected of having an infection?
9. Quality improvement	What the agency is doing to improve quality of care
QAPI-QI committee	Description of structure and goals of agency QAPI/QI committee
10. Regulatory and other external barriers/facilitators	External factors that improve or hinder infection prevention/control or quality improvement at an agency, including patient acuity if tied to CMS reimbursement of referral sources
Agency reputation	Reputation, which may be impacted by publically reported data that impact the public and others' perception of agency quality (Examples: star rating, websites, etc.)
Collaborations - Affiliations	Any collaborations-affiliations that appear to be assisting, helping, and motivating agencies related to infection prevention and control
External initiatives	Quality and infection prevention initiatives that agencies can choose to be a part of (usually started by CMS, DOH, etc.)
External policies - Reimbursement driving quality or compliance	Payment models tied to quality indicators and surveys, which in turn, drive agency compliance with policies and procedures related to infection prevention and control
External resources	External resources that are assisting, helping, and motivating agencies related to infection prevention and control-- Websites (from any external sources) that appear to be assisting, helping, and motivating agencies related to infection prevention and control. DOH-related resources that appear to be assisting, helping, and motivating agencies related to infection prevention and control. Can also be other investments by agency (outside surveyor/monitoring) or external consultant.
Keys to success - Innovation	What is unique at that agency that is helping to prevent/control infections and improve quality? Can include any incentives provided to staff to enhance policy/procedure compliance
11. Uniqueness of the home healthcare setting	Factors related to patient care and infection prevention, control and quality that are unique to home health care (not experienced in other healthcare settings). The unique environment descriptors compared with other healthcare settings, and the different situations that agency staff encounter in various homes (eg, emotional impact, unclean homes, working alone and not knowing specific procedure)
Cleanliness and sanitizing	Explanation of IPC in home environment (hand hygiene/bag technique, “second nature")
Family dynamics/role	Added layer of patient care in home environment (described as barrier and sometimes a facilitator). Patient/family role in IPC in home environment. Expectation (from agency staff) of patient/family role in IPC in home environment (patient/family expected to feel responsibility toward maintaining cleanliness/sanitization)
Patient acuity	Description of patient acuity and how it impacts level of care provided by agency
Patient and caregiver compliance	Patient/caregiver compliance with recommended procedures, specific experiences or challenges faced
Patient as family	Added feeling of responsibility toward patient on behalf of agency staff member due to time spent with patient in their home, lack of family, etc.
Staffing challenges in HH environment	Difficulties faced by agency staff who are not experienced in other healthcare settings (Examples: sick employees, time driving, etc.)
Unpredictability of home health	Staff safety and other issues that are unique to working in a patient's home