Table 3.

Barriers to and Facilitators for High-Risk Care Activities in Long-Term Care Settings

High-Risk Care Activity	Barriers	Facilitators/Strategies
Dressing the resident	• Time pressure to complete task, other HCP in the room waiting to treat resident	• Rapport between HCP and resident (eg, resident communicates wants to HCP)
	• Limited mobility of resident, asks for help getting dressed; HCP does not wear gloves	• HCP places towel over wheelchair to make it more comfortable for resident.
	• Device (eg, catheter), in the way	• HCP and resident work together to dress resident.
	• Interruptions (eg, resident requests different set of clothes)
Changing the residents brief or assistance with toileting	• Immobile resident.	• Bedpan used to assist with toileting
	• Physical limitation of HCP in turning resident.	• Rapport between HCP and resident
	• HCP leaves room to get assistance, does not change gloves.	• HCP assists resident to pull brief up.
	• HCP transfers soiled diaper onto another surface in the room.
	• Device (eg, oxygen breathing tube) in the way
Transferring the resident	• No gloves worn during most transfers	• Mutual support: assistance from another HCP.
	• Physical limitation of the HCP; unable to lift resident alone	• Rapport between HCP and resident.
	• Limited mobility of resident (eg, knee injury); difficult to transfer resident	• HCP assists (lifts and supports) resident up.
	• Noncooperative resident; resident asks for time to calm down before being assisted
Bathing the resident	• Complex disease state of resident; complex care required (i.e., HCP changes gloves and towels several times)	• Resident assists HCP in bathing process.
	• Interruptions (eg, other HCP in room, resident toileting, etc)	• Rapport between HCP and resident
	• Room cluttered, making mobility of HCP to and from glove box challenging	• HCP performs other care activities when interrupted, (eg, linen change).
Wound dressing/care	• Improper glove usage. HCP does not change both gloves, or uses bare hands to dress wound.	• HCP moves trash closer to resident bedside or uses other resident’s trash.
	• Trash far from bed area	• Other HCP assists in moving resident into place for wound care.
	• Restroom occupied, so HCP cannot wash hands after care.	• Double gloving
Changing linens	• Cluttered room, linen placed on the floor	• Resident not in bed (eg, in wheelchair or restroom)
	• Performed by less experienced/trained staff; no gloves worn
	• Time pressure while changing linen (eg, while resident is in the restroom)
	• HCP leaves room to pick extra linen, does not change gloves.
Device care	• Complex disease state of residents; improper care by HCP leading to adverse effect, (eg, bleeding)	• HCP picks supplies from floor and places in trash during glove disposal.
	• Resident is sitting in wheelchair.
	• Trash overflowing

Note. HCP, healthcare personnel.