A conceptual framework of decision making process for appropriate Isolation Precautions measures by Certified Nurses in Infection Control in Japan

Background: In many Japanese healthcare institutions, the isolation precautions based on the guidelines of Centers for Disease Control and Prevention are used for infection control measures. However, Japanese healthcare institutions face many difficulties implementing these recommended guidelines due to structural constraints. For example, there are more multi-bed rooms than private rooms in most Japanese hospitals.  Working within these constraints, Certified Nurses in Infection Control (CNICs) assess infectious risks, and prioritize usage of private rooms, as well as oversee implementation of necessary procedures based on their assessment.

Objective: The purpose of this study was to develop a conceptual framework of CNIC’s decision-making process for determining appropriate isolation precautions measures including infectious risk assessment.

Methods: 1. Design: A descriptive qualitative study using Directed Content Analysis
2. Participants: 145 CNICs who have over 5 years of experience after being certified by the Japanese Nursing Association were candidates. Finally, 40CNICs participated after gaining informed consent.
3. Using the extant research findings and the theory of Decision Making (Simon,1960; Wilson and Alexis,1962; Harrison,1995), the provisional conceptual framework was developed.
4. Using semi-structured questions, interviews were performed. From that recorded verbatim, decision-making elements of isolation precautions and the factors affecting the decision-making process were extracted and coded. Categories and sub-categories were created from that coding. After extracting the categories matching and non-matching categories to the provisional conceptual framework were compared and considered in order to revise it.

Results: Those CNICs conducted a risk assessment for potential transmission from infected or carrier patients to other patients. CNIC’s point of view towards risk assessment was classified into “characteristics of microorganism”, “individuality of the patient” and “risk of the entire unit”. Influencing factors for decision making on isolation precautions were categorized into “organizational culture”, “human resources”, “hospital facilities environment” “ethical issues” and “external factors”. Other influencing factors for decision making were categorized as CNIC's “ability”, “quality”, “knowledge” and “experience”.

Conclusions: A conceptual framework was developed for evaluating the decision-making procedures used by CNICs towards isolation precautions. This study was the first report of the decision-making process of CNICs towards appropriate isolation precautions using the descriptive qualitative study design in Japan.  This finding could be usage by CNICs who have not enough experience as infection control personnel or resources for infection control procedures.