Identifying Underlying Barriers to Infection Prevention on the Front Lines of Patient Care

Elaine L. Larson, Ph.D., R.N.


"AHRQ’s support of my work helps clinicians understand the benefit of systematic feedback and the need to follow HAI prevention practices in a supportive environment."


Researchers who study healthcare-associated infections (HAIs) are building a solid base of knowledge about why infections occur and how to prevent them. There is also growing recognition of how staff involvement and workplace demands affect HAI prevention. These are areas where AHRQ grantee Elaine L. Larson, Ph.D., R.N., is adding to the knowledge base.  

A professor of nursing research and epidemiology at Columbia University School of Nursing in New York, Dr. Larson has used AHRQ funding to investigate HAI prevention practices in pediatric long-term care facilities, where children live with medically complex conditions that require lengthy treatment and multiple interactions with health providers. As a result, residents of these facilities are highly susceptible to contracting HAIs.

In her 2012 study, Keep It Clean for Kids (KICK), Dr. Larson began investigating how to prevent HAIs in this patient population, a topic that had received little attention despite their high risk of HAIs.  After implementing a five-step intervention that included hand hygiene, she and her team found modest but inconsistent improvement across three separate pediatric long-term care facilities. The results were partially due to the unique attributes of the type of setting: health providers often put a high priority on treating residents like family members instead of acute-care patients, and some providers lacked systematic feedback and misunderstood the consistency of their infection prevention practices.

In her most recent AHRQ-funded work, which began in 2016, Dr. Larson continues to examine the practical realities of implementing HAI prevention practices in busy acute-care settings, but now at the health system level.  She and her team are exploring the numerous challenges faced by nursing staff who are at the front line of preventing and controlling HAIs. Previous studies on the relationship between nursing care and HAI risk have examined single factors, such as adhering to specific guidelines.  Dr. Larson is studying whether unit- or system-level factors, such staffing shortages, distractions, or competing priorities, can also affect nurses’ ability to consistently follow HAI prevention practices. 

To examine these factors, Dr. Larson’s study is using an electronic database of 1 million patient discharges from four large urban New York hospitals over a 9-year span between 2006 and 2014.  The team plans to assess the relationship of HAIs to nursing care demands and staffing. They will also study how outbreaks of emerging community-onset infectious diseases—including influenza A, H1N1, Ebola, measles, and hospital-based exposures to pathogens—play a role.  Understanding the relationship between nursing care demands and staffing and the risk of HAIs can help organizations better anticipate and develop optimal system-level infection prevention practices.   

Recently named to the Presidential Advisory Council for Combating Antibiotic-Resistant Bacteria, Dr. Larson has received numerous awards from infectious disease, academic, and nursing research organizations.  She is a member of the Society of Healthcare Epidemiologists of America, Association of Professionals in Infection Control and Epidemiology, the Infectious Diseases Society of America, and the Institute of Medicine.  Dr. Larson has served as editor of the American Journal of Infection Control  since 1995.

Principal Investigator: Elaine L. Larson, Ph.D., R.N., Professor of Nursing Research and Epidemiology
Institution: Columbia School of Nursing
Grantee Since: 2005
Type of Grant: Various

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Page last reviewed June 2018
Page originally created June 2018
Internet Citation: Identifying Underlying Barriers to Infection Prevention on the Front Lines of Patient Care. Content last reviewed June 2018. Agency for Healthcare Research and Quality, Rockville, MD.
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