Project Firstline New Hampshire: Learning Needs Assessment

2021

Project FirstlineNew Hampshire: Learning Needs Assessment

ABBREVIATED REPORTSURVEY RESULTS AND RECOMMENDATIONS

Appendix F

Results

Survey Participants Employment and Experience Among respondents with completed surveys, the vast majority (89%) considered themselves currently employed full-time (Table 2) with over 80% working more than 32 hours a week (Table 3). Most were experienced in working in a healthcare setting, with nearly two-thirds reporting greater than ten years’ experience (Table 4).

Table 2. Current Employment n %

Full-Time 1642 89 Part-Time 108 6 Per Diem/Irregular hours 104 6

Table 3. Average Number of Hours Worked per Week n %

Fewer than 8 hours 11 1 8-20 hours 87 5 21-32 hours 219 12 More than 32 hours per week 1537 83

Table 4. Number of Years Working in Healthcare n %

Less than 1 year 51 3 1-5 years 294 16 6-10 years 288 16 More than 10 years 1221 66

Appendix F

Facility/Primary Workplace Table 5 represents the frequency of responses before workplace categories were collapsed for cross-tabulation.

Table 5. Primary Workplace n %

Acute Care Hospital 667 36 Nursing Home/Long-Term Care Facility 391 21 Outpatient Facility (e.g., Community Health Center, Medical Practice) 272 15 Critical Access Hospital/Skilled Nursing Facility/Swing 162 9 Assisted Living Facility 81 4 Behavioral Health Facility 50 3 State Health Department 45 2 Home Health 33 2 Emergency Medical Technician (EMT)/Emergency Medical Service (EMS)/Fire 30 2

Ambulatory Surgical Center 28 2 Pharmacy 17 1 Dental Facility 11 1 Local Health Department 7 0.4 Rehabilitation Hospital 7 0.4 Other-Non-Clinical 26 1 Other* 27 2

*Adult Day, Clinical Laboratory/Phlebotomy, Correctional Facility, Home Health, Hospice,Non-Specified Clinical, Non-Specified Environmental Services, School Nurse, Senior Living -Not Assisted Living Facility, Veterinary Technician (each category n<10)

**Note: There were no respondents to the survey who worked in a dialysis facility.

Appendix F

Table 6 describes the frequency of respondents in the collapsed workplace categories. Collapsed categories were created based on similarity in setting or sample size. We took the following actions:

● Included ambulatory surgical center responses with the outpatient facility category● Combined state and local health department responses into one local/state health department category● Included a few of the categories with a small number of respondents in the other category. This included

dental, home health, and pharmacy.

The largest group of respondents worked in acute care hospitals (36%), followed by nursing home/ long-term care facilities (21%), outpatient facilities (16%) and critical access hospital / skilled nursing facilities / swing bed facilities (9%). Smaller percentages of respondents worked in assisted living facilities (4%), health departments (3%), behavioral health facilities (3%), EMS/EMT/Fire (2%) and other non-clinical (1%).

Table 6. Primary Workplace (Collapsed Categories) n %

Acute Care Hospital 674 36 Nursing Home/Long-Term Care Facility 391 21 Outpatient** 300 16 Critical Access Hospital/Skilled Nursing Facility/Swing 162 9 Assisted Living Facility 81 4 Local/State Health Department 52 3 Behavioral Health Facility 50 3 EMS/EMT/Fire 30 2 Other Non-Clinical 26 1 Other* 88 5 *Includes all primary workplaces with n<10 (Dental, Home Health,Pharmacy, workplaces written in “other” that did not reach the threshold of 10 responses in order to become their own category) **Outpatient includes: Ambulatory Surgical Center and Outpatient Facility (e.g. Community Health Center, Medical Practice)

Appendix F

Table 8 describes the original role categories that comprise the collapsed role category. Roles with similar characteristics, training or functions were combined. In some cases, such as EMT/Paramedics and Activities/Recreation role categories with a small number of respondents were retained as independent categories because there was an interest in their specific training needs.

Table 8. Collapsed vs. Original Role Categories Collapsed Role Category Original Category

Licensed Prescribers

Medical Doctors, Doctors of Osteopathy, Physician Assistants, Nurse Practitioners, Certified Nurse Midwives, Dentists, CRNA, Pharmacists

Non-Clinical Support Staff Non-Clinical Support Staff, Social Workers, Sterile Cleaning Technicians, Chaplains and Behavioral Health Workers

Laboratorian Laboratory Workers

Health Educator Health Educators, Epidemiologists, Quality Improvement, Dieticians/Nutritionists, and Infection Preventionists

Environmental and Food Services Environmental, Food Service Professionals, Laundry, Maintenance, Shipping and Receiving Departments

Physical Therapy (PT)/ Occupational Therapy (OT)/ Rehab

Registered Physical, Occupational, Speech, Respiratory, and Rehabilitation Therapists

RN/LPN Registered Nurses and Licensed Practical Nurses

LNA/Clinical Other Licensed Nursing Assistants, Personal Care Aides, and Dental Hygienists

Healthcare Administrator Healthcare Administrators

Activities/Recreational Therapy Non Registered Life Enrichment, Recreational, and Activities Workers and Assistants

MA/Clinical Support Non-LNA Medical Assistants (MA), Healthcare/Feeding Assistants

Technician

Radiology, Computed tomography (CT) Scan, Mammography, Ultrasound, Audiology, Optician, Sonography, Biomedical, Pharmacy, and Surgical Technicians,

EMT/Paramedics EMT and Paramedics

Other

Non-Categorized roles (14) including: Patient Service Representative (PSR), Geri Tech, Medical Services, Health Promotion, Program Manager (2), Director Long-Term Care, Memory Unit, Planner, Resident Care Director, Program Evaluator, Veterinary Technician, Hotel Supervisor, Developmental Disabilities

Appendix F

Table 9 describes the frequency of collapsed roles reported by respondents. Over one quarter of respondents identified as RN/LPN. About 20% of respondents were non-clinical support staff and 9% were in the LNA/clinical other category.

Table 9. Primary Professional Role (Collapsed Categories) n %

RN/LPN 502 27 Non-Clinical Support Staff 368 20 LNA/Clinical Other 158 9 Administrator 124 7 Licensed Prescriber 117 6 Technician 110 6 Environmental/Food Services 103 6 Health Educator 87 5 PT/OT/Rehab 87 5 Laboratorian 64 4 MA/Clinical Support Non-LNA 50 3 EMT/Paramedic 45 2 Activities/Recreational Therapy 25 1 Other* 14 1

*Other category decreased because CRNA (n=4) and Chaplain (n=4) were added to LicensedPrescriber and Non-Clinical Support Staff, respectively.

Appendix F

Primary Specialty We asked physicians, physician assistants, nurse practitioners, certified nurse midwives, RN/LPNs and technicians to answer an additional question regarding the specialty in which they primarily work within their facility. As shown in Table 10, inpatient setting was selected by 24% of the respondents followed by long- term care/rehabilitation (18%), and outpatient setting (14%). Less than 10% of respondents reported working in other specialties, including administration (7%), emergency department (6%), dementia unit (5%), and operating room (5%).

Table 10. Primary Specialty (n=897) n %

Inpatient Medical/Surgical/Subspecialty 212 24 Long-Term Care/Rehabilitation 160 18 Outpatient Care Only 129 14 Administration 60 7 Emergency 55 6 Dementia 48 5 Operating Room 48 5 Intensive Care 29 3 Home Health 14 2 Pharmacy 13 1 Cardiology 13 1 Nutrition and Dietetics 12 1 Radiology 12 1 Psychiatry 11 1 Labor Room 11 1 Education 11 1 Laboratory 6 1 Dialysis Unit 3 0 Other* 50 6 *Behavioral Health, Case Management, Environmental Services, Hospice, Infection Prevention, IV, Pediatrics (each category n<10)

Appendix F

General Training Preferences As displayed in Tables 12 - 14, an overwhelming majority of respondents indicated that they would prefer to receive infection control training in English (99.8%) and would like to access remote learning via a computer/laptop (91%). Eighty-seven percent (87%) feel it is somewhat or very important to be able to ask questions live during a training, either verbally or through a chat function.

Table 12. Language Preference n %

English 1851 99.8 Spanish 13 1 French 5 0.3 Chinese 2 0.1 German 3 0.2 Portuguese 1 0.1 Other* 3 0.2 *Includes Arabic and Creole**Could choose more than one so will not add to 100%

Table 13. Device Preference for Accessing Remote Training n %

Computer/Laptop 1694 91 Smartphone (e.g., IPhone, Android) 741 40 Tablet or IPad 495 27 Phone (audio only) 174 9 Other* 22 1 *In-person/hands-on, with captions, written, webinars/zoom - see tablebelow**Could choose more than one so will not add to 100%

Table 14. Importance of Asking Questions Live During Training n %

Not important 235 13 Somewhat important 1100 59 Very Important 519 28

Appendix F

Table 15 shows responses related to useful post-training resources. The majority of respondents (70%) chose print materials such as pocket cards, posters etc. and digital materials such as emails and online resources (62%). Half of respondents indicated that seminars and webinars on best practices would be useful. Virtual office hours with infection control experts/educators was less frequently selected at 22%

Table 15. Useful Post-Training Support n %

Print materials related to infection control activities (e.g., pocket cards, posters, etc.) 1299 70 Digital materials related to infection control activities (e.g., emails, online resources, etc.) 1154 62

Regular seminars/webinars on best practices related to infection control 932 50

Virtual office hours with infection control experts/educators 406 22 Other* 13 1 *Materials, Print Materials, With Someone**Could choose more than one so will not add to 100%

Appendix F

Preferred Training Method by Primary Role Table 16 describes the preferred training method by primary role. As noted in the methods section, respondents were asked how likely they were to use each training method. Somewhat and highly likely responses were combined to indicate preference. Overall, the top preferences were for written materials (92%), pre-recorded on-line videos (91%), and discussion with peers (91%). Of note, while a high percentage of respondents stated that it was important for them to have the option of live interactions, only the discussion with peers would provide that option. However, a large number of respondents also chose discussion with an expert (88%), classroom/onsite training (86%), and live webinars (82%) as a preferred training method. Respondents were least likely to access training through a podcast (54%) or social media (44%).

There were slight differences in method preferences by healthcare worker role. Of particular note is that the LNA/clinical other group most often indicated a preference for a “live” training that has more possibility of interaction, such as classroom/onsite training, discussion with an expert, and discussion with peers. This was similar for healthcare workers working in activities/recreational therapy, although the results within this small group should be interpreted with caution. Environmental/food service professionals were less interested in live webinars and instead preferred pre-recorded online videos. Licensed prescribers overwhelmingly indicated a desire to receive written materials, as did RN/LPNs and non-clinical support staff. Those working in PT/OT/rehabilitation indicated a preference for learning via a discussion with peers, while EMT/paramedics seemed interested in most all of the training methods, with the exception of podcasts and social media.

Appendix F

Table 16. Somewhat/Highly Likely to Use Training Method By Role Pre-

recorded online video

Live Webinar Podcast Written

Materials

Classroom/ Onsite

Training

Social Media

Discussion with an Expert

Discussion with

Group of Peers

All Respondents (1,854)

1684 1528 996 1703 1595 811 1632 1683 91% 82% 54% 92% 86% 44% 88% 91%

Activities/ Recreational

Therapy (n=25)

18 20 9 19 24 12 24 25

72% 80% 36% 76% 96% 48% 96% 100%

Administrator (n=124)

116 118 82 114 100 56 114 114 94% 95% 66% 92% 81% 45% 92% 92%

EMT/Paramedic (n=45)

43 42 25 43 44 22 43 43 96% 93% 56% 96% 98% 49% 96% 96%

Environmental/ Food Services

(n=103)

95 67 43 93 84 52 86 93

92% 65% 42% 90% 82% 51% 84% 90%

Health Educator (n=87)

83 82 50 81 67 35 80 81 95% 94% 58% 93% 77% 40% 92% 93%

Laboratorian (n=64)

61 58 38 60 56 21 55 58 95% 91% 59% 94% 88% 33% 86% 91%

Licensed Prescriber (n=117)

105 96 74 113 95 41 106 106 90% 82% 63% 97% 81% 35% 91% 91%

LNA/Clinical Other (n=158)

135 110 64 136 149 81 143 149 85% 70% 41% 86% 94% 51% 91% 94%

MA/Clinical Support Non-LNA

(n=50)

40 42 23 44 44 24 43 43

80% 84% 46% 88% 88% 48% 86% 86% Non-Clinical Support Staff

(n=368)

326 320 204 339 324 166 311 323

89% 87% 55% 92% 88% 45% 85% 88%

PT/OT/Rehab (n=87)

78 75 45 79 76 32 78 83 90% 86% 52% 91% 87% 37% 90% 95%

RN/LPN (n=502) 467 401 273 473 430 212 444 457

93% 80% 54% 94% 86% 42% 88% 91%

Technician (n-110) 104 85 60 98 94 51 95 97

95% 77% 55% 89% 86% 46% 86% 88% Other (n=14) 13 12 6 11 8 6 10 11

93% 86% 43% 79% 57% 43% 71% 79%

Appendix F

Training Topics, Experiences and Preferences Training Topic Background In order to understand future training needs, it was important to gauge respondents' experience with past training related to infection control topics. It was also critical to understand their confidence in these areas as far as understanding the topic, explaining it to others, and demonstrating it to others. We adopted the CDC’s survey list of training topics and added germ theory to the list. Definitions were provided in the survey for reference (Table 17).

Table 17. Definitions of Survey Terms

Term Definition

Infection Control Approaches used to prevent or stop the spread of infections in healthcare

Training Topics

Germ Theory The theory that germs cause disease

Infection Control Recommendations

Steps to take to stop the spread of infections

Infection Control Communication

Sharing information related to stopping the spread of infections

Hand Hygiene Washing hands with water and soap or other antiseptic agents

Personal Protective Equipment (PPE)

Equipment worn to minimize exposures to hazards that cause injuries or illnesses. Examples include masks, gloves, gowns, etc.

Source Control Precautions taken to reduce infection such as maintaining physical distance, wearing surgical masks or cloth face coverings, following respiratory hygiene / cough etiquette

Screening Procedures used to identify people at risk of having an illness or condition

Cleaning Disinfecting surfaces and materials

Appendix F

Prior Training Experience We questioned respondents about whether they had any prior training related to infection control and if so, the types of topics in which they were trained. As shown in Table 18, 91% of survey respondents indicated that they had past training experience on one or more topics related to infection control.

Table 18. Received Prior Training Specific to Infection Control

n % Yes 1684 91 No 170 9

The top three topic areas where the overwhelming majority of respondents had previous training included hand hygiene (98%) and PPE (96%) (Table 19). A large number of respondents had past training in cleaning (78%). More than half had prior training experience in infection control communication (65%) and screening (54%). Those topics where fewer than half of respondents had prior experience included source control (43%) and germ theory (32%).

Table 19. Prior-Training Topics (n=1,684) n %

Hand Hygiene 1650 98 PPE 1624 96 Cleaning 1320 78 Infection Control Communication 1088 65 Screening 903 54 Source Control 715 43 Germ Theory 545 32 Other Infection Control Topic* 76 5 None of the Above 4 0.2 **Could choose more than one so will not add to 100% *Includes such responses as hazardous substance/blood-borne, COVID-related, infectionprevention/control, and stewardship.

Confidence in Training Topics There were slight variations in how the confidence questions were asked for each topic area. In the topic of germ theory, respondents were only asked about their confidence in understanding it, and in the topic of infection control recommendations, respondents were asked about their confidence in understanding it and ability to explain it. For the remaining six topic areas, respondents were asked to assess their confidence in three areas: 1) understanding, 2) explaining (to colleagues or patients) or 3) demonstrating the topic area. Response optionsincluded “Not at all confident”; “Somewhat confident”; “Very confident” and “Not Applicable to Current Job”.

In order to understand potential training needs, we looked at lack of confidence. As noted in the methods section, due to a very small number of participants selecting “not at all confident” in the topics, we collapsed

Appendix F

somewhat and not at all confident to indicate a relative lack of confidence in a particular training area. When looking the confidence tables that follow, including “overall” confidence and confidence by selected roles for each topic, it is important to understand that the lower the percentage the higher the confidence, whereas confidence levels with higher percentages indicated lower level of confidence.

Across all respondents, the lowest level of confidence was in the areas of demonstrating source control and demonstrating screening. For both topics, about one quarter of respondents stated that they were either not at all confident or somewhat confident (Table 20). Additionally, 24% of respondents did not feel confident in explaining source control to others. The topic with the highest level of confidence in all areas (understanding, explaining and demonstrating) was hand hygiene. Of note, in comparison to the other topics, a high percentage of respondents indicated that they did not understand germ theory (15%).

It is important to note the difference in confidence level within a single topic between understanding, explaining, and demonstrating. For example, while only 5% of respondents had low confidence in their understanding of infection control communication, almost 17% indicated they were not as confident when it came to explaining it to a colleague or demonstrating the topic. Similarly, only about 4% of respondents expressed low confidence in understanding PPE, but 21% express low confidence in demonstrating PPE.

Table 20. Lack of Confidence in Training Topics (n=1854)

Percent somewhat or not at all confident in ability to... Understand Explain to Others (*or

Explain to Colleague) Demonstrate to

Others (*or Explain to Patient)

Germ Theory 15% N/A N/A

Infection Control Recommendations 3% 15% N/A

Infection Control Communication (*Note variation in answer choices) 5% 17% 17%

Hand Hygiene 1% 4% 4%

PPE 4% 10% 21%

Source Control 14% 24% 26%

Screening 11% 17% 26%

Cleaning 4% 10% 18%

Appendix F

Confidence in Training Topics by Role Given the large number of roles and topic areas, we focused this section of the report on those roles with the largest sample size. This includes RN/LPN (27% of the survey sample), non-clinical support staff (20%) and LNA/clinical other (9%). The full table with all roles related to this analysis has been provided to DHHS as part of the Excel data file.

RN/LPNs - Table 21: The RN/LPN group showed higher confidence than average across all topic areas. For example, while 17% of all respondents expressed low confidence in demonstrating infection control communication, only 9% of RNs/LPNs felt either somewhat or not at all confident. The lowest confidence levels were found in the areas of explaining and demonstrating source control, followed by demonstrating screening and cleaning. This is consistent with the overall results.

Table 21. RN/LPN Lack of Confidence in Training Topics (n=502)

Overall RN/LPN Overall RN/LPN Overall RN/LPN


Explain to Colleague)

Demonstrate to Others (* or Explain to

Patient)

Germ Theory 15% 12% N/A N/A N/A N/A

Infection Control Recommendations 3% 2% 15% 8% N/A N/A

Infection Control Communication* (*Note variation in answer choices)

5% 4% 17% 10% 17% 9%

Hand Hygiene 1% 1% 4% 2% 4% 1%

PPE 4% 1% 10% 4% 21% 12%

Source Control 14% 10% 24% 16% 26% 18%

Screening 11% 5% 17% 8% 26% 15%

Cleaning 4% 2% 10% 6% 18% 15%

Appendix F

Non-Clinical Support Staff - Table 22. Non-clinical support staff reported lower levels of confidence in nearly every infection control topic when comparing to the overall group. An example of these differences was illustrated when examining responses to confidence related to PPE topics. With respect to understanding the importance of PPE, non-clinical respondents reported lack of confidence was double that of the survey respondents overall (8% vs. 4%). Nineteen (19) percent of non-clinical respondents reported a lack of confidence in explaining the importance of PPE to others as compared to 10% of the overall sample. Thirty-two (32) percent of this group reported a lack of confidence in demonstrating how to use PPE correctly versus 21%of survey respondents overall. Similar to overall respondents, non-clinical support staff had the least confidencein source control and screening. In fact, more than a third (35%) of non-clinical support staff did not feelconfident in explaining or demonstrating source control. The only exception to lower confidence levels in non-clinical support staff was in the area of understanding hand hygiene, where both the overall and non-clinicalsupport group report a low (1%) lack of confidence.

Table 22. Non-Clinical Support Staff Lack of Confidence in Training Topics (n=368)

Overall

Non- Clinical Support

Staff

Overall

Non-Clinical Support

Staff

Overall

Non- Clinical Support

Staff

Percent somewhat or not at all confident in ability to... Understand

Explain to Others (*or Explain to

Colleague)

Demonstrate to Others (*or Explain

to Patient) Germ Theory 15% 23% N/A N/A N/A N/A Infection Control Recommendations 3% 6% 15% 26% N/A N/A Infection Control Communication (*Note variation in answer choices) 5% 6% 17% 24% 17% 26%

Hand Hygiene 1% 1% 4% 6% 4% 8%

PPE 4% 8% 10% 19% 21% 32%

Source Control 14% 19% 24% 32% 26% 35% Screening 11% 16% 17% 24% 26% 31% Cleaning 4% 7% 10% 17% 18% 25%

Appendix F

LNA/Clinical Other - Table 23: Those in the LNA/clinical other group were comparable to the average confidence level on most topics. One exception was in the area of demonstrating to others how to use PPE. LNA/clinical other staff showed more confidence in this area than average, with only 12% choosing somewhat or not at all confident as compared to 21% of the overall sample. Similar to the overall sample, this group expressed the lowest confidence in explaining and demonstrating source control and screening.

Table 23. LNA/Clinical Other Lack of Confidence in Training Topics (n=158)

Overall LNA /

Clinical Other

Overall LNA /

Clinical Other

Overall LNA /

Clinical Other


Explain to Colleague)

Demonstrate to Others (*or Explain to

Patient) Germ Theory 15% 16% N/A N/A N/A N/A Infection Control Recommendations 3% 4% 15% 15% N/A N/A

Infection Control Communication (*Note variation in answer choices)

5% 4% 17% 16% 17% 17%

Hand Hygiene 1% 3% 4% 4% 4% 3%

PPE 4% 3% 10% 11% 21% 12%

Source Control 14% 11% 24% 17% 26% 22% Screening 11% 10% 17% 17% 26% 24% Cleaning 4% 4% 10% 10% 18% 15%

Appendix F

Interest in Training Topic by Primary Role Table 24 describes the training topic interests for respondents in different primary roles. Overall, the most frequently selected training topics were source control and germ theory. About 38% and 32% of respondents, respectively, expressed interest in receiving training on these topics. Almost 30% of respondents were also interested in infection control communication. By far the topic in lowest demand was hand hygiene, with only 6% of respondents selecting this as a topic on which they would like more training.

Ten of the fourteen healthcare worker categories had source control as the topic with the highest percentage of interest. Environmental and food service professionals, however, showed much less interest in this topic. Only 25% of this group chose this as a desired training topic.

Germ theory generated interest for many groups as well. Forty percent (40%) of EMT/Paramedics chose germ theory as a topic of interest. Environmental and food service professionals, technicians, MA/clinical support non-LNA, and non-clinical support also showed more interest in this topic than any other. Compared to the average for all respondents, a lower percentage (12%) of licensed prescribers were interested in a training on germ theory.

Appendix F

Table 24. Interest in Training Topic by Primary Role

Germ Theory

Infection Control

Commun-ication

Hand hygiene PPE Source

Control Screening Cleaning

All Respondents (n=1,854)

592 545 107 306 695 411 361 32% 29% 6% 17% 38% 22% 20%

Activities/ Recreational Therapy (n=25)

7 9 1 5 13 4 7 28% 36% 4% 20% 52% 16% 28%

Administrator (n=124) 36 38 7 25 51 27 33

29% 31% 6% 20% 41% 22% 27% Clinical Support Non-LNA (n=50)

18 16 4 8 14 11 9 36% 32% 8% 16% 28% 22% 18%

Clinical-Other (n=158) 58 38 9 20 61 41 25

37% 24% 6% 13% 39% 26% 16%

EMT/Paramedic (n=45) 18 12 1 4 18 13 7

40% 27% 2% 9% 40% 29% 16% Environmental/Food Services (n=103)

29 28 6 16 26 15 18 28% 27% 6% 16% 25% 15% 18%

Health Educator (n=87) 30 35 8 20 36 23 23

35% 40% 9% 23% 41% 26% 26%

Laboratorian (n=64) 18 23 3 9 23 10 6

28% 36% 5% 14% 36% 16% 9% Licensed Prescriber (n=117)

14 25 3 20 45 25 19 12% 21% 3% 17% 39% 21% 16%

Non-Clinical Support Staff (n=368)

119 97 24 57 111 76 75 32% 26% 7% 16% 30% 21% 20%

PT/OT/Rehab (n=87) 22 19 1 14 34 22 17

25% 22% 1% 16% 39% 25% 20%

RN/LNA (n=502) 170 168 30 79 211 112 101

34% 34% 6% 16% 42% 22% 20%

Technician (n-110) 47 31 9 27 44 27 18

43% 28% 8% 25% 40% 25% 16%

Other (n=14) 6 6 1 2 8 5 3

43% 43% 7% 14% 57% 36% 21%

Appendix F

Interest in Training Topic by Primary Workplace Table 25 describes the overall interest in training topics, and the interest in training topic by the primary workplace of respondents. For the overall group, the topic of source control shows the highest level of interest (38%) followed by the topic of germ theory (32%), with hand hygiene being the lowest interest for the overall group (6%). When we look at topic interest by primary workplace, there are some notable variations. As compared to the overall average (22%), there was a higher level of interest in the topic of screening for those whose primary workplace was a health department (37%), EMS/EMT/Fire (37%) or a behavioral health facility (36%). Those who worked in the other non-clinical settings indicated a lower interest in the topic of screening (15%). Health department employees reported a greater interest in infection control communication (46%) and PPE (25%), when compared to respondents overall (30% and 17%, respectively). Employees of assisted living facilities showed a greater than average desire to learn about cleaning, with 31% selecting this topic compared to 22% overall.

Table 25. Interest in Training Topic by Primary Workplace

Germ Theory

Infection Control

Communication

Hand Hygiene PPE Source

Control Screening Cleaning

All Respondents (n=1,854)

592 545 107 306 695 411 361 32% 29% 6% 17% 38% 22% 20%

Acute Care Hospital (n=674)

205 167 34 102 250 139 124 30% 25% 5% 15% 37% 21% 18%

Assisted Living Facility (n=81)

22 21 6 16 37 15 25 27% 26% 7% 20% 46% 19% 31%

Behavioral Health Facility (n=50)

20 16 2 10 23 18 9 40% 32% 4% 20% 46% 36% 18%

Critical Access Hospital/Skilled Nursing Facility/Swing (n=162)

38 51 11 34 65 40 35

24% 32% 7% 21% 40% 25% 22%

EMS/EMT/Fire (n=30) 13 11 1 1 13 11 3

43% 37% 3% 3% 43% 37% 10% Local/State Health Department (n=52)

20 24 4 13 20 19 10 39% 46% 8% 25% 39% 37% 19%

Nursing Home/Long-Term Care Facility (n=391)

152 139 28 60 146 72 86

39% 36% 7% 15% 37% 18% 22%

Other Non-Clinical (n=26)

7 7 5 3 6 4 3 27% 27% 19% 12% 23% 15% 12%

Outpatient (n=300) 93 84 16 52 96 67 55

31% 28% 5% 17% 32% 22% 18% Other (n=88) 22 25 0 15 39 26 11

25% 28% 0% 17% 44% 30% 13%

Appendix F

Interest in Training Topics by Primary Role by Primary Workplace The purpose of examining interest in training topics by primary role by workplace was to identify differences in training preferences for professionals working in specific healthcare settings. Tables 26 – 32 illustrate results for roles with a survey sample of at least 100 respondents. Please note: results shown in these tables should be interpreted with caution, especially when the number of respondents in the cell is less than 10. If there were less than four respondents for a role within a facility, we collapsed that facility into the “Other” category and noted this in the table. Administrators - Table 26: Following the overall results presented in Table 26, administrators in most settings showed the highest preference for source control training. One exception was administrators at a critical access hospital/skilled nursing/swing facility, which had zero requests for source control. On the opposite end of the spectrum, administrators in behavioral health facilities overwhelmingly reported interest in source control, with 89% selecting this topic.

Table 26. Topic Interests Among Administrators in Various Workplaces

Total in

Facility Germ

Theory

Infection Control Comm.

Hand Hygiene PPE

Source Control Screening Cleaning

Administrator 124 36 38 7 25 51 27 33

29% 31% 6% 20% 41% 22% 27%

Acute Care Hospital 24 8 7 3 6 11 6 9

33% 29% 13% 25% 46% 25% 38%

Assisted Living Facility

15 4 5 1 6 8 4 8

27% 33% 7% 40% 53% 27% 53%

Behavioral Health Facility

9 2 0 0 2 8 3 1

22% 0% 0% 22% 89% 33% 11%

Critical Access Hospital/Skilled Nursing Facility/Swing

10 1 3 1 1 0 0 3

10% 30% 10% 10% 0% 0% 30%

Nursing Home/Long-Term Care Facility

37 14 15 2 7 17 9 7

38% 41% 5% 19% 46% 24% 19%

Outpatient 19 4 6 0 2 4 3 4

21% 32% 0% 11% 21% 16% 21%

Other** 10 3 2 0 1 3 2 1

30% 20% 0% 10% 30% 20% 10% *No administrators that completed the survey worked in Behavioral Health Facilities, Other-Non-Clinical, or EMS/EMT/Fire.

**Other includes Local/State Health Department

Appendix F

LNA/Clinical Other -Table 27: Germ theory and source control training were the training topics that had the most demand among LNA/clinical other staff overall, with 39% and 37% of respondents indicating interest. Desire for germ theory training was notably higher among LNA/clinical other staff of nursing home/long-term care facilities, with about half of respondents choosing this topic.

Table 27. Topic Interests Among LNA/Clinical Other Staff in Various Workplaces Total in Facility

Germ Theor

y


Hand Hygiene

PPE Source Control

Screening Cleaning

Clinical-Other 158 58 38 9 20 61 41 25 37% 24% 6% 13% 39% 26% 16%

Acute Care Hospital

44 13 6 1 5 17 11 3 30% 14% 2% 11% 39% 25% 7%


27 7 6 1 5 12 6 5 26% 22% 4% 19% 44% 22% 19%


13 5 5 0 1 4 4 2

38% 38% 0% 8% 31% 31% 15%


59 30 17 6 8 24 16 14

51% 29% 10% 14% 41% 27% 24%

Outpatient 5 1 0 0 0 0 0 0 20% 0% 0% 0% 0% 0% 0%

Other** 10 2 4 1 1 4 4 1 20% 40% 10% 10% 40% 40% 10%

*No clinical-other that responded to the survey worked in Local/State Health Departments, EMS/EMT/Fire,or Other Non-Clinical.**Other includes Behavioral Health Facility

Appendix F

Environmental/Food Service Professionals - Table 28: Overall, germ theory and infection control communication was chosen by the highest percentage of environmental/food service professionals who responded to the survey (28% and 27%, respectively). There was even more interest in infection control communication among those who worked in nursing home/long-term care (50%).Environmental/food service professionals working in nursing home/long-term care facilities also showed a high interest in cleaning (29%) when compared with environmental/food service peers overall (18%).

Table 28. Topic Interests Among Environmental/Food Service Professionals in Various Workplaces Total in Facility

Germ Theory


Hand Hygiene

PPE Source Control

Screening Cleaning

Environmental/Food Services

103 29 28 6 16 26 15 18 28% 27% 6% 16% 25% 15% 17%

Acute Care Hospital 29 8 3 1 4 7 4 2 28% 10% 3% 14% 24% 14% 7%


9 1 0 0 1 1 2 0 11% 0% 0% 11% 11% 22% 0%


12 4 2 2 3 4 1 2

33% 17% 17% 25% 33% 8% 17%


42 12 21 2 7 11 6 12 29% 50% 5% 17% 26% 14% 29%

Other** 11 4 2 1 1 3 2 2 36% 18% 9% 9% 27% 18% 18%

*No environmental/food services that responded to the survey worked in local/state health departments orEMS/EMT/Fire.**Other includes outpatient, behavioral health facility, and other non-clinical

Appendix F

Licensed Prescribers - Table 29: All licensed prescribers, regardless of the facility in which they practiced, showed the strongest desire for additional training in source control.

Table 29. Topic Interests Among Licensed Prescribers in Various Workplaces Total

in Facility

Germ Theory


Hand Hygiene

PPE Source Control

Screening Cleaning

Licensed Prescriber 117 14 25 3 20 45 25 19 12% 21% 3% 17% 38% 21% 16%

Acute Care Hospital

51 4 9 1 10 18 11 11 8% 18% 2% 20% 35% 22% 22%


9 1 3 1 3 5 3 2

11% 33% 11% 33% 56% 33% 22%

Outpatient 39 7 7 1 4 12 5 5 18% 18% 3% 10% 31% 13% 13%

Other** 18 2 6 0 3 10 6 1 11% 33% 0% 17% 56% 33% 6%

*No licensed prescribers who responded to the survey worked in Local/State Health Departments, AssistedLiving Facilities, EMS/EMT/Fire, or Other Non-Clinical.**Other includes Nursing Home/Long-Term Care Facility and Behavioral Health Facility

Appendix F

Non-Clinical Support Staff - Table 30: The highest percentage of non-clinical support staff in most facilities selected germ theory as a desired training topic. Please note: numbers are small and should be interpreted with caution. Non-clinical staff working in behavioral health facilities reported more demand than average for germ theory training, infection control communication, and screening, with close to half selecting these topics. Non-clinical support staff in critical access hospital/skilled nursing/swing facilities also indicated slightly different interests than those in other settings. A much lower than average percentage of non-clinical support staff in these settings selected germ theory as a desired training topic (18% versus 32% overall), while their interest in cleaning was greater than average (32% versus 20% overall).

Table 30. Topic Interests Among Non-Clinical Support Staff in Various Workplaces Total in Facility

Germ Theory


Hand Hygiene

PPE Source Control

Screening Cleaning

Non-Clinical Support Staff

368 119 97 24 57 111 76 75

32% 26% 7% 15% 30% 21% 20%



7 4 2 1 1 4 0 2

57% 29% 14% 14% 57% 0% 29% Behavioral Health Facility

23 12 11 1 5 9 11 6

52% 48% 4% 22% 39% 48% 26% Critical Access Hospital/Skilled Nursing Facility/Swing

34 6 7 4 9 12 9 11

18% 21% 12% 26% 35% 26% 32%

Local/State Health Department

16 8 4 1 2 5 8 2 50% 25% 6% 13% 31% 50% 13%


76 26 17 4 8 21 8 17 34% 22% 5% 11% 28% 11% 22%

Other Non-Clinical 20 6 4 0 2 5 2 2 30% 20% 0% 10% 25% 10% 10%

Outpatient 68 19 16 4 12 17 14 10 28% 24% 6% 18% 25% 21% 15%

Other 11 1 4 1 2 4 2 3 9% 36% 9% 18% 36% 18% 27%

*No Non-Clincal Support Staff who responded to the survey worked in EMS/EMT/Fire.

Appendix F

Technicians - Table 31: The majority (80%) of technicians worked in acute care hospitals or outpatient facilities. The topic chosen by the most technicians in these facilities was germ theory (44%). Additionally, half of technicians working at critical access hospitals/skilled nursing/swing facilities indicated an interest in source control training.

Table 31. Topics of Interest Among Technicians in Various Workplaces Total in Facility

Germ Theory


Hand Hygiene

PPE Source Control

Screening Cleaning

Technician 110 47 31 9 27 44 27 18

43% 28% 8% 25% 40% 25% 16%



12 4 4 1 5 6 2 3

33% 33% 8% 42% 50% 17% 25%

Outpatient 27 13 8 3 7 10 9 5 48% 30% 11% 26% 37% 33% 19%

Other** 10 3 3 1 3 7 4 2 30% 30% 10% 30% 70% 40% 20%

*No Technicians who responded to the survey worked at Assisted Living Facilities, Nursing Home/Long-TermCare Facilities, EMS/EMT/Fire, or Other Non-Clinical**Other includes Local/State Health Department and Behavioral Health Facility

Appendix F

RN/LPNs - Table 32: For RN/LPNs working in most settings, source control was the training topic in highest demand. RN/LPNs in nursing home/long-term care facilities reported more interest (44%) in infection control communication training than the average among RN/LPNs (34%).

Table 32. Topics of Interest Among RN/LPNs in Various Workplaces Total in Facility

Germ Theory


Hand Hygiene

PPE Source Control

Screening Cleaning

RN/LNA 502 170 168 30 79 211 112 101

34% 33% 6% 16% 42% 22% 20%

Acute Care Hospital

241 77 65 11 30 100 51 45

32% 27% 5% 12% 41% 21% 19% Assisted Living Facility

13 4 4 3 3 6 0 5 31% 31% 23% 23% 46% 0% 38%

Behavioral Health Facility

6 3 4 1 2 3 2 2 50% 67% 17% 33% 50% 33% 33%


36 9 12 1 4 15 10 4

25% 33% 3% 11% 42% 28% 11%

Local/State Health Department

6 1 3 1 2 2 1 3

17% 50% 17% 33% 33% 17% 50%


116 48 51 9 19 49 25 23

41% 44% 8% 16% 42% 22% 20%

Outpatient 68 23 24 3 15 30 19 16 34% 35% 4% 22% 44% 28% 24%

Other 16 5 5 1 4 6 4 3 31% 31% 6% 25% 38% 25% 19%

*No RN/LNAs who responded to the survey worked at EMS/EMT/Fire.**Other includes other non-clinical

Appendix F

Recommendations Based on the results from both parts of the Project Firstline Learning Needs Assessment, the following three recommendations are offered to enhance the value and effectiveness of future infection control training.

1. Use adult learning principles in the development of all training, regardless of deliverymethod.Malcolm Knowles developed Adult Learning Theory in 1968. This theory acknowledges the unique learning needs of adults as compared to children. It has been adapted over many decades, and its core principles are still relevant for the development of effective training for adult learners.5 Suggestions based upon the learning needs assessment include:

5 O'Neill, E. (2020). What is Adult Learning Theory?. Retrieved 12 August 2021, from https://www.learnupon.com/blog/adult-learning-theory/ ; Cultural Orientation Resource Center. (2010). Adult Learning and Retention: Factors and Strategies [Ebook]. Retrieved from http://www.culturalorientation.net/content/download/480/3397/file/Tools%20for%20Trainers%20Adult_Learning.pdf

Appendix F

https://www.learnupon.com/blog/adult-learning-theory/

http://www.culturalorientation.net/content/download/480/3397/file/Tools%20for%20Trainers%20Adult_Learning.pdf

http://www.culturalorientation.net/content/download/480/3397/file/Tools%20for%20Trainers%20Adult_Learning.pdf

• Explain the benefit, value and purpose behind training, guidance and protocols. Adult learnerswant to know how what they are learning is applicable to their daily lives. Establishing this baselineunderstanding develops mutual respect between the trainer and the learner, builds buy in, and willultimately improve implementation of infection control measures.

• Draw upon participant life experiences. To make training content relevant to learners, it is importantto give them opportunities to use their experience as a reference and resource. For instance, beforebeginning a training on source control, the trainer might ask participants to share one way that they haveapplied source control and one challenge that they have encountered in their facility.

• Facilitate peer learning. Participants will benefit from hearing different perspectives and real-worldexamples from their peers. Models such as shadowing, mentoring, learning dyads and train the trainerwill deepen understanding and strengthen infection control skills.

• Offer opportunities for review and reflection. Adult learners need to use information quickly afterthey learn it. Some ideas to help training participants move along the continuum from knowledgeacquisition to comprehension:

o Make time for learners to ask questions in real time during a live training evento Provide opportunities for participants to ask questions after a pre-recorded video, self-paced

course or provision of written guidance. This could be accomplished through online messageboards, a telephone/email hotline or creation of dedicated office hours (in person or virtual).

o Ask training participants to write a reflection about what they have learned and share it withsomeone else

o Include interactive quizzes after a self-paced online training

• Prioritize practice. Giving learners the chance to practice soon after training will improve confidencein demonstrating infection control procedures. Just in Time training is one promising model that wasendorsed by listening session participants. Small group practice sessions with individualized feedbackare another option to consider.

• Provide multiple pathways for learning. People have different learning styles, preferences and kindsof intelligence. The most effective trainings use a variety of strategies to engage learners. For example,an in person or online training could include a short lecture followed by a breakout session where smallgroups of participants discuss a case study and then report back to the larger group. Use of audiovisualsupports and experiential activities are also encouraged.

2. Tailor training to different roles, settings, and experience levels.The Learning Needs Assessment offers rich insight into how training might be adapted to suit the needs and preferences of different frontline healthcare workers. For example:

• RN/LPNs have a strong interest in learning about source control. Results from the confidencequestions indicate that they would benefit most from training that helps them to explain and demonstratesource control to others. Self-paced training may work well for this group, as over 90% said that theywere likely to use pre-recorded videos or written materials in their learning.

Appendix F

• EMT/Paramedics would also like training in source control, but their responses to the trainingmethods question indicate that onsite or live webinars might be a better format for them.

• Environmental/Food Service Professionals have less demand for source control training thanthose in other roles. Germ theory may be a higher priority for this group. Delivery methods that they aremost likely to use include pre-recorded videos, written materials and discussions with a group of peers.Live webinars seem to be less desirable for this group than for other frontline workers.

• New and inexperienced employees may be more likely to need intensive training withindividualized feedback. Written materials without any other supports may be particularly inadequatefor this group.

3. Offer ongoing training to ensure that healthcare workers and professionals working inhealth-related settings remain prepared.In the last 12 years, frontline healthcare workers have experienced infectious disease threats from H1N1, Ebola, anti-microbial resistant organisms and COVID-19. New variants of COVID-19 indicate that infection prevention protocols will continue to evolve. Ongoing attention to effective infection control training will ensure that healthcare workers have the resources to protect themselves, their facility, their family and their community from these threats.

Appendix F

Appendix A - Acronym List

Acronyms List● ACS - American Community Survey● BLS - Bureau of Labor Statistics● CDC - Centers for Disease Control and Prevention● COVID-19 - Coronavirus Disease 2019● CRNA - Certified Registered Nurse Anesthetist● CT - Computed Tomography● DDS - Doctor of Dental Surgery● DHHS - Department of Health and Human Services● DMD - Doctor of Dental Medicine● DO - Doctor of Osteopathic Medicine● EMS - Emergency Medical Services● EMT - Emergency Medical Technician● HAI - Healthcare-Associated Infections● JSI - JSI Research and Training Institute, Inc.● LNA - Licensed Nursing Assistant● LPN - Licensed Practical Nurse● MA - Medical Assistants● MD - Doctor of Medicine● NH - New Hampshire● OT - Occupational Therapy● PASW - Predictive Analytics SoftWare● PPE - Personal Protective Equipment● PSR - Patient Service Representative● PT - Physical Therapy● RN - Registered Nurse

Appendix F

Documents

Project Firstline New Hampshire: Learning Needs Assessment