Five core areas to focus infection prevention and transmission risk breaches training based on quarantine staff orientation sessions: A qualitative study

Background & Aim: Breach awareness in relation to types, mitigation, and reporting should be a routine part of infection prevention training. Understanding breaches can reduce risk of disease transmission to staff and communities when contextualized to the infectious disease, environment, and situation. At a large-scale Australian COVID-19 quarantine facility, this study examined the core personal protective equipment and infection prevention breaches new quarantine workers identified during their site orientation to inform future breach training. Methods & Materials: Through the application of a qualitative approach, the project implemented a descriptive thematic analysis to identify the different types of breaches staff presented. An additional summative content analysis method was applied to determine if the breaches staff identified were breaching and if the risk level staff allocated to the breach was mapped to the risk of disease transmission. Data were collected from 30 orientation sessions and included 603 breach risk responses for analysis. Results: There were five core breach areas identified: donning and doffing of personal protective equipment, failure of personal protective equipment or lack of equipment, environmental factors, staff behaviors, and resident behaviors. The breach allocations by staff demonstrated knowledge deficits across health and non-health staff in disease transmission, particularly in the actual level of the risk for transmission. Conclusion:  Breaches awareness in relation to types, mitigation and reporting should be a routine part of infection prevention training. The five areas of breaches present an adaptable foundation to base infection prevention breach training for any health facility. When contextualised to the communicable disease, environment and situation, understanding breaches can reduce the risk of disease transmission to staff and communities.