The acceptability of screening for Carbapenemase Producing Enterobacteriaceae (CPE): cross-sectional survey of nursing staff and the general publics' perceptions

Background: Carbapenemase Producing Enterobacteriaceae (CPE) has spread rapidly and presents a growing challenge in antimicrobial resistance (AMR) management internationally. Screening for CPE may involve a rectal swab, there are limited treatment options for affected patients, and colonised patients are cared for in isolation to protect others. These measures are sound infection prevention precautions; however, the acceptability of CPE screening and its consequences are currently unknown. The aim of this study was 'To determine factors influencing acceptability of CPE screening from the perspectives of nursing staff and the general public.' Methods: National cross-sectional surveys of nursing staff (n = 450) and the general public (n = 261). The Theoretical Domains Framework (TDF) guided data collection and analysis. Regression modelling was used to identify factors that predicted acceptability of CPE screening. Results: For nursing staff, the following predictor variables were significant: intention to conduct CPE screening (OR 14.19, CI 5.14-39.22); belief in the severity of the consequences of CPE (OR 7.13, CI 3.26-15.60); knowledge of hospital policy for screening (OR 3.04, CI 1.45-6.34); preference to ask patients to take their own rectal swab (OR 2.89, CI 1.39-6.0); awareness that CPE is an organism of growing concern (OR 2.44, CI 1.22-4.88). The following predictor variables were significant for the general public: lack of knowledge of AMR (β -.11, p =.01); social influences (β.14, p =.032); social norms (β.21p =.00); acceptability of being isolated if colonised (β.22, p =.000), beliefs about the acceptability of rectal swabbing (β.15, p =.00), beliefs about the impact of careful explanation about CPE screening from a health professional (β.32, p =.00). Integrating results from staff and public perspectives points to the importance of knowledge of AMR, environmental resources, and social influences in shaping acceptability. Conclusions: This is the first study to systematically examine the acceptability of CPE screening across nursing staff and the public. The use of TDF enabled identification of the mechanisms of action, or theoretical constructs, likely to be important in understanding and changing CPE related behaviour amongst professionals and public alike.