# Healthcare providers’ experiences in caring for MDRO carriers with a focus on the moral dimensions of care: a systematic review

## TL;DR

This study explores how healthcare providers experience caring for patients with drug-resistant infections, focusing on moral challenges and work conditions.

## Contribution

The paper systematically reviews healthcare providers' moral and practical challenges in caring for MDRO carriers, highlighting gaps in ethical support.

## Key findings

- Healthcare providers face uncertainty about safety and IPC measure proportionality.
- PPE use and isolation room access create emotional and relational barriers with patients.
- Resource shortages and poor infrastructure hinder IPC adherence and provider support.

## Abstract

Providing care to multi-drug resistant organisms (MDRO) carriers has a profound impact on healthcare providers (HCPs), potentially challenging their personal and professional values. Understanding HCPs’ experiences is key to addressing challenges in providing care to carriers and to support HCPs when providing this care. This review aims to examine experiences of HCPs with a focus on moral dimensions of care.

We systematically searched Cochrane library, CINAHL, EMBASE, PsycINFO, PubMed and Web of Science. Experiences were analysed using a thematic analysis approach. This review was registered in PROSPERO (CRD42023418340).

Eighteen studies were included, primarily conducted in hospitals and nursing homes. Experiences were categorized into three levels: the individual HCP, the care practice and the institutional setting. First, HCPs are uncertain about personal health and safety, have different knowledge levels and question proportionality of infection prevention and control (IPC) measures. Second, HCPs say that wearing PPE limits connection with carriers and note various other challenges regarding the care relationship such as considering how often to enter an isolation room. Third, HCPs face shortages in resources such as time, experience poor infrastructure making it difficult to adhere to IPC measures and specify a need for management support regarding caring for carriers. Moral dimensions of care received limited attention. An example is that HCPs do not want to betray colleagues who ignore IPC measures, but simultaneously fear transmission due to poor compliance.

The diverse experiences provide input for future interventions to support HCPs in caring for MDRO carriers. The limited attention to moral dimensions of care restricts understanding of HCPs’ values and challenges. Strengthening support requires further research, particularly qualitative studies led by ethics experts.