Infection prevention and control in nursing homes under pandemic-level pressure: qualitative insights from Swedish care workers

BACKGROUND: The COVID-19 pandemic placed considerable pressure on nursing homes, where care workers faced high workloads, uncertainty, and emotional strain while also being expected to implement extensive infection prevention and control (IPC) measures. Understanding how such everyday experiences affect adherence to IPC measures is essential for strengthening future guideline implementation and training. This study aimed to explore care workers' experiences during the COVID-19 pandemic, with a focus on IPC measures and the realities of everyday work. METHODS: A qualitative descriptive design was used. Semi-structured interviews were conducted with 22 nurse assistants and care aides from 19 nursing homes in northern and southern Sweden (May-November 2023). The interviews were recorded, transcribed and then analyzed using inductive qualitative content analysis. The study was guided by the Consolidated Criteria for Reporting Qualitative Research. RESULTS: Three main categories captured nurse assistants' and care aides' experiences of how demanding everyday realities during the pandemic shaped adherence to IPC measures. (1) Organizational determinants highlighted the importance of leadership presence, clear information, and resource availability. (2) Individual aspects described how knowledge, beliefs, and physical discomfort influenced motivation to adhere. (3) Ethical issues related to IPC measures reflected tensions between IPC practices and meeting residents' social and emotional needs. CONCLUSIONS: This study highlights how leadership, resources, and knowledge supported IPC adherence, while personal beliefs and ethical implications complicated practice. Future preparedness requires policies that integrate organizational support with the human dimensions of care, ensuring that infection control and dignified care are mutually reinforced.