Enactment of infection control link nurse roles in nursing homes; a multimethod study

Implementation of the infection control link nurse (ICLN) role could be a promising strategy to enhance infection prevention and control (IPC) in nursing homes. Yet, little is known about how this role is enacted in practice. This study therefore examines the implementation of the ICLN role in nursing homes, how ICLNs enact their role in practice, and the factors influencing role enactment. In this multimethod study, we administered two questionnaires (Q1: organizational implementation; Q2: local enactment), and conducted semi structured interviews with ICLNs working in nursing homes. Respondents were recruited via snowball sampling, from initial contacts identified through broad outreach and professional networks. Quantitative data were analyzed descriptively while qualitative data were analyzed using a thematic analysis-informed approach. Between June 2024 and January 2025, 118 questionnaires were completed and 21 semi-structured interviews were conducted with ICLNs. The questionnaire administered on organizational level (Q1) indicated that within most nursing home organizations ICLNs were appointed (30/36, 83.3%). However, the organizational IPC structure within which the ICLN role was implemented varied considerably, as did the extent of training and support. Findings from the questionnaire administered on location level (Q2) showed variation in how ICLNs enacted the role. Interviews with ICLNs further clarified that organizational alignment and supervisors’ prioritization of IPC shaped the availability of IPC resources (training and allocated time), while supervisor engagement appeared to influence ICLNs’ perceived authority and role perceptions. In turn, facilitation of IPC application, through expert input or peer learning, supported more proactive role enactment and ongoing IPC improvements. ICLNs who reported an absence of these factors also mentioned role uncertainty and lower motivation, and more often described a reactive approach to IPC. These ICLNs also reported feeling less capable of achieving sustained IPC improvements. The ICLN role has been widely implemented in nursing homes, however, its enactment varies and is influenced by multiple factors. Our findings suggest that supportive organizational conditions may be important for enabling proactive role enactment, possibly by strengthening ICLN role ownership. Additionally, the presence of a dedicated facilitator may enable ICLNs to identify opportunities for IPC improvement and follow up on these.