Reducing health care-associated infections (HAIs): lessons learned from a national collaborative of regional HAI programs.

BACKGROUND: Health care-associated infections (HAIs) are a leading cause of death in United States health care settings, with an overall estimated annual incidence of 1.7 million. As antimicrobial resistance has increased, so too have efforts to reduce HAI rates. The objective of this study was to identify commonly cited lessons learned across a wide variety of HAI projects and hospital settings. METHODS: Thirty-three hospitals participated in 5 different regional collaboratives supported by the Agency for Healthcare Research and Quality (AHRQ). Data on hospitals' successes, challenges, and lessons learned were collected via key informant interviews and structured, standardized case report forms. RESULTS: Seven commonly cited themes were identified: foster change by first understanding resistance; commit to regular strategic communication and join a collaborative; start small and tailor implementation to local needs and cultures; engage frontline staff by involving them in the project and enlisting champions; educate and reeducate; convince administration to provide leadership, funds, and dedicated staff and assign accountability; and provide timely, relevant feedback and celebrate successes. CONCLUSION: Despite the diversity of hospital settings, cultures, personnel, and HAI reduction projects, we found that hospitals encounter similar challenges and facilitators across projects. We offer a model of 7 process elements shown to be important to successful implementation.

Implementing the MRSA bundle in ICUs: one citywide collaborative's key lessons learned.

Because bundle implementation in intensive care units to reduce methicillin-resistant Staphylococcus aureus is challenging, we conducted in-depth interviews with implementation teams at 5 participating hospitals. Key lessons learned across hospitals included the following: maintain management support, engage frontline staff, build the right multidisciplinary team, conduct process mapping, and commit to data collection and feedback.

A national collaborative for reducing health care‒associated infections: current initiatives, challenges, and opportunities.

There has been increasing interest and an upsurge in efforts to prevent hospital-associated infections (HAIs), a leading cause of death in the United States. This study was conducted to assess current strategies and efforts of HAI reduction initiatives in hospitals. HAI reduction initiatives and factors influencing institutional participation in these initiatives were categorized. Data were collected via open-ended questions on surveys performed in 5 different HAI collaboratives. Thematic analysis of the coded qualitative data was conducted. A total of 1,212 health care professionals from 33 different hospitals participated. Improving hand hygiene was the most frequently mentioned HAI reduction initiative implemented in the previous year. Initiatives for reducing central line or central venous catheter infections and ventilator-associated pneumonia also were commonly cited. The most frequently mentioned challenges to implementing HAI reduction initiatives included poor adherence, insufficient resources, staffing problems, lack of culture change, no impetus to change, and issues related to staff and patient education. Many respondents identified engaging physicians as particularly challenging.These findings suggest that consistently improving hand hygiene remains a widespread problem for reducing HAIs and sustaining this type of behavioral change is difficult. Furthermore, ensuring staff and physician engagement and compliance in HAI reduction efforts remains challenging for most hospitals.

Barriers and facilitators to nursing handoffs: Recommendations for redesign.

During a handoff, communication errors can lead to adverse events and suboptimal patient care. As a result, many institutions want to redesign their handoff processes, but have little specific guidance from the literature. We examined two approaches to nursing end-of-shift reports both taped and written, to identify specific factors limiting and facilitating such handoffs. Twenty nurses were interviewed using a semistructured format. They were asked about the current reporting process, the limitations, the elements that helped, and ideas for improvement. Analyses revealed that inadequate information, inconsistent quality, limited opportunity to ask questions, equipment malfunction, insufficient time to generate reports, and interruptions, limited handoffs. Facilitators were "pertinent" content, notes and space for notes, face-to-face interaction, and structured form/checklist. Recommendations for redesign are defining content pertinent to the unit, structuring handoffs so that information is received in a standard way, embedding an opportunity for questions into the process, planning for all 3 handoff subprocesses, and conducting peer evaluations and education.