Exploring the adaptive and interpretive dynamics of implementation in infection p

描述（由申请人提供）：探索感染预防实施的适应性和解释性动力学摘要患者在医疗环境中接受治疗期间获得的感染，称为医疗相关感染（HAI），是美国医院护理中最常见的并发症之一。它们在发病率、死亡率和成本方面造成巨大损失。医院和临床医生可以使用各种简单的循证指南来预防HAI。尽管存在这些感染预防措施，但仍然存在一个难题：许多医院没有采用这些措施，即使采用了，也面临着让医护人员持续使用这些措施的巨大挑战。预防HAI的措施与实际措施之间的差距是改善感染预防的关键障碍。然而，对预防感染的执行动态系统了解甚少。所了解的情况主要来自对执行过程的回顾。因此，我们对感染预防方面的组织变革随着时间的推移实际发生的方式的认识存在差距。本论文项目的目的是探讨一家医院的经验，因为它实施了一个组织范围内的感染预防措施，以确定成功的组织变革的障碍和促进因素。该项目有三个主要目标：1）描述在实施感染预防措施时适应当地情况的动态过程，重点是变化如何发生并随着时间的推移而持续2）确定医院工作人员如何解释和理解感染预防实践的变化，并了解这些解释如何影响工作人员采取的行动，以实施改变后的实践，3）通过研究感染预防的适应性和解释性动态的理论思想如何因HAI类型、单位文化和结构、前线员工的专业身份以及预防实践的证据基础的强度而有所不同，来发展和完善这些理论思想。该项目是一个为期2年的多方法定性案例研究的一家医院，正在进行“预防HAI”的倡议，以减少这些感染的发生率。方法将包括民族志观察的倡议活动和深入采访两组医院员工在多个时间点：参与规划和实施的倡议和一线临床工作人员。这项研究将产生有关实施过程的知识，可用于改善其他医疗机构循证感染预防实践的实施策略的设计。改善循证感染预防实践的实施非常重要，因为持续使用这些实践可以帮助降低HAI传播给患者的比率。减少并最终消除这些感染将提高向住院患者提供护理的质量、安全性和成本效益。 公共卫生相关性：拟议的研究与公共卫生、政策和实践相关，因为它将产生可用于改进战略设计的知识，以实施循证感染预防实践。改进这些实践的实施很重要，因为这些实践的一致使用可以帮助降低HAI传播给患者的比率。减少并最终消除这些感染将提高向住院患者提供护理的质量、安全性和成本效益。

DESCRIPTION (provided by applicant): Exploring the Adaptive and Interpretive Dynamics of Implementation in Infection Prevention Abstract Infections acquired by patients during the course of receiving treatment within a healthcare setting, known as healthcare-associated infections (HAIs), are one of the most common complications of hospital care in the United States. They exact a tremendous toll in morbidity, mortality and costs. Various simple, evidence-based guidelines are available to hospitals and clinicians to use in the prevention of HAIs. Despite the existence of these infection prevention measures, a puzzle remains: many hospitals have not adopted them and even when they do, face considerable challenges in getting healthcare workers to consistently use them. The gap between what should be done to prevent HAIs and what is actually done is a critical barrier to improvement in infection prevention. Yet little systematic knowledge about the dynamics of implementation in infection prevention exists. What is known largely comes from retrospective accounts of the implementation process. As a result, there is a gap in our knowledge about the way in which organizational change in infection prevention actually occurs over time. The purpose of this dissertation project is to explore the experience of one hospital as it implements an organization-wide infection prevention initiative in order to identify barriers and facilitators to successful organizational change. The project has three primary aims: 1) To describe the dynamic process of adaptation to local context in the implementation of an infection prevention initiative with a focus on how change happens and is sustained over time 2) To identify how hospital staff interpret and make sense of changes to infection prevention practice and to understand how these interpretations influence the actions staff take to implement changed practices into their everyday work, and 3) To develop and refine theoretical ideas relating to the adaptive and interpretive dynamics of implementation in infection prevention by examining how they vary by type of HAI, unit culture and structure, professional identity of frontline staff and the strength of the evidence base available for the prevention practice. The project is a 2-year multi-method qualitative case study of one hospital that is undertaking a "Preventing HAI" initiative to reduce the rates of these infections. Methods will include ethnographic observations of initiative activities and in-depth interviews with two groups of hospital employees at multiple points in time: those involved in planning and implementing the initiative and frontline clinical staff. This study will generate knowledge about the implementation process that can be used to improve the design of implementation strategies for evidence-based infection prevention practices in other healthcare organizations. Improving implementation of evidence-based infection prevention practices is important because the consistent use of these practices can help reduce rates of HAIs transmitted to patients. The reduction and eventual elimination of these infections will improve the quality, safety and cost- effectiveness of care delivered to hospitalized patients. PUBLIC HEALTH RELEVANCE: The proposed research is relevant to public health, policy and practice because it will generate knowledge that can be used to improve the design of strategies to implement evidence-based infection prevention practices. Improving implementation of these practices is important because the consistent use of these practices can help reduce rates of HAIs transmitted to patients. The reduction and eventual elimination of these infections will improve the quality, safety and cost-effectiveness of care delivered to hospitalized patients.