Implementing Evidence to Prevent Urinary Infection and Enhance Patient Safety

描述(由申请人提供)：确保循证实践在现实世界的临床环境中的有效使用可能是具有挑战性的。我们认为，护士在实施这些做法方面发挥了关键作用，特别是旨在预防与医疗保健相关的感染的做法。导尿管相关的尿路感染是美国最常见的与医疗保健相关的感染，是一种代价高昂且具有潜在致命性的疾病。密歇根州正在启动一项雄心勃勃的患者安全项目，以减轻与留置导尿术相关的疾病负担。这项研究的首要目标是确定和制定战略，以优化在患者安全和医疗保健相关感染预防领域的关键实践的实施。本研究有三个目的：1)描述作为密歇根州患者安全倡议的一部分的导管相关尿路感染预防捆绑包(膀胱束)的采用和实施情况，并评估患者结果，如导尿管的使用和感染率；2)确定和比较跨不同医院实施膀胱束的障碍和促进者；3)制定和评估促进膀胱束实施的策略和评估患者结果，包括导尿管使用、停止使用、重新插入和感染率。本次调查包括定量和定性数据的收集和分析。我们已经组建了一个跨学科团队，该团队已经在先前的研究中成功地合作，以实施这一及时和创新的患者安全项目。对于第一个目标，我们将使用调查方法来描述膀胱束的传播、采用和实施以及关键的患者结果。对于第二个目标，我们将主要使用定性方法，包括电话采访和现场访问。这一办法将使我们能够更深入地审查复杂的组织因素，这些因素要么是促进者，要么是执行膀胱束的障碍。我们还将制定实施战略和工具，然后将与正在实施膀胱束的三家医院合作进行评估。对于第三个目标，我们建议在实施干预措施之前、期间和之后收集定性数据，以便进行形成性评估，包括对实施过程、成果和可持续性的评估。我们还将收集有关患者结局的量化数据，如导管使用、停用和感染率。公共卫生相关性：导尿管相关的尿路感染是一种常见的、代价高昂的潜在致命性疾病。这项研究的目的是开发有助于预防导尿管相关尿路感染的方法。我们的研究还将为如何预防其他与医疗保健相关的感染提供见解，从而创建一个更安全的医疗保健系统。

DESCRIPTION (provided by applicant): Ensuring the effective use of evidence-based practices in real-world clinical settings can be challenging. We believe that nurses play a key role in the implementation of such practices, especially practices aimed at preventing healthcare-associated infection. Catheter-related urinary tract infection} the most frequent healthcare-associated infection in the United States} is a costly and potentially lethal condition. The state of Michigan is initiating an ambitious patient safety project to ameliorate the burden of disease associated with indwelling catheterization. The overarching objective of this research is to identify and develop strategies to optimize the implementation of key practices in the field of patient safety and healthcare-associated infection prevention. This study has three aims: 1) To describe the adoption and implementation of a Catheter-Associated Urinary Tract Infection Prevention Bundle (Bladder Bundle) as part of a Michigan state-wide patient safety initiative and assess patient outcomes such as catheter utilization and infection rates; 2) To identify and compare the barriers to and facilitators of implementing the Bladder Bundle across a diverse group of hospitals; and 3) To develop and evaluate strategies to facilitate implementation of the Bladder Bundle and assess patient outcomes including catheter utilization, discontinuation, re-insertion, and infection rates. This investigation includes the collection and analysis of both quantitative and qualitative data. We have assembled an interdisciplinary team that has already worked successfully together on a prior study to conduct this timely and innovative patient safety project. For the first aim we will use survey methods to describe the diffusion, adoption, and implementation of the Bladder Bundle and key patient outcomes. For the second aim we will use primarily qualitative methods, consisting of both phone interviews and site visits. This approach will allow us to examine in greater depth complex organizational factors that serve as either facilitators or barriers to implementing the Bladder Bundle. We will also develop implementation strategies and tools that will then be evaluated in collaboration with three hospitals that are in the process of implementing the Bladder Bundle. For the third aim we propose to collect qualitative data before, during, and after the implementation of the intervention in order to conduct a formative evaluation, including an evaluation of implementation process, attainment, and sustainability. We will also collect quantitative data on patient outcomes such as catheter use, discontinuation, and infection rates. PUBLIC HEALTH RELEVANCE: Catheter-related urinary tract infection is a common, costly, and potentially lethal condition. The purpose of this research is to develop methods to help prevent catheter-related urinary tract infection. Our study will also provide insight on how to prevent other healthcare-associated infections, thereby creating a safer healthcare system.