Building implementation science for VA healthcare associated infection prevention

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 DESCRIPTION (provided by applicant): Background: The United States ranks 30th in the world in mortalty associated with infectious diseases. Healthcare-associated infections (HAI) are a major cause of morbidity and mortality in Veterans. According to the Centers for Disease Control and Prevention (CDC) there were 722,000 HAIs in U.S. acute care hospitals in 2011 and 75,000 attributable deaths. If HAI were ranked individually, it would tied with diabetes as the 7th leading cause of death. An Institute of Medicine study estimated the cost of these infections at 4.5 to 5.7 billion dollars per year and at a per-patient cost ranging from $5,000-$50,000 per episode. Prevention of HAI is included in the VHA Blueprint for Excellence as preventable HAIs greatly impact patient safety through increased readmissions and mortality. For these reasons, the VA National Center for Patient Safety has committed funding our proposal (PI: Safdar) to create a Patient Safety Center of Inquiry - Human-factors Engineering to prevent Resistant Organisms - the HERO Center at our VA-the William S. Middleton Memorial Veterans Hospital, Madison. The first proposed project will implement and evaluate using a mixed-methods, approach an evidence-based intervention - daily chlorhexidine bathing in hospitalized Veterans for prevention of HAI. Objectives (Year 1): We will establish an infrastructure for a practice-based quality improvement (QI) network: the VA Healthcare Infection prevention Network (VHIN) and will establish a patient advisory council, which will prepare patients to be active participants in infection prevention activities within a VA learning healthcare system. Furthermore, in Year 2 we will use VHIN to assess current practices and needs related to Veteran HAI prevention in collaboration with VHIN partners across VHA. We will use a mixed methods approach based on domains and constructs of the Consolidated Framework for Implementation Research (CFIR). Special attention will be given to gather information on practices related to daily chlorhexidine bathing (the first project of the HERO Center). Daily chlorhexidine bathing was selected as an initial target due to a large body of literature supporting its efficacy and its inclusion in national prevention guidelines as a level I (strong evidence to support adoption) intervention, as well as non-uniform implementation across VHA. We will advance the agenda of the VA National Center for Patient Safety by 1) developing a research network to rapidly deploy and evaluate evidence-based interventions for HAI prevention across VA - to organize processes of delivering evidence-based healthcare, 2) facilitating future QI studies to achieve the best possible outcomes within sustainable cost and, 3) allowing a broad-scale evaluation of practices while examining variation in intervention effect mediators and moderators along with patient acceptance. Methods: We will begin by creating a multidisciplinary steering committee, including patient participation, and by creating a repository of current practices in HAI prevention across VA. Once infrastructure is established, VHIN will serve as the platform for VA facilities seeking to undertake pragmatic implementation science initiatives related to HAI prevention. Although our attention will focus on daily chlorhexidine bathing; the approach and methods used will serve as a framework for other HAI-prevention initiatives. For example, as optimal methods for implementing chlorhexidine bathing are determined they will be rapidly disseminated (using VHIN); thus closing the gap between evidence and the practical use of evidence.