Building implementation science for VA healthcare associated infection prevention

 描述（由申请人提供）： 背景：美国在与传染病相关的死亡率方面排名世界第30位。卫生保健相关感染（HAI）是退伍军人发病和死亡的主要原因。根据疾病控制和预防中心（CDC）的数据，2011年美国急性护理医院有722，000例HAI，75，000例可归因死亡。如果HAI单独排名，它将与糖尿病并列为第七大死亡原因。研究所 医学研究估计，这些感染的成本为每年45亿至57亿美元， 每个患者的费用范围为每次发作5，000 - 50，000美元。预防HAI包含在VHA卓越蓝图中，因为可预防的HAI通过增加再入院率和死亡率极大地影响患者安全。出于这些原因，VA国家患者安全中心已承诺资助我们的提案（PI：Safdar），以创建一个患者安全调查中心-人为因素工程，以防止耐药生物-英雄中心在我们的VA-威廉S。米德尔顿纪念退伍军人医院，麦迪逊。第一个拟议的项目将使用混合方法实施和评估，采用循证干预措施-住院退伍军人每天洗氯己定洗澡预防HAI。目标（第一年）：我们将建立一个基于实践的质量改进（QI）网络的基础设施：VA医疗感染预防网络（VHIN），并将建立一个患者咨询理事会，该理事会将使患者做好准备，积极参与VA学习医疗保健系统内的感染预防活动。此外，在第二年，我们将与VHA的VHIN合作伙伴合作，使用VHIN评估与退伍军人HAI预防相关的当前实践和需求。我们将使用基于实施研究综合框架（CFIR）的领域和结构的混合方法。将特别注意收集与每日洗必泰沐浴有关的做法的信息（HERO中心的第一个项目）。选择每日洗必泰洗澡作为初始目标，是因为大量文献支持其疗效，并将其作为I级（支持采用的有力证据）干预措施纳入国家预防指南，以及VHA的实施不统一。我们将通过以下方式推进弗吉尼亚州国家患者安全中心的议程：1）开发一个研究网络，以快速部署和评估弗吉尼亚州HAI预防的循证干预措施-组织提供循证医疗保健的过程，2）促进未来的QI研究，以在可持续的成本范围内实现最佳可能的结果，3）允许对实践进行广泛的评估，同时检查干预效果介导者和调节者沿着患者接受度的变化。研究方法：我们将开始通过创建一个多学科的指导委员会，包括患者的参与，并通过创建一个存储库，目前的做法，在HAI预防整个VA。一旦基础设施建立，VHIN将作为VA设施寻求开展与HAI预防相关的务实实施科学举措的平台。虽然我们的注意力将集中在每日洗必泰洗澡;所使用的方法和手段将作为其他HAI预防措施的框架。例如，当确定了洗必泰沐浴的最佳方法时，它们将迅速传播（使用VHIN）;从而缩小证据与证据实际使用之间的差距。

 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.