Searching for Management Approaches to Reduce HAI Transmission (SMART)

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Project Summary/Abstract In hospitals, healthcare-associated infections (HAIs) impact the lives of patients through prolonged hospitalization, morbidity, and death, and result in significant financial costs to both health systems and society. Central line–associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are considered two of the most preventable types of HAIs. Despite the availability of clinical evidence-based reduction strategies, hospitals vary in abilities to successfully reduce CLABSI and CAUTI rates. Efforts to apply clinical evidence to practice through the Comprehensive Unit-based Safety Program (CUSP) and similar programs have also shown mixed success, and have been largely limited to ICU environments. Moreover, research suggests variation in success is due to a lack of guidance on management practices that address the context in which CLABSI- and CAUTI-prevention efforts take place. Thus there is a need to explore how to successfully translate HAI-reduction efforts such as CUSP to non-ICU settings (clinical practice), and how to shape context (management practice)--including both culture and management strategies-- to proactively support clinical teams. Our proposal, Searching for Management Approaches to Reduce HAI Transmission (SMART), builds on prior work to explicate and operationalize management practices that were suggested to be associated with successful CLABSI-reduction efforts, as well as expand these practices to promote CAUTI reduction. We employ a mixed-methods approach in three phases to (1) develop valid and reliable measures of structural management practices for use as a survey (HAI Management Practice Guideline Survey) that can be used in both medical/surgical units and ICUs; (2) administer the HAI Management Practice Guideline Survey within Ohio hospitals to determine the positive predictive value of the measurement instrument as it relates to CLABSI- and CAUTI-prevention, and expand survey data collection to a national sample; and (3) integrate these findings into a Management Practices Toolkit that includes an organization-specific data dashboard for monitoring progress in support of HAI-prevention efforts, and disseminate the toolkit nationwide. The SMART Toolkit we develop will contain three components: (1) an Online Survey Platform, (2) Visualization and Dashboarding, and (3) an Implementation Training Program. Hospitals will thus be able to use the SMART Toolkit to answer the questions – how is my hospital doing, in both absolute and relative terms, and what can I do to impact my outcomes – using real-time reporting tools and with guidance about implementing structural management practices that have proved effective at improving patient safety at other hospitals across the nation.