Implementation of Chlorhexidine Bathing to Reduce Healthcare-Associated Infections-the Icare study

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 DESCRIPTION (provided by applicant): Healthcare-associated infections cause increased morbidity, mortality and medical costs. It is estimated that 722,000 people get a healthcare-associated infection every year (1 in 25 hospitalized patients) and 75,000 people with HAIs die. In recent years, the evidence base for interventions to reduce healthcare-associated infections has grown substantially and HAIs are considered largely preventable and a patient safety issue. However, a considerable gap continues to exist between evidence and practice in the field of healthcare-associated infection prevention. Thus, an important opportunity and challenge to reduce the health and economic burden of healthcare-associated infection in the United States is the translation of interventions in multiple real world settings. Daily chlorhexidine bathing isan efficacious and effective intervention that can reduce healthcare-associated infections. Key issues to address to disseminate this intervention into widespread practice include the adaptation of the intervention for use in multiple settings and populations; research on the feasibility, acceptability, reach and uptake of the intervention for both the facility and individul participants and implementation evaluation including barriers and facilitators assessment. We propose to implement and evaluate the process of implementing a daily chlorhexidine bathing intervention using an innovative systems engineering approach, the Systems Engineering Initiative for Patient Safety in multiple non ICU settings. We will employ a mentored implementation approach and will evaluate the implementation using a multiple case study approach including assessment of barriers and facilitators and fidelity to the daily chlorhexidine bathing intervention using direct observations, chlorhexidine usage, electronic health record documentation and microbiologic assessment of chlorhexidine concentrations. We will also explore the impact of the daily chlorhexidine bathing intervention on healthcare-associated infections. This study will provide a framework to implement and evaluate other evidence-based interventions for healthcare- associated infection prevention.