Searching for Management Approaches to Reduce HAI Transmission (SMART)

项目摘要/摘要 在医院，医疗保健相关感染(HAI)通过延长时间影响患者的生命 住院、发病率和死亡，并导致卫生系统和 社会。中心线相关性血流感染和导尿管相关性尿路感染 感染(CAUTI)被认为是两种最可预防的禽流感。尽管有可用的 临床循证减少策略，医院成功降低CLABSI和 CAUTI利率。通过综合单元安全将临床证据应用于实践的努力 计划(CUSP)和类似计划也显示出好坏参半的成功，很大程度上仅限于ICU 环境。此外，研究表明，成功的差异是由于缺乏对管理的指导 针对CLABSI和CAUTI预防工作的背景的做法。因此，有一种 需要探索如何成功地将CUSP等降低HAI的努力转化为非ICU环境(临床 实践)，以及如何塑造环境(管理实践)--包括文化和管理战略-- 积极支持临床团队。 我们的建议，寻找减少HAI传播的管理方法(SMART)，建立在 之前的工作，以阐明和实施建议与之相关的管理做法 成功地减少CLABSI的努力，以及扩大这些做法，以促进减少CAUTI。我们 采用混合方法分三个阶段：(1)制定有效和可靠的结构措施 作为调查使用的管理实践(HAI管理实践指南调查)，可用于 内科/外科单位和ICU；(2)管理HAI管理实践指南调查 俄亥俄州医院确定测量仪器的阳性预测值，因为它与 CLABSI和CAUTI-预防，并将调查数据收集扩大到全国样本；以及(3)整合 这些调查结果纳入管理实践工具包，其中包括特定于组织的数据仪表板，用于 监测支持HAI预防工作的进展情况，并在全国范围内传播该工具包。聪明人 我们开发的工具包将包含三个组件：(1)在线调查平台，(2)可视化和 仪表板，以及(3)实施培训计划。因此，医院将能够使用智能 回答这些问题的工具包-我的医院在绝对和相对方面的表现如何，我可以做些什么 影响我的结果-使用实时报告工具并指导实施结构性 事实证明，管理实践在改善全国其他医院的患者安全方面是有效的。

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.