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Elliot AE, Bowman C, Schoeneman K. The Artifacts of Culture Change 2.0: A Person-Directed Implementation Tool. ACTIVITIES, ADAPTATION & AGING 2023. [DOI: 10.1080/01924788.2023.2188770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Affiliation(s)
- Amy E. Elliot
- Research and Evaluation Consultant,Amy Elliot Consulting, Columbus, Ohio
| | - Carmen Bowman
- MHS, Edu-Catering Catering Education for Compliance and Culture Change, Huntingburg, Indiana
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Backman C, Wooller KR, Hasimja‐Saraqini D, Demery Varin M, Crick M, Cho‐Young D, Freeman L, Delaney L, Squires JE. Intervention to reduce unnecessary urinary catheter use in a large academic health science centre: A one-group, pretest, posttest study with a theory-based process evaluation. Nurs Open 2022; 9:1432-1444. [PMID: 33988900 PMCID: PMC8859062 DOI: 10.1002/nop2.920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/17/2021] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
AIM To evaluate an intervention to reduce unnecessary urinary catheter use and prevent catheter-associated urinary-tract infections (CAUTI) in hospitalized patients across an academic health science centre. METHODS We conducted a one-group, pretest, posttest study with a theory-based process evaluation. Phase 1 consisted of a pre/postintervention to test the impact of a CAUTI protocol. Audits on four units were conducted, and data were analysed descriptively. Phase 2 consisted of a theory-based process evaluation to understand the barriers/enablers to the implementation. Semistructured interviews were conducted and then analysed using a systematic approach. RESULTS In Phase 1, all inpatients with urinary catheters admitted to the units (N = 4) during the study period (N = 99, pre) and (N = 99, post) were included. CAUTI prevalence rate was 18.2% pre versus 14.1% post (p = .563). In Phase 2, participants (N = 18) who worked on the units were interviewed, and a total of 13 barriers and 19 enablers were found.
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Affiliation(s)
- Chantal Backman
- School of NursingFaculty of Health SciencesUniversity of OttawaOttawaONCanada
- Ottawa Hospital Research InstituteOttawaONCanada
- Bruyère Research InstituteOttawaONCanada
| | | | | | | | - Michelle Crick
- School of NursingFaculty of Health SciencesUniversity of OttawaOttawaONCanada
| | - Danielle Cho‐Young
- School of NursingFaculty of Health SciencesUniversity of OttawaOttawaONCanada
| | | | | | - Janet E. Squires
- School of NursingFaculty of Health SciencesUniversity of OttawaOttawaONCanada
- Ottawa Hospital Research InstituteOttawaONCanada
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Meddings J, Greene MT, Ratz D, Ameling J, Fowler KE, Rolle AJ, Hung L, Collier S, Saint S. Multistate programme to reduce catheter-associated infections in intensive care units with elevated infection rates. BMJ Qual Saf 2020; 29:418-429. [PMID: 31911543 PMCID: PMC7176547 DOI: 10.1136/bmjqs-2019-009330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 10/04/2019] [Accepted: 10/13/2019] [Indexed: 01/02/2023]
Abstract
Background Preventing central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) remains challenging in intensive care units (ICUs). Objective The Agency for Healthcare Research and Quality Safety Program for ICUs aimed to reduce CLABSI and CAUTI in units with elevated rates. Methods Invited hospitals had at least one adult ICU with elevated CLABSI or CAUTI rates, defined by a positive cumulative attributable difference metric (CAD >0) in the Centers for Disease Control and Prevention’s Targeted Assessment for Prevention strategy. This externally facilitated programme implemented by a national project team and state hospital associations included on-demand video modules and live webinars reviewing a two-tiered approach for implementing key technical and socioadaptive factors to prevent catheter infections, using principles and tools based on the Comprehensive Unit-based Safety Program. CLABSI, CAUTI and catheter use data were collected (preintervention 13 months, intervention 12 months). Multilevel negative binomial models assessed changes in catheter-associated infection rates and catheter use. Results Of 366 recruited ICUs from 220 hospitals in 16 states and Puerto Rico for two cohorts, 280 ICUs completed the programme including infection outcome reporting; 274 ICUs had complete outcome data for analyses. Statistically significant reductions in adjusted infection rates were not observed (CLABSI incidence rate ratio (IRR)=0.75, 95% CI 0.52 to 1.08, p=0.13; CAUTI IRR=0.79, 95% CI 0.59 to 1.06, p=0.12). Adjusted central line utilisation (IRR=0.97, 95% CI 0.93 to 1.00, p=0.09) and adjusted urinary catheter utilisation were unchanged (IRR=0.98, 95% CI 0.95 to 1.01, p=0.14). Conclusion This multistate programme targeted ICUs with elevated catheter infection rates, but yielded no statistically significant reduction in CLABSI, CAUTI or catheter utilisation in the first two of six planned cohorts. Improvements in the interventions based on lessons learnt from these initial cohorts are being applied to subsequent cohorts.
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Affiliation(s)
- Jennifer Meddings
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA .,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - M Todd Greene
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - David Ratz
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Jessica Ameling
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Karen E Fowler
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Andrew J Rolle
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois, USA
| | - Louella Hung
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois, USA
| | - Sue Collier
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois, USA
| | - Sanjay Saint
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Tomczyk S, Aghdassi S, Storr J, Hansen S, Stewardson AJ, Bischoff P, Gastmeier P, Allegranzi B. Testing of the WHO Infection Prevention and Control Assessment Framework at acute healthcare facility level. J Hosp Infect 2019; 105:83-90. [PMID: 31870887 DOI: 10.1016/j.jhin.2019.12.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Monitoring and evaluation are an essential part of infection prevention and control (IPC) implementation. The authors developed an IPC assessment framework (IPCAF) to support implementation of the World Health Organization (WHO) guidelines on core components of IPC programmes in acute healthcare facilities. AIM To evaluate the usability and reliability of the IPCAF tool for global use. METHODS The IPCAF is a questionnaire with a scoring system to measure the level of IPC implementation according to the eight WHO core components. The tool was pre-tested qualitatively, revised and translated selectively. A convenience sample of hospitals was invited to participate in the final testing. At least two IPC professionals from each hospital independently completed the IPCAF and a usability questionnaire online. The tool's internal consistency and interobserver reliability or intraclass correlation coefficient (ICC) were assessed, and usability questions were summarized descriptively. FINDINGS In total, 46 countries, 181 hospitals and 324 individuals participated; 52 (16%) and 55 (17%) individual respondents came from low- and lower-middle income countries, respectively. Fifty-two percent of respondents took less than 1 h to complete the IPCAF. Overall, there was adequate internal consistency and a high ICC (0.92, 95% confidence interval 0.89-0.94). Ten individual questions had poor reliability (ICC <0.4); these were considered for revision according to usability feedback and expert opinion. CONCLUSIONS The WHO IPCAF was tested using a robust global study and revised as necessary. It is now an effective tool for IPC improvement in healthcare facilities.
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Affiliation(s)
- S Tomczyk
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland; Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - S Aghdassi
- Charité Universitätsmedizin Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - J Storr
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - S Hansen
- Charité Universitätsmedizin Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - A J Stewardson
- Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, Australia
| | - P Bischoff
- Charité Universitätsmedizin Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - P Gastmeier
- Charité Universitätsmedizin Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - B Allegranzi
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland; Institute of Global Health, University of Geneva, Geneva, Switzerland.
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Patel PK, Olmsted RN, Hung L, Popovich KJ, Meddings J, Jones K, Calfee DP, Fowler KE, Saint S, Chopra V. A Tiered Approach for Preventing Central Line-Associated Bloodstream Infection. Ann Intern Med 2019; 171:S16-S22. [PMID: 31569225 DOI: 10.7326/m18-3469] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Payal K Patel
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., J.M., S.S., V.C.)
| | - Russell N Olmsted
- Integrated Clinical Services Team, Trinity Health, Livonia, Michigan (R.N.O.)
| | - Louella Hung
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (L.H.)
| | | | - Jennifer Meddings
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., J.M., S.S., V.C.)
| | - Karen Jones
- University of Michigan Medical School, Ann Arbor, Michigan (K.J.)
| | | | - Karen E Fowler
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (K.E.F.)
| | - Sanjay Saint
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., J.M., S.S., V.C.)
| | - Vineet Chopra
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., J.M., S.S., V.C.)
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Meddings J, Manojlovich M, Fowler KE, Ameling JM, Greene L, Collier S, Bhatt J, Saint S. A Tiered Approach for Preventing Catheter-Associated Urinary Tract Infection. Ann Intern Med 2019; 171:S30-S37. [PMID: 31569226 DOI: 10.7326/m18-3471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jennifer Meddings
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (J.M., S.S.)
| | | | - Karen E Fowler
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (K.E.F.)
| | | | - Linda Greene
- University of Rochester Highland Hospital, Rochester, New York (L.G.)
| | - Sue Collier
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.C., J.B.)
| | - Jay Bhatt
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.C., J.B.)
| | - Sanjay Saint
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (J.M., S.S.)
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Popovich KJ, Davila S, Chopra V, Patel PK, Lassiter S, Olmsted RN, Calfee DP. A Tiered Approach for Preventing Methicillin-Resistant Staphylococcus aureus Infection. Ann Intern Med 2019; 171:S59-S65. [PMID: 31569224 DOI: 10.7326/m18-3468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Shannon Davila
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.D., S.L.)
| | - Vineet Chopra
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (V.C., P.K.P.)
| | - Payal K Patel
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (V.C., P.K.P.)
| | - Shelby Lassiter
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.D., S.L.)
| | - Russell N Olmsted
- Integrated Clinical Services Team, Trinity Health, Livonia, Michigan (R.N.O.)
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Saint S, Meddings J, Fowler KE, Vaughn VM, Ameling JM, Rohde JM, Popovich KJ, Calfee DP, Krein SL, Chopra V. The Guide to Patient Safety for Health Care-Associated Infections. Ann Intern Med 2019; 171:S7-S9. [PMID: 31569222 DOI: 10.7326/m18-3443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sanjay Saint
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (S.S., V.M.V., S.L.K., V.C.)
| | - Jennifer Meddings
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System,Ann Arbor, Michigan (J.M.)
| | - Karen E Fowler
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (K.E.F.)
| | - Valerie M Vaughn
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (S.S., V.M.V., S.L.K., V.C.)
| | - Jessica M Ameling
- University of Michigan Medical School, Ann Arbor, Michigan (J.M.A., J.M.R.)
| | - Jeffrey M Rohde
- University of Michigan Medical School, Ann Arbor, Michigan (J.M.A., J.M.R.)
| | - Kyle J Popovich
- Rush University Medical Center/Stroger Hospital of Cook County, Chicago, Illinois (K.J.P.)
| | | | - Sarah L Krein
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (S.S., V.M.V., S.L.K., V.C.)
| | - Vineet Chopra
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (S.S., V.M.V., S.L.K., V.C.)
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Colborn KL, Bronsert M, Hammermeister K, Henderson WG, Singh AB, Meguid RA. Identification of urinary tract infections using electronic health record data. Am J Infect Control 2019; 47:371-375. [PMID: 30522837 DOI: 10.1016/j.ajic.2018.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/13/2018] [Accepted: 10/14/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Population ascertainment of postoperative urinary tract infections (UTIs) is time-consuming and expensive, as it often requires manual chart review. Using the American College of Surgeons National Surgical Quality Improvement Program UTI status of patients who underwent an operation at the University of Colorado Hospital, we sought to develop an algorithm for identifying UTIs using data from the electronic health record. METHODS Data were split into training (operations occurring between 2013-2015) and test (operations in 2016) sets. A binomial generalized linear model with an elastic-net penalty was used to fit the model and carry out variables selection. International classification of disease codes, common procedural terminology codes, antibiotics, catheterization, and common procedural terminology-specific UTI event rates were included as predictors. The Youden's J statistic was used to determine the optimal classification threshold. RESULTS Of 6,840 patients, 134 (2.0%) had a UTI. The model achieved 92% specificity, 80% sensitivity, 100% negative predictive value, 16% positive predictive value, and an area under the curve of 0.94 using a decision threshold of 0.03. CONCLUSIONS A model with 14 predictors from the electronic health record identifies UTIs well, and it could be used to scale up UTI surveillance or to estimate the impact of large-scale interventions on UTI rates.
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Affiliation(s)
- Kathryn L Colborn
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Michael Bronsert
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Surgery, Surgical Outcomes and Applied Research Program, School of Medicine, University of Colorado Anschutz Medical Campus, University of Colorado, Aurora, CO
| | - Karl Hammermeister
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Surgery, Surgical Outcomes and Applied Research Program, School of Medicine, University of Colorado Anschutz Medical Campus, University of Colorado, Aurora, CO; Department of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - William G Henderson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Surgery, Surgical Outcomes and Applied Research Program, School of Medicine, University of Colorado Anschutz Medical Campus, University of Colorado, Aurora, CO
| | - Abhinav B Singh
- Department of Surgery, Surgical Outcomes and Applied Research Program, School of Medicine, University of Colorado Anschutz Medical Campus, University of Colorado, Aurora, CO
| | - Robert A Meguid
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Surgery, Surgical Outcomes and Applied Research Program, School of Medicine, University of Colorado Anschutz Medical Campus, University of Colorado, Aurora, CO
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