QUERI – Quality Enhancement Research Initiative

Combating Antimicrobial Resistance through Rapid Implementation of Available Guidelines and Evidence (CARRIAGE)

Salt Lake City, UT, Hines, IL, and Iowa City, IA

View program fact sheet

The goal of the Combating Antimicrobial Resistance through Rapid Implementation of Available Guidelines & Evidence (CARRIAGE) QUERI program is to address the growing public health crisis of anti­microbial resistance through strate­gies that support the uptake of new and existing evidence-based practices, policies, and programs targeting the improved use of antibiotics and the prevention of healthcare-associated infections. CARRIAGE QUERI is a series of related projects unified around the common goal of arresting and potentially reversing the spread of antimicrobial resistance in VA healthcare facilities and beyond. Specific objectives are to:

• Foster improved healthcare worker handwashing practice by repairing the broken audit-and-feedback mechanism in VA acute-care hospitals via a VISN-wide quality improvement project;
• Support and enhance the implementation of new VA guidelines to detect and prevent the spread of highly resistant carbapenem-resistant Enterobacteriaceae (CRE) in VA hospitals; and
• Promote judicious inpatient antibiotic use through a novel self-stewardship "timeout" project that prompts VA providers to evaluate the continued need for antibiotics.

Expected Findings and Impacts:

The CARRIAGE QUERI program is expected to have substantial and long-lasting impact in improving VA quality of care and patient safety, both by leveraging the current investments of its operational partners in the form of national initiatives or guidelines – and by informing future infection prevention and patient safety efforts, including the implemen­tation of future VA-wide practice guidelines or bundles. Better control of the spread of antimicrobial-resistant organisms within VA healthcare facilities is expected through:

• Improved handwashing compliance via a novel audit method that can be readily imple­mented throughout the VA system;
• More appropriate and judicious use of broad-spectrum antibiotics via self-stewardship and decision-support for frontline VA providers; and
• Identification and promotion of "best practices" that facilitate the success of national VA infection prevention policy implementation.

Principal Investigators: Michael Rubin, MD, PhD (michael.rubin2@va.gov); Charlesnika Evans, MPH, PhD; and Eli Perencevich, MD, MS.

Principal Operational Partners: National Infectious Diseases Service (NIDS), MDRO Program Office, National Center for Patient Safety (NCPS), VA Antimicrobial Stewardship Task Force, and the National Center for Occupational Health and Infection Control (COHIC).