QUERI – Quality Enhancement Research Initiative

Building Implementation Science for VA Healthcare-Associated Infection Prevention

Madison, WI

Overview:

Healthcare-associated infections (HAI) are a major cause of morbidity and mortality among Veterans. According to the Centers for Disease Control and Prevention (CDC) there were 722,000 HAIs in U.S. acute care hospitals in 2011, resulting in 75,000 deaths. Moreover, an Institute of Medicine study estimated the cost of these infections at 4.5 to 5.7 billion dollars per year at a per-patient cost ranging from $5,000-$50,000 per episode. Prevention of HAI is included in the VHA Blueprint for Excellence as preventable HAIs greatly impact patient safety through increased readmissions and mortality. For these reasons, the VA National Center for Patient Safety (NCPS) has committed funding to create the Human-factors Engineering to prevent Resistant Organisms (HERO Center)located at the William S. Middleton Memorial Veterans Hospital in Madison, WI. The first project will implement and evaluate an evidence-based intervention - daily chlorhexidine bathing of hospitalized Veterans for prevention of HAI. In Year two, investigators will use VHIN (VA Healthcare-Associated Infection Prevention Network) to assess current practices and needs related to HAI prevention in collaboration with VHIN partners across the VA healthcare system.

Project Objectives:

This Initiative will advance the agenda of the VA National Center for Patient Safety by:

• Develop a research network to rapidly deploy and evaluate evidence-based interventions for HAI prevention across VA , in order to organize processes of delivering evidence-based healthcare;
• Facilitate future quality improvement studies to achieve the best possible outcomes within sustainable cost; and
• Allow a broad-scale evaluation of practices, while examining variation in intervention effect mediators and moderators along with patient acceptance.

Specific Aims of the Initiative also include:

• Establishing the national VHIN infrastructure to connect individual VA facilities and mitigate barriers to implementation of HAI prevention activities;
• Activating patients and their families in infection prevention studies as active consumers and stakeholders;
• Initiating a national patient core group within VHIN that will advance patient-centered infection-prevention issues;
• Assessing current practices and needs related to HAI prevention quality improvement in collaboration with VHIN members and partners, with specific attention to practices related to infection prevention (e.g., chlorhexidine bathing);
• Evaluate the formation and use of VHIN using process evaluation measures; and
• Ensure sustainability of VHIN, including patient activation.

Methodology:

Investigators will create a multi-disciplinary steering committee, including Veterans, as well as a repository of current practices in HAI prevention across VA. Once infrastructure is established, VHIN will serve as the platform for VA facilities seeking to undertake pragmatic implementation science initiatives related to HAI prevention. Although the initial focus will be on daily chlorhexidine bathing, the approach and methods used will serve as a framework for other HAI-prevention initiatives. For example, as optimal methods for implementing chlorhexidine bathing are determined they will be rapidly disseminated (using VHIN), thereby closing the gap between evidence and its practical use.

Operations Partner:

The National Center for Patient Safety (NCPS) is part of the VA Quality, Safety & Value, which leads VA patient safety efforts, working to reduce and prevent the inadvertent harm to patients as a result of healthcare.

Principal Investigator: Nasia Safdar, MD, PhD; contact at Nasia.Safdar@va.gov .