Infection control professionals

Infection control professionals (ICPs) play a critical role in implementing and managing healthcare-associated infection reduction interventions, whereas frontline staff are responsible for delivering direct and ongoing patient care. The objective of our study was to determine if ICPs and frontline staff have different perspectives about the facilitators and challenges of central line-associated bloodstream infection (CLABSI) prevention program success. Methods: We conducted key informant interviews at 8 hospitals that participated in the Agency for Healthcare Research and Quality CLABSI prevention initiative called “On the CUSP: Stop BSI.” We analyzed interview data from 50 frontline nurses and 26 ICPs to identify common themes related to program facilitators and challenges. Results: We identified 4 facilitators of CLABSI program success: education, leadership, data, and con- sistency. We also identified 3 common challenges: lack of resources, competing priorities, and physician resistance. However, the perspective of ICPs and frontline nurses differed. Whereas ICPs tended to focus on general descriptions, frontline staff noted program specifics and often discussed concrete examples. Conclusions: Our results suggest that ICPs need to take into account the perspectives of staff nurses when implementing infection control and broader quality improvement initiatives. Further, the deliberate in- clusion of frontline staff in the implementation of these programs may be critical to program success. Infection control professionals

Copyright � 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

A central line-associated bloodstream infection (CLABSI) can occur when a central venous catheter, a procedure often asso- ciated with intensive care unit (ICU) settings,1 is not inserted correctly or not maintained properly. CLABSIs result in significant financial and nonfinancial costs to health systems and society because such infections increase risk of prolonged hospitaliza- tions, morbidity, and death.2,3 Fortunately, the implementation of standardized, evidence-based protocols can lead to dramatic and sustained reductions of CLABSIs in hospital ICUs.4-8 However, Infection control professionals

ney, ScD, MS, Department of University, 2231 N High St,

201. McAlearney). the Agency for Healthcare

). The views expressed in this present any US government e affiliated. ency for Healthcare Research

tion for Professionals in Infection

success rates vary between organizations.8,9 Some hospitals have virtually eliminated CLABSIs, and have sustained a rate of 0 infections for more than 24 months, whereas others have had less consistent results.10

Infection control in hospitals and their ICUs is extremely chal- lenging. Many people are involved (nurses, physicians, adminis- tration personnel, patients, and their families), and this certainly contributes to the problem of infection control. For example, these different individuals and groups of providers may have different opinions about how to reduce healthcare-associated infection (HAI) rates. Infection control professionals (ICPs) play a critical role in leading HAI-reduction interventions, and are responsible for the implementation and ongoing management of such interventions across hospitals and their ICUs. At the same time, frontline staff are responsible for delivering direct and ongoing patient care, and must determine how to incorporate infection control interventions within daily practice. Infection control professionals

Single hospital case studies of CLABSI reduction programs have engaged frontline staff in intervention design and implementation

Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Table 1 Interview questions about facilitators and challenges of healthcare-associated infection (HAI) initiatives

� Do you have any stories about barriers to introducing and implementing these HAI efforts at this organization?

B How were these barriers overcome?

� Were there new problems introduced with the implementation of the HAI initiative?

B How did these problems get resolved? B Do any of problems or barriers remain? B What could have been done differently to improve what happened with Infection control professionals

these changes?

� Were there things that occurred before implementation of these HAI efforts that needed to be addressed to facilitate implementation?

� What were the most important things that you think went well with intro- duction and use of the HAI initiative?

B What went right with this introduction of HAI efforts in this organization?

� What suggestions do you have for improvements in the use of these HAI initiatives?

B Do you have ideas about how work roles could be changed to improve the process?

B Do you have other ideas about how the process could be improved?

A.S. McAlearney, J.L. Hefner / American Journal of Infection Control 42 (2014) S216-S222 S217 Infection control professionals

and reported this as a critical success factor.11,12 Further, leader- ship has been a frequently mentioned attribute of success, and nonclinical factors such as leadership and management practices have been posited as a potential explanation for between- organization variability in program outcomes.8,13,14 For ICPs to as- sume their critical leadership role in CLABSI prevention programs, they must understand the perspective of frontline staff. Studies have suggested that there is potential for disparity in perspectives between managers and their clinical staff with respect to the implementation and effects of patient safety initiatives,15,16 but this area is largely understudied in the infection prevention literature.

To advance this line of research, our study explored the ques- tion, do ICPs and frontline staff have different perspectives about the facilitators and barriers associated with implementation and effects of a CLABSI prevention protocol? We analyzed interviews with ICPs and staff across 8 hospitals that participated in a CLABSI prevention program funded by the Agency for Healthcare Research and Quality (AHRQ) called “On the CUSP: Stop BSI.” Comprehensive unit-based safety program (CUSP), is a formal model for translating CLABSI reduction evidence into practice. We wanted to examine if and how the perspectives of ICPs and frontline nurses varied to improve our understanding about the factors that may contribute to successful CLABSI prevention efforts Infection control professionals

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