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Building Implementation Science for VA Healthcare-Associated Infection Prevention

Healthcare-associated infections (HAI) are a major cause of morbidity and mortality among Veterans. Prevention of HAI is included in the VHA Blueprint for Excellence as preventable HAIs greatly impact patient safety through increased readmissions and mortality. Due to the immediacy of addressing emergent infectious threats among Veterans, expediting the research to practice pipeline in varying VA practice settings is critical.

In 2015, a frontline, VA-wide practice-based quality-improvement platform—the VA Healthcare Infection Prevention Network (VHIN)—was funded through the Quality Enhancement Research Initiative (QUERI), along with the National Center for Patient Safety (NCPS). As one of 18 Partnered Evaluation Initiatives (PEIs), VHIN was created to help facilitate the rapid implementation and evaluation of evidence-based infection prevention practices across the VA healthcare system. VHIN works to organize processes of delivering evidence-based infection prevention and to allow for a broad-scale evaluation of practices. As patient engagement also is central to VHIN's mission, investigators incorporated a Veteran advisory council that will prepare patients to be active participants in infection prevention activities within a VA learning healthcare system.

VHIN is currently assessing current practices and needs related to HAI prevention in collaboration with VHIN partners across VHA. The needs assessment includes key informant interviews, self-administered online questionnaire to all VA acute-care facilities, and in-depth post-survey interviews of VA infection prevention practitioners. Key informant interviews yielded four content areas of interest: 1) General, 2) Chlorhexidine Gluconate (germicidal mouthwash) Bathing, 3) Clostridium difficile Infection Prevention Practices, and 4) Carbapenem Resistant Enterobacteriaceae (CRE) Prevention Practices. The survey has been deployed and the results are being analyzed. The needs assessment part of this project will identify barriers to infection prevention implementation; inform future infection prevention QI projects; and will inform strategic priorities for VA's Multi-Drug Resistant Organisms (MDRO) Program, the National Center for Patient Safety, and VHIN. Involving key stakeholders, including clinicians and patients, early in the process can facilitate collaboration, prioritization, and continuous improvement of infection control practices.

Opportunities Ahead

VHIN's high performing network is expected to facilitate the timely evaluation and implementation of evidence-based practices demonstrated to reduce HAI, and examine VA- wide practice and variabilities in implementation strategies. VHIN investigators anticipate VA-wide implementation of best practices will not only improve care, but restore trust and confidence in VA. In addition, they anticipate improving access by involving patients as consumers and stakeholders in this project, to share their access and care experiences as it relates to HAI prevention. Patient stories on HAI may be a powerful vehicle to promote dissemination, and may provide a resource for other implementation researchers who are working on issues related to infection control and prevention.

For more information about VHIN, please contact Principal Investigator Nasia Safdar, MD, PhD at Nasia.Safdar@va.gov .