Saint Sanjay, Kowalski Christine P, Banaszak-Holl Jane, Forman Jane, Damschroder Laura, Krein Sarah L
Department of Veterans Affairs Ann Arbor HSR&D Center of Excellence, VA Ann Arbor Healthcare System, MI, USA.
Jt Comm J Qual Patient Saf. 2009 May;35(5):239-46. doi: 10.1016/s1553-7250(09)35032-1.
As of October 2008, hospitals in the United States no longer receive Medicare reimbursement for certain types of health care-associated infection (HAI), thereby heightening the need for effective prevention efforts. The mere existence of evidence-based practices, however, does not always result in the use of such practices because of the complexities inherent in translating evidence into practice. A qualitative study was conducted to determine the barriers to implementing evidence-based practices to prevent HAI, with a specific focus on the role played by hospital personnel.
In-depth phone and in-person interviews were conducted between October 2006 and September 2007 with 86 participants (31 physicians) including chief executive officers, chiefs of staff, hospital epidemiologists, infection control professionals, intensive care unit directors, nurse managers, and frontline physicians and nurses, in 14 hospitals.
Active resistance to evidence-based practice change was pervasive. Successful efforts to overcome active resisters included benchmarking infection rates, identifying effective champions, and participating in collaborative efforts. Organizational constipators-mid- to high-level executives who act as insidious barriers to change-also increased the difficulty in implementing change. Recognizing the presence of constipators is often the first step in addressing the problem but can be followed with including the organizational constipator early in group discussions to improve communication and obtain buy-in, working around the individual, and terminating the constipator's employment.
Two types of personnel-active resistors and organizational constipators-impeded HAI prevention activities, and several approaches were used to overcome those barriers. Hospital administrators and patient safety leaders can use the findings to more successfully structure activities that prevent HAI in their hospitals.
截至2008年10月，美国医院不再因某些类型的医疗保健相关感染（HAI）获得医疗保险报销，因此更迫切需要采取有效的预防措施。然而，仅仅存在循证实践并不一定会导致这些实践的应用，因为将证据转化为实践存在内在的复杂性。开展了一项定性研究，以确定实施预防HAI的循证实践的障碍，特别关注医院工作人员所起的作用。
2006年10月至2007年9月，对14家医院的86名参与者（31名医生）进行了深入的电话和面对面访谈，参与者包括首席执行官、医务主任、医院流行病学家、感染控制专业人员、重症监护病房主任、护士经理以及一线医生和护士。
对循证实践变革的积极抵制普遍存在。克服积极抵制者的成功努力包括对感染率进行基准对比、确定有效的倡导者以及参与协作努力。组织阻碍者——即那些成为变革潜在障碍的中高层管理人员——也增加了实施变革的难度。认识到组织阻碍者的存在往往是解决问题的第一步，但接下来可以在小组讨论早期让组织阻碍者参与进来，以改善沟通并获得其支持，绕过个人开展工作，以及终止组织阻碍者的工作。
两类人员——积极抵制者和组织阻碍者——阻碍了HAI预防活动，并且采用了几种方法来克服这些障碍。医院管理人员和患者安全负责人可以利用这些研究结果，更成功地组织其医院内预防HAI的活动。
