Pushing beyond resistors and constipators: implementation considerations for infection prevention best practices.

Despite increased knowledge in the science of infection prevention, the implementation of evidence-based best practices remains a challenge. The dissemination of infection prevention risk reduction best practices should be approached with flexibility and a collaborative perspective. High-quality evidence and cost assessments to support interventions are important initial considerations. An implementation framework should be contextually appropriate, take into account an organization's culture, and be mindful of an approach that minimizes complexity. Trialing an intervention within a specific unit may later lead to increased uptake organization wide. Highly functional collaborations with effective leaders are needed for successful implementation. Leadership for infection prevention initiatives may include upper level management; however, hospital epidemiologists and infection preventionists often play this role. Although published data fail to identify a single best integrative strategy for infection prevention practice change, success has been associated with education initiatives and seminars, audit and feedback, distribution of educational materials, marketing, mass media, positive deviance, and the employment of champions, facilitators, role models, and opinion leaders. Local personnel, such as organizational resistors and constipators, can be barriers to idea dissemination and implementation. In addition to a thoughtfully conceived implementation strategy, dealing with infection prevention resistors and constipators includes getting their buy-in early in the dissemination process, working around them, or terminating their employment. More data are needed to best define which infection prevention dissemination strategies are most effective.