*RAND Corporation, Santa Monica †David Geffen School of Medicine at UCLA, Los Angeles, CA ‡IMPAQ International, Columbia, MD.
Med Care. 2014 Feb;52(2 Suppl 1):S33-45. doi: 10.1097/MLR.0000000000000084.
Healthcare-associated infections (HAIs) have long been the subject of research and prevention practice. When findings show potential to significantly impact outcomes, clinicians, policymakers, safety experts, and stakeholders seek to bridge the gap between research and practice by identifying mechanisms and assigning responsibility for translating research to practice.
This paper describes progress and challenges in HAI research and prevention practices, as explained through an examination of Health and Human Services (HHS) Action Plan's goals, inputs, and implementation in each area.
We used the Context-Input-Process-Product evaluation model, together with an HAI prevention system framework, to assess the transformative processes associated with HAI research and adoption of prevention practices.
Since the introduction of the Action Plan, HHS has made substantial progress in prioritizing research projects, translating findings from those projects into practice, and designing and implementing research projects in multisite practice settings. Research has emphasized the basic science and epidemiology of HAIs, the identification of gaps in research, and implementation science. The basic, epidemiological, and implementation science communities have joined forces to better define mechanisms and responsibilities for translating HAI research into practice. Challenges include the ongoing need for better evidence about intervention effectiveness, the growing implementation burden on healthcare providers and organizations, and challenges implementing certain practices.
Although these HAI research and prevention practice activities are complex spanning multiple system functions and properties, HHS is making progress so that the right methods for addressing complex HAI problems at the interface of patient safety and clinical practice can emerge.
医疗保健相关感染(HAIs)一直是研究和预防实践的主题。当研究结果显示有可能对结果产生重大影响时,临床医生、政策制定者、安全专家和利益相关者寻求通过确定机制并为将研究转化为实践分配责任来弥合研究和实践之间的差距。
本文通过检查卫生与公众服务部(HHS)行动计划在每个领域的目标、投入和实施情况,描述 HAI 研究和预防实践的进展和挑战。
我们使用了情境-投入-过程-产品评估模型,以及 HAI 预防系统框架,来评估与 HAI 研究和采用预防实践相关的变革过程。
自行动计划推出以来,HHS 在优先考虑研究项目、将这些项目的研究结果转化为实践以及在多地点实践环境中设计和实施研究项目方面取得了重大进展。研究强调了 HAI 的基础科学和流行病学、研究中的差距识别以及实施科学。基础、流行病学和实施科学社区已联手,以更好地定义将 HAI 研究转化为实践的机制和责任。挑战包括对干预有效性的更好证据的持续需求、医疗保健提供者和组织日益增加的实施负担,以及某些实践的实施挑战。
尽管这些 HAI 研究和预防实践活动非常复杂,涉及多个系统功能和特性,但 HHS 正在取得进展,以便可以出现解决患者安全和临床实践界面上复杂 HAI 问题的正确方法。