Krein Sarah L, Harrod Molly, Collier Sue, Davis Kristina K, Rolle Andrew J, Fowler Karen E, Mody Lona
Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.
Am J Infect Control. 2017 Dec 1;45(12):1342-1348. doi: 10.1016/j.ajic.2017.07.006. Epub 2017 Aug 12.
Reducing health care-associated infections (HAIs), such as catheter-associated urinary tract infection (CAUTI), is a critical performance improvement target in nursing homes. The Agency for Healthcare Research and Quality Safety Program for Long-term Care: Health Care-Associated Infections/Catheter-Associated Urinary Tract Infection, a national performance improvement program, was designed to promote implementation of a CAUTI prevention program through state-based or regional collaboratives in more than 500 nursing homes across the United States.
Qualitative interviews were conducted with 8 purposefully selected organizational leads (who led implementation activities for a group of facilities) and 8 facility leads (who led implementation activities at a given facility) to understand implementation successes and challenges and experiences of participants involved in the program. Key themes were identified using a rapid analysis approach.
Key themes related to general perceptions, changes due to program participation, and factors influencing program implementation were identified. In general, the program was viewed positively by organizational and facility leads with changes in catheter care practices, staff empowerment, and improvements in knowledge identified as benefits. Implementation challenges included the time required for program start-up as well as issues with staff and physician support, logistic barriers, and staffing turnover.
Despite some challenges, the observed program success and positive views of those participating suggest that collaboratives are an important strategy for providing nursing homes with enhanced expertise and support to prevent HAIs and ensure resident safety.
减少医疗保健相关感染（HAIs），如导尿管相关尿路感染（CAUTI），是疗养院关键的绩效改进目标。医疗保健研究与质量局长期护理安全计划：医疗保健相关感染/导尿管相关尿路感染，一项全国性的绩效改进计划，旨在通过基于州或地区的合作，在美国500多家疗养院推广CAUTI预防计划的实施。
对8名经过有目的挑选的组织负责人（领导一组设施的实施活动）和8名设施负责人（领导特定设施的实施活动）进行了定性访谈，以了解该计划实施的成功经验、挑战以及参与该计划的人员的经历。采用快速分析方法确定关键主题。
确定了与总体看法、因参与计划而产生的变化以及影响计划实施的因素相关的关键主题。总体而言，组织和设施负责人对该计划评价积极，认为导尿管护理实践的改变、员工赋权以及知识的提高是有益之处。实施挑战包括计划启动所需的时间以及员工和医生支持、后勤障碍和人员流动方面的问题。
尽管存在一些挑战，但观察到的计划成功以及参与者的积极看法表明，合作是为疗养院提供增强的专业知识和支持以预防HAIs并确保居民安全的重要策略。
