Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI.
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI.
Am J Infect Control. 2023 Oct;51(10):1124-1131. doi: 10.1016/j.ajic.2023.03.014. Epub 2023 Mar 26.
In 2012, the veteran's affairs (VA) multidrug-resistant organism (MDRO) Program Office launched a national Clostridioides difficile Infection (CDI) Prevention Initiative to address CDI as the most common cause of healthcare associated infections, mandating use of a VA CDI Bundle of prevention practices in inpatient facilities. We draw upon frontline worker perspectives to explore work system barriers and facilitators to the sustained implementation of the VA CDI Bundle using the systems engineering initiative for patient safety (SEIPS) framework.
We interviewed 29 key stakeholders at 4 participating sites between October 2019-July 2021. Participants included infection prevention and control (IPC) leaders, nurses, physicians, and environmental management staff. Interviews were analyzed to identify themes and perceptions of facilitators and barriers to CDI prevention.
IPC leadership was most likely to know of the specific VA CDI Bundle components. Other participants demonstrated general knowledge of CDI prevention practices, with role-based variation in the depth of awareness of specific practices. Facilitators included leadership support, mandated CDI training and prevention practices, and readily available training from multiple sources. Barriers included limits to communication about facility or unit-level CDI rates, ambiguous communications about CDI prevention practice updates and VA mandates, and role-hierarchies that may limit team members' clinical contributions.
Recommendations include improving centrally-mandated clarity about and standardization of CDI prevention policies, including testing. Regular IPC training updates for all clinical stakeholders are also recommended.
A work system analysis using SEIPS identified barriers and facilitators to CDI prevention practices that could be addressed both nationally at the system level and locally at the facility level, specifically in the areas of communication and coordination.
2012 年，退伍军人事务部（VA）多药耐药菌（MDRO）项目办公室发起了一项全国性艰难梭菌感染（CDI）预防计划，以解决 CDI 作为最常见的医疗保健相关感染的问题，并要求在住院设施中使用 VA CDI 预防包。我们借鉴一线工作人员的观点，利用患者安全系统工程倡议（SEIPS）框架，探讨工作系统障碍和促进因素，以持续实施 VA CDI 预防包。
我们在 2019 年 10 月至 2021 年 7 月期间在 4 个参与地点采访了 29 名关键利益相关者。参与者包括感染预防和控制（IPC）负责人、护士、医生和环境管理人员。对访谈进行了分析，以确定主题和对 CDI 预防的促进因素和障碍的看法。
IPC 领导层最有可能了解特定的 VA CDI 预防包组件。其他参与者对 CDI 预防实践有一般的了解，对特定实践的认识程度因角色而异。促进因素包括领导力支持、强制性 CDI 培训和预防实践，以及来自多个来源的现成培训。障碍包括对设施或单位层面 CDI 率的沟通限制、关于 CDI 预防实践更新和 VA 授权的模糊沟通，以及可能限制团队成员临床贡献的角色层次结构。
建议包括提高中央授权的 CDI 预防政策的清晰度和标准化，包括测试。还建议对所有临床利益相关者进行定期的 IPC 培训更新。
使用 SEIPS 进行的工作系统分析确定了 CDI 预防实践的障碍和促进因素，可以在系统层面上在全国范围内和在设施层面上在当地解决，特别是在沟通和协调方面。
