Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Department of Medical Microbiology and Infection Control, University Medical Centre Utrecht, Utrecht, the Netherlands.
Antimicrob Resist Infect Control. 2024 Jun 13;13(1):63. doi: 10.1186/s13756-024-01418-0.
To promote the nation-wide implementation of semi-automated surveillance (AS) of surgical site infection after hip and knee arthroplasty, the Dutch National Institute for Public Health and the Environment (RIVM) deployed a decentralised multifaceted implementation strategy. This strategy consisted of a protocol specifying minimum requirements for an AS system, supported by a user manual, education module, individual guidance for hospitals and user-group meetings. This study describes an effect evaluation and process evaluation of the implementation strategy for AS in five frontrunner hospitals.
To evaluate the effect of the implementation strategy, the achieved phase of implementation was determined in each frontrunner hospital at the end of the study period. The process evaluation consisted of (1) an evaluation of the feasibility of strategy elements, (2) an evaluation of barriers and facilitators for implementation and (3) an evaluation of the workload for implementation. Interviews were performed as a basis for a subsequent survey quantifying the results regarding the feasibility as well as barriers and facilitators. Workload was self-monitored per profession. Qualitative data were analysed using a framework analysis, whereas quantitative data were analysed descriptively.
One hospital finished the complete implementation process in 240 person-hours. Overall, the elements of the implementation strategy were often used, positively received and overall, the strategy was rated effective and feasible. During the implementation process, participants perceived the relative advantage of AS and had sufficient knowledge about AS. However, barriers regarding complexity of AS data extraction, data-infrastructure, and validation, lack of capacity and motivation at the IT department, and difficulties with assigning roles and responsibilities were experienced.
A decentralised multifaceted implementation strategy is suitable for the implementation of AS in hospitals. Effective local project management, including clear project leadership and ownership, obtaining commitment of higher management levels, active involvement of stakeholders, and appropriate allocation of roles and responsibilities is important for successful implementation and should be facilitated by the implementation strategy. Sufficient knowledge about AS, its requirements and the implementation process should be available among stakeholders by e.g. an education module. Furthermore, exchange of knowledge and experiences between hospitals should be encouraged in user-group meetings.
为了在全国范围内推广髋关节和膝关节置换术后手术部位感染的半自动监测（AS），荷兰国家公共卫生和环境研究所（RIVM）部署了一种分散的多方面实施策略。该策略包括规定 AS 系统最低要求的协议，辅以用户手册、教育模块、针对医院的个别指导和用户组会议。本研究描述了在五家前沿医院实施 AS 实施策略的效果评估和过程评估。
为了评估实施策略的效果，在研究结束时确定了每个前沿医院的实施阶段。过程评估包括（1）评估策略要素的可行性，（2）评估实施的障碍和促进因素，（3）评估实施的工作量。访谈是作为随后调查的基础，对可行性以及障碍和促进因素进行量化评估。工作量由每个专业人员自行监测。定性数据采用框架分析进行分析，而定量数据采用描述性分析。
一家医院在 240 个人工时内完成了整个实施过程。总体而言，实施策略的要素经常被使用，受到积极评价，总体而言，该策略被评为有效且可行。在实施过程中，参与者感知到 AS 的相对优势，并且对 AS 有足够的了解。然而，在 AS 数据提取的复杂性、数据基础设施、验证、IT 部门的能力和动力不足以及角色和职责分配困难方面遇到了障碍。
分散的多方面实施策略适合在医院实施 AS。有效的本地项目管理，包括明确的项目领导和所有权、获得更高管理层的承诺、利益相关者的积极参与以及适当分配角色和职责，对于成功实施非常重要，并且应该由实施策略来促进。利益相关者应该具备有关 AS、其要求和实施过程的足够知识，例如通过教育模块。此外，应该在用户组会议上鼓励医院之间的知识和经验交流。
