Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website
HSRD Conference Logo



2019 HSR&D/QUERI National Conference Abstract

Printable View

4082 — Utilizing Implementation Tracking Tools to Drive Effectiveness of Infection Prevention Interventions

Lead/Presenter: Cassie Goedken,  COIN - Iowa City
All Authors: Goedken CC (Center for Comprehensive Access Delivery & Research, Iowa City VA Health Care System), Reisinger, HS (Center for Comprehensive Access Delivery & Research, Iowa City VA Health Care System; Department of Internal Medicine, Carver College of Medicine, University of Iowa), Chasco, EE (Center for Comprehensive Access Delivery & Research, Iowa City VA Health Care System;Department of Internal Medicine, Carver College of Medicine, University of Iowa) Goto, M,(Center for Comprehensive Access Delivery & Research, Iowa City VA Health Care System; Department of Internal Medicine, Carver College of Medicine, University of Iowa) Scherer, A (Center for Comprehensive Access Delivery & Research, Iowa City VA Health Care System; Department of Internal Medicine, Carver College of Medicine, University of Iowa) Marra, AR (Center for Comprehensive Access Delivery & Research, Iowa City VA Health Care System; Department of Internal Medicine, Carver College of Medicine, University of Iowa) Evans, C (VA Center of Innovation for Complex Chronic Healthcare (CINCCH) Hines VA; Department of Preventive Medicine and Center for Healthcare Studies Institute for Public Health and Medicine (IPHAM), Northwestern University) Rubin, MA, (VA Salt Lake City Health Care System; University of Utah School of Medicine) Perencevich, E (Center for Comprehensive Access Delivery & Research, Iowa City VA Health Care System; Department of Internal Medicine, Carver College of Medicine, University of Iowa)

Objectives:
Many efficacious infection prevention interventions face challenges when translated into real-world practice. Most implementation research lacks descriptions of specific implementation strategies, making it difficult to understand mechanisms of success and facilitate replication. In this Veterans Health Administration (VHA)-funded quality improvement (QI) project of a novel hand hygiene (HH) audit/feedback approach, we tracked implementation strategies and contextual factors to improve documentation of these mechanisms and support future replication.

Methods:
Five acute-care VHA hospitals in the Midwest participated in this QI project focused on monitoring HH compliance. Sites identified an external HH observer from outside the acute-care units to collect entry/exit compliance from October 2016-September 2017. After three months of observations, sites received a unique HH feedback tool—a HH Rates Poster—developed by the QI team. Two implementation tracking tools were used to track the various implementation activities and contextual factors among sites. The Interaction Tracking Tool tracked QI team interactions with each site (categorized by implementation strategy; e.g., observer training, audit/feedback) and the length of time of each interaction (dosage). The other tool was based on the Consolidated Framework for Implementation Research (CFIR) domains (CFIR Tracking Tool) and tracked the unique contextual factors and barriers/facilitators encountered at sites. Tracking tools were completed by the implementation lead and reviewed at qualitative team meetings.

Results:
Across all sites, 132 interactions were tabulated using the Interaction Tracking Tool; of these, 15 implementation strategies (e.g., audit/feedback, facilitation) were used. These strategies accounted for 75 hours of interactions with sites. The CFIR Tracking Tool provided an easily-accessible reference summarizing each site. All sites liked the HH observation tool used to collect observations. Opinions of the poster varied—from strongly disliked and not utilized, to liked and utilized.

Implications:
Tracking tools identify implementation mechanisms necessary for the intervention, and denote ones of lesser importance. Both tools were found to be beneficial and have important uses, however the CFIR Tracking Tool proved to be more important for rapidly understanding the implementation and site-specific influences for this VHA HH QI project.

Impacts:
Improving documentation of implementation mechanisms can promote use of consistent implementation strategies and drive effective infection prevention interventions.