Evaluating implementation of methicillin-resistant Staphylococcus aureus (MRSA) prevention guidelines in spinal cord injury centers using the PARIHS framework: a mixed ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2015-09-09

AUTHORS

Salva N. Balbale, Jennifer N. Hill, Marylou Guihan, Timothy P. Hogan, Kenzie A. Cameron, Barry Goldstein, Charlesnika T. Evans

ABSTRACT

BACKGROUND: To prevent methicillin-resistant Staphylococcus aureus (MRSA) in Spinal Cord Injury and Disorder (SCI/D) Centers, the "Guidelines for Implementation of MRSA Prevention Initiative in the Spinal Cord Injury Centers" were released in July 2008 in the Veterans Affairs (VA) Health Care System. The purpose of this study was to use the Promoting Action on Research Implementation in Health Systems (PARiHS) framework to evaluate the experiences of implementation of SCI/D MRSA prevention guidelines in VA SCI/D Centers approximately 2-3 years after the guidelines were released. METHODS: Mixed methods were used across two phases in this study. The first phase included an anonymous, web-based cross-sectional survey administered to providers at all 24 VA SCI/D Centers. The second phase included semi-structured telephone interviews with providers at 9 SCI/D Centers. The PARiHS framework was used as the foundation of both the survey questions and semi-structured interview guide. RESULTS: The survey was completed by 295 SCI/D providers (43.8 % response rate) from 22 of the 24 SCI/D Centers (91.7 % participation rate). Respondents included nurses (57.3 %), therapists (24.4 %), physicians (11.1 %), physician assistants (3.4 %), and other health care professionals (3.8 %). Approximately 36 % of the SCI/D providers surveyed had not seen, did not remember seeing, or had never heard of the MRSA SCI/D guidelines, whereas 42.3 % of providers reported that the MRSA SCI/D guidelines were fully implemented in their SCI/D Center. Data revealed numerous barriers and facilitators to guideline implementation. Facilitators included enhanced leadership support and provider education, focused guideline dissemination to reach SCI/D providers, and strong perceived evidence supporting the guidelines. Barriers included lack of awareness of the guidelines among physical therapists and physician assistants and challenges in cohorting/isolating MRSA-positive patients and following contact precautions. CONCLUSIONS: Successful implementation of MRSA infection prevention guidelines in SCI/D settings requires (1) guideline dissemination that reaches the full range of SCI/D providers working in inpatient, outpatient, and other care settings, (2) provider education that is frequent and systematic, (3) strong leadership support, and (4) that barriers unique to the recommendations are addressed. These findings may be used to inform selection of implementation strategies and optimize infection prevention beyond MRSA as well as in other specialty care populations. More... »

PAGES

130

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s13012-015-0318-x

DOI

http://dx.doi.org/10.1186/s13012-015-0318-x

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1020922878

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/26353798


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28 schema:description BACKGROUND: To prevent methicillin-resistant Staphylococcus aureus (MRSA) in Spinal Cord Injury and Disorder (SCI/D) Centers, the "Guidelines for Implementation of MRSA Prevention Initiative in the Spinal Cord Injury Centers" were released in July 2008 in the Veterans Affairs (VA) Health Care System. The purpose of this study was to use the Promoting Action on Research Implementation in Health Systems (PARiHS) framework to evaluate the experiences of implementation of SCI/D MRSA prevention guidelines in VA SCI/D Centers approximately 2-3 years after the guidelines were released. METHODS: Mixed methods were used across two phases in this study. The first phase included an anonymous, web-based cross-sectional survey administered to providers at all 24 VA SCI/D Centers. The second phase included semi-structured telephone interviews with providers at 9 SCI/D Centers. The PARiHS framework was used as the foundation of both the survey questions and semi-structured interview guide. RESULTS: The survey was completed by 295 SCI/D providers (43.8 % response rate) from 22 of the 24 SCI/D Centers (91.7 % participation rate). Respondents included nurses (57.3 %), therapists (24.4 %), physicians (11.1 %), physician assistants (3.4 %), and other health care professionals (3.8 %). Approximately 36 % of the SCI/D providers surveyed had not seen, did not remember seeing, or had never heard of the MRSA SCI/D guidelines, whereas 42.3 % of providers reported that the MRSA SCI/D guidelines were fully implemented in their SCI/D Center. Data revealed numerous barriers and facilitators to guideline implementation. Facilitators included enhanced leadership support and provider education, focused guideline dissemination to reach SCI/D providers, and strong perceived evidence supporting the guidelines. Barriers included lack of awareness of the guidelines among physical therapists and physician assistants and challenges in cohorting/isolating MRSA-positive patients and following contact precautions. CONCLUSIONS: Successful implementation of MRSA infection prevention guidelines in SCI/D settings requires (1) guideline dissemination that reaches the full range of SCI/D providers working in inpatient, outpatient, and other care settings, (2) provider education that is frequent and systematic, (3) strong leadership support, and (4) that barriers unique to the recommendations are addressed. These findings may be used to inform selection of implementation strategies and optimize infection prevention beyond MRSA as well as in other specialty care populations.
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35 schema:keywords Affairs (VA) Health Care System
36 Cord Injury Centers
37 D Centers
38 D MRSA prevention guidelines
39 D guidelines
40 D providers
41 D settings
42 Disorders Center
43 Injury Center
44 MRSA Prevention Initiative
45 MRSA SCI/D guidelines
46 MRSA infection prevention guidelines
47 MRSA prevention guidelines
48 MRSA-positive patients
49 PARIHS framework
50 Promoting Action
51 Research Implementation
52 SCI/D Centers
53 SCI/D MRSA prevention guidelines
54 SCI/D guidelines
55 SCI/D providers
56 SCI/D settings
57 Staphylococcus aureus
58 Staphylococcus aureus (MRSA) prevention guidelines
59 VA SCI/D Centers
60 Veterans Affairs Health Care System
61 action
62 assistants
63 aureus
64 aureus (MRSA) prevention guidelines
65 awareness
66 barriers
67 care population
68 care professionals
69 care settings
70 care system
71 center
72 challenges
73 contact precautions
74 cord injury
75 cross-sectional survey
76 data
77 dissemination
78 education
79 enhanced leadership support
80 evidence
81 experience
82 experience of implementation
83 facilitators
84 findings
85 first phase
86 foundation
87 framework
88 full range
89 guide
90 guideline dissemination
91 guideline implementation
92 guidelines
93 health care professionals
94 health care system
95 health systems framework
96 implementation
97 implementation strategies
98 infection prevention
99 infection prevention guidelines
100 initiatives
101 injury
102 inpatients
103 interview guide
104 interviews
105 lack
106 lack of awareness
107 leadership support
108 methicillin-resistant Staphylococcus aureus
109 methicillin-resistant Staphylococcus aureus (MRSA) prevention guidelines
110 method
111 methods study
112 mixed methods study
113 numerous barriers
114 nurses
115 outpatients
116 patients
117 phase
118 physical therapists
119 physician assistants
120 physicians
121 population
122 precautions
123 prevention
124 prevention guidelines
125 prevention initiatives
126 professionals
127 provider education
128 providers
129 purpose
130 questions
131 range
132 recommendations
133 respondents
134 second phase
135 selection
136 semi-structured interview guide
137 semi-structured telephone interviews
138 setting
139 specialty care populations
140 spinal cord injury
141 spinal cord injury center
142 strategies
143 strong leadership support
144 study
145 successful implementation
146 support
147 survey
148 survey questions
149 system
150 system framework
151 telephone interviews
152 therapists
153 web-based cross-sectional survey
154 years
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