Laboratory practices for identification and reporting of carbapenem-resistant <i>Enterobacteriaceae</i> in Department of Veterans Affairs facilities

Brown

et al. 2020

Preprint

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Background Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing (CP) CRE are difficult to treat, resulting in high mortality in healthcare settings every year. The Veteran’s Health Administration (VHA) disseminated guidelines in 2015 and an updated directive in 2017 for control of CRE focused on laboratory testing, prevention, and management. The Consolidated Framework for Implementation Research (CFIR) framework was used to examine contextual factors and identify best practices influencing implementation of the 2015 guidelines/2017 directive in VA Medical Centers (VAMCs).Methods Qualitative interviews were conducted at 29 VAMCs with staff involved in implementing CRE guidelines at their facility. Survey and VHA administrative data were used to identify geographically representative large and small VAMCs with varying levels of CRE incidence. Interviews addressed perceptions of guideline dissemination, laboratory testing, staff attitudes and training, patient education, and technology support. Participant responses were coded using a consensus-based mixed deductive-inductive approach guided by CFIR. A quantitative analysis comparing CFIR constructs and emergent codes to sites actively screening for CRE (vs. non-screening) and any (vs. no) CRE positive cultures was conducted with a Fisher’s exact test.Results Forty-three semi-structured interviews were conducted between 10/2017-8/2018 with laboratory staff (47%), Multi-Drug Resistant Organism Program Coordinators (MPCs, 35%), infection preventionists (12%), and physicians (6%). Participants cited the need for more standardized tools to promote effective communication (e.g., electronic screening). Participants also indicated that CRE-specific educational materials were needed for staff, patient, and family members. Quantitative analysis identified the following CFIR constructs as being significantly associated with CRE screening or presence of CRE: Leadership Engagement, Relative Priority Available Resources, Team Communication, and Access to Knowledge & Information.Conclusions Effective CRE identification, prevention and treatment requires ongoing collaboration between clinical, microbiology, infection prevention, antimicrobial stewardship, and infectious diseases specialists. Our results emphasize the importance of leadership’s role in promoting positive facility culture, including increasing healthcare worker’s awareness of infection control and prevention for emerging pathogens, access to resources, improving communication and facilitating successful implementation of the CRE guidelines.

Section: Methodsmentioning

confidence: 99%

Evaluation of Carbapenem-Resistant Enterobacteriaceae (CRE) Guideline Implementation in the Veteran’s Affairs Medical Centers Using the Consolidated Framework for Implementation Research

Brown

et al. 2020

Preprint

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“…1 [11][12]. In the rst phase, an online survey of VA microbiology laboratory staff was conducted and focused on knowledge of CRE guidelines and related laboratory procedures, involvement in guidelines implementation, and comfort excuting the guidelines [8]. A parallel survey, addressing knowledge of and comfort with various aspects of the guidelines was conducted with MPCs at 134 VAMCs with acute-care and long-term care VAMCs [9].…”

Section: Methodsmentioning

confidence: 99%

“…CRE screening status of facilities was initially obtained from surveys completed by VA microbiology laboratory staff and MPCs during the rst phase of the mixed methods evaluation and clari ed in the qualitative interviews. [8][9]. To ensure that we collected the best available information on gaps and/or CRE practices, we oversampled facilities reporting active screening for CRE/CP-CRE and those with more CRE positive cultures.…”

Section: Methodsmentioning

confidence: 99%

“…MDRO Program Coordinators (MPCs) (similar to an infection preventionist in the private sector) support various Infection Control Program functions (e.g., MDRO surveillance, hand hygiene program, data collection, and reporting) [7] and had primary responsibility for implementing the CRE/CP-CRE national guidelines. Previously published elements of this mixed methods evaluation include: 1) an online survey of VA microbiology laboratory staff at 129 VAMCs [8] and 2) an online survey of MPCs at 134 VAMCs with acute-care and long-term care units [9]. This paper focuses on the nal phase of this mixed methods evaluation by describing results of semistructured interviews conducted with MPCs and microbiology laboratory staff to identify and understand the contextual factors and help characterize best practices and challenges that in uenced CRE guideline implementation in VAMCs.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of Carbapenem-Resistant Enterobacteriaceae (CRE) Guideline Implementation in the Veteran’s Affairs Medical Centers Using the Consolidated Framework for Implementation Research

Brown³

et al. 2020

Preprint

Self Cite

Background: Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing (CP) CRE are difficult to treat, resulting in high mortality in healthcare settings every year. The Veteran’s Health Administration (VHA) disseminated guidelines in 2015 and an updated directive in 2017 for control of CRE focused on laboratory testing, prevention, and management. The Consolidated Framework for Implementation Research (CFIR) framework was used to analyze qualitative interview data to identify contextual factors and best practices influencing implementation of the 2015 guidelines/2017 directive in VA Medical Centers (VAMCs). The overall goals were to determine CFIR constructs to target to improve CRE guideline/directive implementation and understand how CFIR, as a multi-level conceptual model, can be used to inform guideline implementation.Methods: Semi-structured interviews were conducted at 29 VAMCs with staff involved in implementing CRE guidelines at their facility. Survey and VHA administrative data were used to identify geographically representative large and small VAMCs with varying levels of CRE incidence. Interviews addressed perceptions of guideline dissemination, laboratory testing, staff attitudes and training, patient education, and technology support. Participant responses were coded using a consensus-based mixed deductive-inductive approach guided by CFIR. A quantitative analysis comparing qualitative CFIR constructs and emergent codes to sites actively screening for CRE (vs. non-screening) and any (vs. no) CRE positive cultures was conducted using Fisher’s exact test.Results: Forty-three semi-structured interviews were conducted between 10/2017-8/2018 with laboratory staff (47%), Multi-Drug Resistant Organism Program Coordinators (MPCs, 35%), infection preventionists (12%), and physicians (6%). Participants requested more standardized tools to promote effective communication (e.g., electronic screening). Participants also indicated that CRE-specific educational materials were needed for staff, patient, and family members. Quantitative analysis identified CRE screening or presence of CRE as being significantly associated with the following qualitative CFIR constructs: Leadership Engagement, Relative Priority Available Resources, Team Communication, and Access to Knowledge & Information. Conclusions: Effective CRE identification, prevention and treatment requires ongoing collaboration between clinical, microbiology, infection prevention, antimicrobial stewardship, and infectious diseases specialists. Our results emphasize the importance of leadership’s role in promoting positive facility culture, including access to resources, improving communication and facilitating successful implementation of the CRE guidelines.

Section: Introductionmentioning

confidence: 99%

Evaluation of carbapenem-resistant Enterobacteriaceae (CRE) guideline implementation in the Veterans Affairs Medical Centers using the consolidated framework for implementation research

Brown

et al. 2021

Implement Sci Commun

Self Cite

Background Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing (CP) CRE are difficult to treat, resulting in high mortality in healthcare settings every year. The Veterans Health Administration (VHA) disseminated guidelines in 2015 and an updated directive in 2017 for control of CRE focused on laboratory testing, prevention, and management. The Consolidated Framework for Implementation Research (CFIR) framework was used to analyze qualitative interview data to identify contextual factors and best practices influencing implementation of the 2015 guidelines/2017 directive in VA Medical Centers (VAMCs). The overall goals were to determine CFIR constructs to target to improve CRE guideline/directive implementation and understand how CFIR, as a multi-level conceptual model, can be used to inform guideline implementation. Methods Semi-structured interviews were conducted at 29 VAMCs with staff involved in implementing CRE guidelines at their facility. Survey and VHA administrative data were used to identify geographically representative large and small VAMCs with varying levels of CRE incidence. Interviews addressed perceptions of guideline dissemination, laboratory testing, staff attitudes and training, patient education, and technology support. Participant responses were coded using a consensus-based mixed deductive-inductive approach guided by CFIR. A quantitative analysis comparing qualitative CFIR constructs and emergent codes to sites actively screening for CRE (vs. non-screening) and any (vs. no) CRE-positive cultures was conducted using Fisher’s exact test. Results Forty-three semi-structured interviews were conducted between October 2017 and August 2018 with laboratory staff (47%), Multi-Drug-Resistant Organism Program Coordinators (MPCs, 35%), infection preventionists (12%), and physicians (6%). Participants requested more standardized tools to promote effective communication (e.g., electronic screening). Participants also indicated that CRE-specific educational materials were needed for staff, patient, and family members. Quantitative analysis identified CRE screening or presence of CRE as being significantly associated with the following qualitative CFIR constructs: leadership engagement, relative priority, available resources, team communication, and access to knowledge and information. Conclusions Effective CRE identification, prevention, and treatment require ongoing collaboration between clinical, microbiology, infection prevention, antimicrobial stewardship, and infectious diseases specialists. Our results emphasize the importance of leadership’s role in promoting positive facility culture, including access to resources, improving communication, and facilitating successful implementation of the CRE guidelines.