Strategies for the implementation of a nasal decolonization intervention to prevent surgical site infections within the Veterans Health Administration

Stacey Hockett Sherlock; Cassie Cunningham Goedken; Erin C Balkenende; Kimberly C Dukes; Eli N Perencevich; Heather Schacht Reisinger; Graeme N Forrest; Christopher D Pfeiffer; Katelyn A West; Marin Schweizer

doi:10.3389/frhs.2022.920830

Strategies for the implementation of a nasal decolonization intervention to prevent surgical site infections within the Veterans Health Administration

Front Health Serv. 2022 Aug 17:2:920830. doi: 10.3389/frhs.2022.920830. eCollection 2022.

Authors

Stacey Hockett Sherlock^{1

2}, Cassie Cunningham Goedken¹, Erin C Balkenende^{1

2}, Kimberly C Dukes^{1

2}, Eli N Perencevich^{1

2}, Heather Schacht Reisinger^{1

2

3}, Graeme N Forrest⁴, Christopher D Pfeiffer^{5

6}, Katelyn A West⁷, Marin Schweizer^{1

2}

Affiliations

¹ Center for Access and Delivery Research and Evaluation (CADRE), VA Iowa City Health Care System, Iowa City, IA, United States.
² Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, United States.
³ Institute for Clinical and Translational Science, The University of Iowa, Iowa City, IA, United States.
⁴ Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States.
⁵ Department of Hospital and Specialty Medicine, VA Portland Health Care System, Portland, OR, United States.
⁶ Department of Medicine, Oregon Health & Sciences University, Portland, OR, United States.
⁷ VA Portland Healthcare System, Portland, OR, United States.

Abstract

As part of a multicenter evidence-based intervention for surgical site infection prevention, a qualitative study was conducted with infection control teams and surgical staff members at three Department of Veterans Affairs Healthcare Systems in the USA. This study aimed to identify strategies used by nurses and other facility champions for the implementation of a nasal decolonization intervention. Site visit observations and field notes provided contextual information. Interview data were analyzed with inductive and deductive content analysis. Interview data was mapped to the Expert Recommendations for Implementing Change (ERIC) compilation of implementation strategies. These strategies were then considered in the context of power and relationships as factors that influence implementation. We found that implementation of this evidence-based surgical site infection prevention intervention was successful when nurse champions drove the day-to-day implementation. Nurse champions sustained implementation strategies through all phases of implementation. Findings also suggest that nurse champions leveraged the influence of their role as champion along with their understanding of social networks and relationships to help achieve implementation success. Nurse champions consciously used multiple overlapping and iterative implementation strategies, adapting and tailoring strategies to stakeholders and settings. Commonly used implementation categories included: "train and educate stakeholders," "use evaluative and iterative strategies," "adapt and tailor to context," and "develop stakeholder interrelationships." Future research should examine the social networks for evidence-based interventions by asking specifically about relationships and power dynamics within healthcare organizations. Implementation of evidence-based interventions should consider if the tasks expected of a nurse champion fit the level of influence or power held by the champion.

Trial registration: ClinicalTrials.gov, identifier: NCT02216227.

Keywords: ERIC strategies; implementation science; infection control; nasal decolonization; qualitative methods; surgical site infection prevention; veterans.

Associated data

ClinicalTrials.gov/NCT02216227