Frontline perspectives of C. difficile infection prevention practice implementation within veterans affairs health care facilities: A qualitative study

Vishala Parmasad; Julie Keating; Linda McKinley; Charlesnika Evans; Michael Rubin; Corrine Voils; Nasia Safdar

doi:10.1016/j.ajic.2023.03.014

Frontline perspectives of C. difficile infection prevention practice implementation within veterans affairs health care facilities: A qualitative study

Am J Infect Control. 2023 Oct;51(10):1124-1131. doi: 10.1016/j.ajic.2023.03.014. Epub 2023 Mar 26.

Authors

Vishala Parmasad¹, Julie Keating², Linda McKinley², Charlesnika Evans³, Michael Rubin⁴, Corrine Voils⁵, Nasia Safdar²

Affiliations

¹ Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI. Electronic address: parmasad@wisc.edu.
² Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI.
³ Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. Veterans Affairs Hospital, Hines.
⁴ IDEAS 2.0 Center, George E. Whalen VA Medical Center, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT.
⁵ William S. Middleton Memorial Veterans Hospital, Madison, WI; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.

PMID: 36977453
DOI: 10.1016/j.ajic.2023.03.014

Abstract

Background: In 2012, the veteran's affairs (VA) multidrug-resistant organism (MDRO) Program Office launched a national Clostridioides difficile Infection (CDI) Prevention Initiative to address CDI as the most common cause of healthcare associated infections, mandating use of a VA CDI Bundle of prevention practices in inpatient facilities. We draw upon frontline worker perspectives to explore work system barriers and facilitators to the sustained implementation of the VA CDI Bundle using the systems engineering initiative for patient safety (SEIPS) framework.

Methods: We interviewed 29 key stakeholders at 4 participating sites between October 2019-July 2021. Participants included infection prevention and control (IPC) leaders, nurses, physicians, and environmental management staff. Interviews were analyzed to identify themes and perceptions of facilitators and barriers to CDI prevention.

Results: IPC leadership was most likely to know of the specific VA CDI Bundle components. Other participants demonstrated general knowledge of CDI prevention practices, with role-based variation in the depth of awareness of specific practices. Facilitators included leadership support, mandated CDI training and prevention practices, and readily available training from multiple sources. Barriers included limits to communication about facility or unit-level CDI rates, ambiguous communications about CDI prevention practice updates and VA mandates, and role-hierarchies that may limit team members' clinical contributions.

Discussion: Recommendations include improving centrally-mandated clarity about and standardization of CDI prevention policies, including testing. Regular IPC training updates for all clinical stakeholders are also recommended.

Conclusions: A work system analysis using SEIPS identified barriers and facilitators to CDI prevention practices that could be addressed both nationally at the system level and locally at the facility level, specifically in the areas of communication and coordination.

Keywords: CDI prevention; Implementation science; Qualitative analysis; SEIPS; VA IPC.

Published by Elsevier Inc.

Publication types

Research Support, U.S. Gov't, P.H.S.
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Clostridioides difficile*
Clostridium Infections* / prevention & control
Cross Infection* / prevention & control
Delivery of Health Care
Humans
Infection Control
Veterans*

Abstract

Publication types

MeSH terms

Grants and funding