@article{50dab8c704da44ee93fe2efb6ee9d9c9,
title = "Translating infection control guidelines into practice: Implementation process within a health care institution",
abstract = "Health-care-associated infections (HAIs) remain a major patient safety problem even as policy and programmatic efforts designed to reduce HAIs have increased. Although information on implementing effective infection control (IC) efforts has steadily grown, knowledge gaps remain regarding the organizational elements that improve bedside practice and accommodate variations in clinical care settings. We conducted in-depth, semistructured interviews in 11 hospitals across the United States with a range of hospital personnel involved in IC (n = 116). We examined the collective nature of IC and the organizational elements that can enable disparate groups to work together to prevent HAIs. Our content analysis of participants' narratives yielded a rich description of the organizational process of implementing adherence to IC. Findings document the dynamic, fluid, interactional, and reactive nature of this process. Three themes emerged: implementing adherence efforts institution-wide, promoting an institutional culture to sustain adherence, and contending with opposition to the IC mandate.",
keywords = "content analysis, health care, culture of, illness and disease, infectious, quality improvement, safety, patient",
author = "Raveis, {Victoria H.} and Conway, {Laurie J.} and Mayuko Uchida and Monika Pogorzelska-Maziarz and Larson, {Elaine L.} and Stone, {Patricia W.}",
note = "Funding Information: As Sandelowski and Leeman (2012) noted, hospitals are complex, multilayered social systems. The growing evidence-based practice advances in implementation science ( Damschroder, Aron, et al., 2009 ) support an implementation process that incorporates attention to the values, practices, and interpersonal networks of health care personnel, as well as other situational factors present in these settings to promote adherence to IC policies (Sandelowski & Leeman). Indeed, the participants{\textquoteright} narratives underscored the utility of a systems approach framework when implementing a hospital-wide change in practice. Given their accounts of the interpersonal dynamics in operation in the work environment, IC efforts would also benefit from further research on social engagement, building collaborations, and fostering collective action as a means of impacting HAI outcomes. Sophisticated, evidence-based social and behavioral approaches that promote the performance of new routines and the relinquishment of established behaviors might be useful resources for infection preventionists and epidemiologists to draw on when implementing adherence to changes in IC practice. We thank the participating hospitals and their employees for their contributions to this study. We acknowledge the contribution of Shanelle Nelson to the coding of the qualitative transcripts, and thank Monique Carrero for her work on the preparation of the article. Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The authors received a grant from the National Institute of Nursing Research (R01-NR010107, P. Stone principal investigator). ",
year = "2014",
month = apr,
doi = "10.1177/1049732314524488",
language = "English (US)",
volume = "24",
pages = "551--560",
journal = "Qualitative Health Research",
issn = "1049-7323",
publisher = "SAGE Publications Inc.",
number = "4",
}