Evaluating implementation of methicillin-resistant Staphylococcus aureus (MRSA) prevention guidelines in spinal cord injury centers using the PARIHS framework: A mixed methods study

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

Research output: Contribution to journalArticle

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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 2-3years 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.

Original languageEnglish (US)
Article number130
JournalImplementation Science
Volume10
Issue number1
DOIs
StatePublished - Sep 9 2015
Externally publishedYes

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Spinal Cord Diseases
Methicillin-Resistant Staphylococcus aureus
Spinal Cord Injuries
Guidelines
Physician Assistants
Health Services Research
Veterans
Physical Therapist Assistants
Interviews
Veterans Health
Delivery of Health Care
Education
Health
Ambulatory Care
Infection
Inpatients

ASJC Scopus subject areas

  • Health Policy
  • Health Informatics
  • Public Health, Environmental and Occupational Health

Cite this

Evaluating implementation of methicillin-resistant Staphylococcus aureus (MRSA) prevention guidelines in spinal cord injury centers using the PARIHS framework : A mixed methods study. / Balbale, Salva N.; Hill, Jennifer N.; Guihan, Marylou; Hogan, Timothy P.; Cameron, Kenzie A.; Goldstein, Barry; Evans, Charlesnika T.

In: Implementation Science, Vol. 10, No. 1, 130, 09.09.2015.

Research output: Contribution to journalArticle

Balbale, Salva N. ; Hill, Jennifer N. ; Guihan, Marylou ; Hogan, Timothy P. ; Cameron, Kenzie A. ; Goldstein, Barry ; Evans, Charlesnika T. / Evaluating implementation of methicillin-resistant Staphylococcus aureus (MRSA) prevention guidelines in spinal cord injury centers using the PARIHS framework : A mixed methods study. In: Implementation Science. 2015 ; Vol. 10, No. 1.
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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 2-3years 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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N2 - 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 2-3years 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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