Common barriers and strategies to implement new anti-MRSA practices in ICUs

Researchers from the Indiana University have identified common barriers and strategies for successfully implementing practice changes in Intensive Care Units (ICUs). The study, published in the August issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, reveals shared lessons learned from six ICUs as they implemented evidence-based practices to reduce Methicillin Resistant Staphylococcus aureus (MRSA) infections.

"Our research found that while implementation plans should be locally-derived, reducing and preventing the spread of infections in ICUs entails overcoming common barriers," said Amber Welsh, PhD of the Indiana University Center for Health Services & Research Outcomes.

In 2006, five Indianapolis-area hospitals began a systematic implementation of practices known to reduce the spread of MRSA, including active surveillance, hand hygiene, patient isolation, and the use of protective equipment like gowns and gloves. A group of researchers led by Dr. Brad Doebbeling then interviewed team members from each hospital to identify common themes of successful implementation shared by all hospitals.

The interviews produced five core themes common to all hospitals:

• Engage front line staff in implementation.
• Build a multi-disciplinary implementation team.
• Commit to data collection, management, and feedback.
• Acquire support of top management.
• Use process mapping and other problem-solving tools.

"The tendency for any organization unit is to say, 'We're different,' implying that change efforts must be tailor-made for each unique group or culture," Dr. Welsh said. "But our research shows that while units are unique, there are commonalities that can guide consideration and planning efforts to implement new practices. We hope that this study will help hospitals realize that change implementation is both a unique and universal activity."