JMIR Publications

ABSTRACT

Background:

Background:

Durable Ventricular Assist Device (VAD) therapy is reserved for patients with advanced heart failure that have a poor estimated one-year survival. However, despite highly protocolized management processes, patients are at a unique risk for healthcare-associated infection (HAI). Few studies have examined optimal strategies for HAI prevention after durable VAD implantation, despite variability in rates across centers and their impact on short and long-term outcomes.

Objective:

Objective:

The objective of this study is to identify recommendations for preventing the most significant HAIs after durable VAD implantation. The study has three specific aims: 1) identify determinants of center-level variability in HAI rates 2) develop a comprehensive understanding of barriers and facilitators for achieving low center HAI rates and 3) develop and disseminate a best practices toolkit for preventing HAIs that accommodates various center contexts.

Methods:

Methods:

This is a sequential mixed methods study starting with a cross-sectional assessment of current practices. To address the first aim, we will conduct: (a) a systematic review of HAI prevention studies and (b) in-depth quantitative analyses using administrative claims, in-depth clinical data, and organizational surveys of VAD Centers. For the second aim, we will apply a mixed methods patient-tracer assessment framework to conduct semi-structured interviews, field observations and document analysis informed by Aim 1 findings at five high-performing (i.e. low HAIs) and five low-performing (i.e. high HAI) Centers, that will be examined using a mixed methods case series analysis. In aim three, we will build upon the findings from the previous aims to develop and field test an HAI preventive toolkit, acquire stakeholder input at an annual cardiac surgical conference, disseminate the final version to VAD Centers nationwide, and conduct follow-up surveys to assess the toolkit’s adoption.

Results:

Results:

We are currently conducting a systematic review of interventional HAI prevention studies and developing the survey addressing the determinants of HAI across VAD Centers.

Conclusions:

Conclusions:

This mixed methods study seeks to assess quantitatively determinants of HAIs across clinical centers and identify qualitatively context-specific facilitators and barriers for attaining low HAI rates. The mixed data findings will be used to develop and disseminate a stakeholder-acceptable toolkit of evidence-based HAI prevention recommendations that will accommodate the specific contexts and needs of VAD Centers.