On the CUSP: Stop CAUTI Supplement from APIC - Physician

20 Pages·2014·1.16 MB·English

SPRING 2014
A S P E C I A L
On the CUSP: Stop CAUTI
SSS UUU PPP PPP LLL EEE MMM EEE NNN TTT
Comprehensive
Unit-based
Safety
Program
INSIDE:
History of CUSP
Stop CAUTI
Meet the national faculty
Developing a CAUTI prevention plan
Success stories from around the U.S.
A SUPPLEMENT TO PREVENTION STRATEGIST
Prevention
CONTENTS
ABOUT ON THE CUSP: 9 How to join On the CUSP: SUCCESS STORIES SPRING 2014
STOP CAUTI PUBLISHER
Stop CAUTI
Katrina Crist, MBA
Learn more about eligibility, data 13 Small steps led to big [email protected]
3 Welcome to the On collection, time requirements, success at Ozarks
the CUSP: Stop CAUTI suggestions for hospital unit teams, Medical Center MANAGING EDITOR
supplement and other frequently asked questions. Starting out small was one of the Janiene Bohannon
[email protected]
The national On the CUSP: Stop keys to implementing a successful
CAUTI project is proud to take CAUTI PREVENTION TOOLS On the CUSP: Stop CAUTI
GRAPHIC DESIGN
part in this special supplement to program throughout the 114-bed
Deb Churchill Basso
Prevention Strategist magazine. 10 Using the four “E”s of Ozarks Medical Center (OMC) in [email protected]
By Barbara S. Edson implementation science to West Plains, Missouri.
develop a CAUTI prevention plan PRODUCTION
4 A Brief History of On the Use scientifically valid methods Heather Williams
[email protected]
CUSP: Stop CAUTI to promote the integration of 15 Making CAUTI reduction a
The national On the CUSP: Stop research findings and other best goal for everyone at Saint
CAUTI effort began in 2009 with practices. Clare’s Health System EDITORIAL COMMITTEE
George Allen, PhD, CIC, CNOR
AHRQ support and with the goal By Marilyn Hanchett Saint Clare’s Health System in
Megan Crosser, BS, MPH, CIC
of reducing mean rates of CAUTI. Denville, New Jersey, is a pioneer Charles Edmiston Jr., PhD, CIC
12 CAUTI insertion and in CAUTI reduction—instituting Mary L. Fornek, RN, BSN, MBA, CIC
5 Meet the On the CUSP: Stop maintenance bundles measures so effective that CAUTI Brenda Helms, RN, BSN, MBA/HCM, CIC
Linda Jamison, MSN, RN, CIC, CCRC
CAUTI national faculty By Dr. George Allen rates have frequently hit zero. Irena Kenneley, PhD, APRN-BC, CIC
The On the CUSP:Stop CAUTI Kari L. Love, RN, BS, MSHS, CIC
Caroline McDaniel, RN, BSN, MSN
program’s national faculty are 19 Resources in the American May M. Riley, RN, MSN, MPH, ACNP, CCRN, CIC
integral in providing support to Journal of Infection Control 17 Working together to get Steven J. Schweon, RN, MPH, MSN, CIC
stakeholders. Access more peer-reviewed articles results—University Medical
A Q&A with Kristina K. Felix, and original research on CAUTI Center of Southern Nevada DISCLAIMER
Prevention Strategist supplements are
Linda R. Greene, Dr. Brian Koll, prevention. Located in Las Vegas, University
published by the Association for Professionals
and Russell N. Olmsted Medical Center of Southern in Infection Control and Epidemiology (“APIC”).
Nevada's staff buy-in was key to All rights reserved. Reproduction, transmission,
distribution, or copying in whole or in part of the
the success of its CUSP CAUTI
contents without express written permission
prevention program. of APIC is prohibited. For reprint and other
requests, please email [email protected].
Success stories written by APIC makes no representations about
Vicky Uhland the accuracy, reliability, completeness, or
timeliness of the material or about the results
to be obtained from using this publication.
You use the material at your own risk. APIC
assumes no responsibility for any injury
and/or damage to persons or property as
a matter of products liability, negligence or
17 otherwise, or from any use or operation of
any methods, products, instructions, or ideas
contained in the material herein. Because
of rapid advances in the medical sciences,
in particular, independent verification of
diagnoses and drug dosages should be made.
Although all advertising material is expected
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inclusion in this publication does not constitute
a guarantee or endorsement of the quality or
value of such product or of the claims made of
it by its manufacturer.
MISSION
APIC’s mission is to create a safer world
through prevention of infection. The
association’s more than 14,000 members
direct infection prevention programs that
save lives and improve the bottom line for
hospitals and other healthcare facilities.
APIC advances its mission through patient
9 safety, implementation science, competencies
and certification, advocacy, and data
standardization. Visit APIC online at
www.apic.org.
2 | SPRING 2014 | Prevention Supplement
A SUPPLEMENT TO PREVENTION STRATEGIST
Welcome to the
On the CUSP:
Stop CAUTI
supplement
Barbara S. Edson, RN, MBA, MHA
Vice President of Clinical Quality
Health Research and
Educational Trust
American Hospital Association
THE NATIONAL On the CUSP: Stop CAUTI project in hospitals and organizations will happen only
“Hospital
is proud to take part in this special supplement to if open communication and effective working
units that Prevention Strategist magazine. Infection preventionists relationships exist on the unit. In On the CUSP:
participated in have played a vital role in the success of the project Stop CAUTI, we’ve observed the units that really
to date. On the CUSP: Stop CAUTI is working with
the 18-month succeed in reducing their HAIs are those com-
APIC, state hospital associations, professional societ-
mitted to working on culture for the long haul.
program ies, and more than 900 hospital units in 41 states
Sustained improvement is only possible within
reduced across the country to reduce one of the most
a culture that ensures the technical work can be
common healthcare-associated infection (HAI).
CAUTI rates delivered to every patient, every time. The Health
We’re doing this through a powerful combina-
by an average Research & Educational Trust and the On the
tion of both evidence-based protocols for use of
of 16 percent.” urinary catheters and improvement of unit safety CUSP: Stop CAUTI project would like to extend
thanks to AHRQ for its support of this national
culture through the Comprehensive Unit-based
initiative, as well as partnering organizations for
Safety Program (CUSP).
their tireless commitment to the project. Thanks
Catheter-associated urinary tract infections
go to the Michigan Health & Hospital Associa-
(CAUTI) have been called “the infection that
tion Keystone Center for Patient Safety & Qual-
gets no respect,” and that perception obscures an
ity, the University of Michigan Health System,
important opportunity. While CAUTI does not
result in as many deaths as other HAIs do, the St. John Hospital and Medical Center, and the
prevalence of CAUTI makes it the perfect “lab” Johns Hopkins Medicine Armstrong Institute for
for testing whether a particular culture-change Patient Safety and Quality. On the CUSP: Stop
model is effective. CAUTI also thanks APIC, Emergency Nurses
The fact remains that HAIs are costly, deadly, Association, Society for Healthcare Epidemiology
and persistent in the field. The results of On of America, and Society of Hospital Medicine,
the CUSP: Stop CAUTI are promising, however. the organizations that provided extended faculty
In September 2013, the program funder, the support. And most of all, thank you to the many
Agency for Healthcare Research and Quality facilities across the country for their dedication to
(AHRQ), released an interim report of data from the project and commitment to safer patient care.
the project. Hospital units that participated in We think you’ll enjoy this special supplement,
the 18-month program reduced CAUTI rates by where you’ll read how lasting improvement has
an average of 16 percent. taken place at diverse facilities, as well as perspec-
Checklists and protocols are essential tools tives of national thought leaders and faculty on
for improving safety, but successful incorpora- the project. We hope you’ll visit the project soon
tion of these tools into “the way we do things” at www.onthecuspstophai.org.
A Supplement: On the CUSP: Stop CAUTI | www.apic.org | 3
A SUPPLEMENT TO PREVENTION STRATEGIST
A Brief History of
On the CUSP:
Stop CAUTI
LEARN
ABOUT
CUSP
IMPLEMENT ASSEMBLE
TEAMWORK AND THE TEAM
COMMUNICATION
APPLY
CUSP
IDENTIFY ENGAGE
DEFECTS THE
THROUGH SENIOR
SENSEMAKING EXECUTIVE
UNDERSTAND
THE SCIENCE
OF SAFETY
IN 2007, the MHA Keystone Center implemented a project to reduce the goal of reducing mean rates of CAUTI in participating clinical units
catheter associated-urinary tract infection (CAUTI), one of the most com- by 25 percent. Like the Stop BSI initiative, Stop CAUTI looks to the work
mon of all HAIs, in 163 inpatient units in 71 Michigan hospitals. The of the MHA Keystone Center as a model and uses the CUSP framework
project implemented two separate bundles—one of which emphasized the developed at Johns Hopkins to address culture change. On the CUSP: Stop
timely removal of nonessential catheters and the proper care of necessary CAUTI was expanded nationwide, and since the launch of the first cohort
catheters, while the other addressed the insertion of catheters, including of participating states in late 2010, more than 1,300 units in approximately
appropriate indications and proper insertion technique. Participating 850 hospitals in more than 36 states have joined the initiative. AHRQ
hospitals achieved a reduction in indwelling catheters from 19 percent to released an interim report of data from the project in September 2013.
14 percent between January 2007 and December 2010, resulting in an Overall, preliminary outcome data show a 16 percent average decrease in
estimated 26 percent reduction of patients with urinary catheters and a CAUTI rates among hospital units that have participated in the program
30 percent improvement in appropriate catheter use. for at least 14 months. View the report online to learn more at www.
The national On the CUSP: Stop CAUTI effort began in 2009 with ahrq.gov/professionals/quality-patient-safety/cusp/using-cusp-prevention/
Agency for Healthcare Research and Quality (AHRQ) support and with
cauti-interim/index.html.
4 | SPRING 2014 | Prevention Supplement
A SUPPLEMENT TO PREVENTION STRATEGIST
Meet the
On the CUSP: Stop CAUTI
national faculty
THE On the CUSP: Stop CAUTI program’s national faculty are integral in providing support to stake-
ON THE CUSP: STOP CAUTI

holders participating in the On the CUSP: Stop CAUTI national collaborative. They coach project leads
and hospital teams and participate in content and coaching calls, in-person learning sessions, consul- NATIONAL FACULTY—
tation on both technical and socio-adaptive aspects of CAUTI prevention for participating hospitals APIC REPRESENTATIVES
and hospital units, and more. The extended faculty consists of three groups: the leaders, the national
faculty, and the regional champions. Together these groups form the national extended faculty network
that supports the national project team. Each faculty member contributes their unique expertise and
perspectives and unites for one common goal—to stop CAUTI via On the CUSP.
APIC had the chance to hear from many of the national faculty members about their roles, common
questions they receive about CAUTI, the importance of becoming part of the project, and much more.
Q:
Kristina K. Felix, BA, RN, CRRN, CIC
Infection Prevention Coordinator
Madonna Rehabilitation Hospital
WHAT ARE SOME OF THE MOST FREQUENT QUESTIONS OR
CONCERNS YOU RECEIVE ABOUT THE PROGRAM?
Olmsted: “I’ve not received con- Greene: “Frequent questions Linda R. Greene, RN, MPS, CIC
cerns about the program/initiative include how to get senior leaders Manager of Infection Prevention
per se, rather more directed at this involved, how to achieve sustain- University of Rochester, Highland Hospital
site of healthcare-associated infection ability, and how to manage multiple
(HAI). Frequently asked questions priorities and keep team members
involve efficacy of antimicrobial uri- engaged and enthusiastic.”
nary catheters, application of NHSN
[National Healthcare Safety Net- Koll: “I am asked how to assure
work] CAUTI criteria, use of urinary senior leadership buy-in, how to
catheters for ICU patient population assure continued team approach,
and difference in extent of reduction and how to incorporate this into a Brian Koll, MD, FACP
in CAUTIs compared to central line- culture of safety.” Chief of Infection Control
associated bloodstream infections Beth Israel Medical Center
[CLABSIs]. More broadly, concerns Felix: “Most frequent questions
often center on balancing compet- include how to implement nurse-
ing priorities and new demands on driven protocols, how to implement
the infection preventionist [IP] with and sustain change with all the
notable increase in awareness of the other initiatives that take time, and
morbidity/mortality of HAIs and how to get frontline staff to buy-in
growing importance of prevention to the need to get the catheter out
under value-based purchasing/popu- as soon as they are no longer medi- Russell N. Olmsted, MPH, CIC
lation health.” cally necessary.” Director, Infection Prevention and
Control Services
Saint Joseph Mercy Health System
A Supplement: On the CUSP: Stop CAUTI | www.apic.org | 5
A SUPPLQEMENT TO: PREVENTION STRATEGIST

WHAT ARE SOME OF THE MOST COMMON
MISCONCEPTIONS ABOUT CAUTI PREVENTION?
Koll: “Misconceptions include that Olmsted: “‘It’s just a Foley so
reduction in Foley use will create what’s the big deal?...’ is another
QQQQQmore work for staff and will lead ::misconception. In the broader
to development of skin breakdown context of patient safety, people
and increase incidence of falls. believe that the Foley catheter is
Other misconceptions include that associated with other risks to safety
CAUTI prevention is only a physi- (e.g., reservoir of multidrug-resis-
cian responsibility and that CAUTIs tant organisms, immobility-pres-
are relatively harmless with minimal sure ulcers, fall risk, and venous
morbidity and mortality.” thromboembolism).”
Greene: “Misconceptions include
Felix: “Common misconceptions:
the following: All ICU patients
UTIs are not as important as other
need a catheter, and CAUTIs are
infections; UTIs don’t really cause
not necessarily associated with
a problem for patients; and CAUTI
adverse outcomes.”
cannot be prevented.”
Q:

WHAT ARE SOME OF THE MOST PREVALENT
MISCONCEPTIONS ABOUT CATHETER PLACEMENT?
Olmsted: “[They are] often used Felix: “Misconceptions include that
under the indication of ‘prolonged all long-term care residents come to
immobility,’ which originally was the emergency department with a
supposed to track to a patient with catheter; all immobile patients or
unstable spine. Others include, ‘all patients who are difficult to move
my patients are critically ill and, need a catheter; indwelling cath-
therefore, need a Foley catheter,’ or eters make it easier for the patient
‘I don’t have time to use alternatives so they don’t have to get up at
to the Foley.’” night; straight catheterization is
too traumatic to do all the time;
Koll: “Some think that all ICU taking a catheter out will cause skin
patients require a Foley or that breakdown; taking a catheter out
the use of intermittent straight will make more work for frontline
catheterization is not good for staff; and an indwelling catheter
patients. Another misconception is the only way to measure output
is that Foleys are the only tool to accurately.”
monitor input and output in heart
failure patients.”
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Q:

ON THE CUSP: STOP CAUTI
HOW IS THE INITIATIVE DIFFERENT
FROM NORMAL PERFORMANCE IMPROVEMENT PROJECTS?
Greene: “Although it is similar, it Olmsted: “[The initiative features] broad engagement across a wide
focuses on both the cultural as well as spectrum of not only providers but organizations as well. For example,
the technical aspects of performance state hospital associations have been instrumental in providing infra-
improvement. Cultural assessment, structure and support for member hospitals. APIC, the Society for
engaging frontline staff and leaders, Healthcare Epidemiology of America, Society for Hospital Medicine,
using specific tools such as the team and the Emergency Nurses Association have provided subject matter
check-up tool, etc., are all part of this expertise, and the American Hospital Association’s Health Research &
work. Research tells us that people Educational Trust coordinates the project. The Agency for Healthcare
have to be engaged in order to get Research and Quality [AHRQ] provides key funding that is built
‘buy-in.’ CUSP really is bi-direc- on experience with prior performance improvement collaboratives.
tional—it really relies on the wisdom Last, a hallmark of On the CUSP is the fusion of technical elements
of the frontline staff while also pro- of HAI prevention with socio-adaptive aspects of providing patient
viding strong leadership support and care. [Reference: Fakih MG, et al. Infect Control Hosp Epidemiol
engagement. Staff can identify where 2013;34:1048-54.] CUSP is a good methodology for reducing CAUTIs
gaps occur. Often, for example, they because it addresses the why and how to improve care that builds on
know why or where catheters are being safety culture at the unit level. Frequently the strategies that are effective
inserted for inappropriate reasons, or in prevention (e.g., hand hygiene) are known, but it’s the behavioral
why nurses or physicians are reluctant aspects of getting the teams to use these that is the ‘Achilles heel’ of
to remove catheters.” infection prevention and control.”
Koll: “It focuses on a culture of Felix: “Any facility can take a study or a guideline, teach the
safety and changing practices to technical aspects of that guideline to direct care staff, and then
ensure sustained gains and includes monitor for change/outcomes. CUSP adds the element of why we
many types of caregivers across the need to follow the best practice. It also brings the team approach
spectrum of care on the inpatient to prevention of infection and a greater chance of sustaining
and outpatient side and the ED.” positive changes.”
Q:

ON THE CUSP: STOP CAUTI
HOW CAN THE INITIATIVE BE
INTEGRATED WITH OTHER PATIENT SAFETY ACTIVITIES?

Felix: “Many aspects of the CUSP Olmsted: “The model can address Greene: “The CAUTI work is based upon
activities can be adapted to other ‘all harms’ and is currently dem- a quality improvement framework that
initiatives to prevent harm to the onstrated by the work of the HHS can be applied in many projects. Clearly,
patients we care for. If you bring Partnership for Patients Hospital the evidence supports frontline engage-
the technical aspects of a task and Engagement Networks [HENs]. ment to have sustainable results. Also, the
bring the ‘why’ or the behavioral The foundational components conceptual framework using the four Es
aspects of a task together you will (technical and socio adaptive) work (Engage, Educate, Execute, and Evaluate)
have better compliance and better well for addressing improvements can be a template for several performance
outcomes.” in patient safety—infection-asso- improvement activities. This program
ciated and non-infectious.” really is a safety program and because
Koll: “[Stop CAUTI] can be inte- culture is local, frontline staff are the best
grated into hourly rounding for people to identify safety risks in their
toileting, fall prevention, pain area. It often starts with the question,
management, and pressure ulcer ‘How will the next patient be harmed?’”
prevention.”
A Supplement: On the CUSP: Stop CAUTI | www.apic.org | 7
A SUPPLEMENT TO PREVENTION STRATEGIST
SHANNON DAVILA,
MSN, RN, CIC, CPHQ
Clinical Quality Improvement Manager
New Jersey Hospital Association
New Jersey state lead for On the CUSP: Stop CAUTI
SARAH KREIN,
“As both an IP and a state lead for this project, I believe PhD, RN
the support and resources offered [via this initiative]
Research Associate Professor,
are above and beyond most quality improvement proj- Division of General Medicine
ects I have participated in before. Here at New Jersey Department of Internal Medicine
Hospital Association, we have had the privilege to host University of Michigan
CUSP national faculty including experts in the field of
“I believe that one difference
infection prevention like Dr. Brian Koll, Dr. David Pegues,
is the extent to which CAUTI pre-
and Linda Greene.”
vention is important hospital-wide,
which can be both a challenge
and an opportunity. Indeed, On
the CUSP: Stop CAUTI can span
multiple units, including medical-
surgical floors and ICUs, and also
includes an emergency depart-
ment program for those who
choose to participate.”
JENNIFER MEDDINGS,
MD, MSC KATHY ALLEN-BRIDSON,
RN, BSN, CIC
Assistant Professor of Internal Medicine
Nurse Epidemiologist
University of Michigan
CDC’s National Healthcare
On the CUSP: Stop CAUTI faculty member
Safety Network
and representative of the Society for Healthcare
Epidemiology of America
“One of the compelling aspects of the pro-
“Preventing CAUTI is a team sport.
gram is the breadth of inpatient settings in
Everyone is responsible for prevention
which indwelling catheters are used to which
of CAUTIs—nurses, physicians, patient-
these prevention efforts can be applied—
assistants, the patient, and family. Every-
from the emergency department, to the reha-
one who requests and/or touches
bilitation unit, and even in some instances in
urinary catheters plays an important
the operating room. They can also be used
role in avoiding unnecessary and inap-
on medical, surgical, obstetrical, and pedi-
propriate urinary catheter use.”
atric units.”
8 | SPRING 2014 | Prevention Supplement
A SUPPLEMENT TO PREVENTION STRATEGIST
How to join
OOnn tthhee CCUUSSPP::
SSttoopp CCAAUUTTII
STATE LEVEL COORDINATORS initiate and manage participation of hospital teams in On the CUSP: Stop CAUTI. If you are a member of a hospital

team and have an interest in joining the initiative, contact the coordinator for your state. A list of state coordinators can be found atwww.onthecuspstophai.

org/on-the-cuspstop-cauti. If you are with a state organization such as a state hospital association, state health department, or a quality improvement orga-

nization, contact Deborah Bohr at [email protected] to learn more about how to get involved.
IN WHAT FORMAT ARE DATA COLLECTED? WHO SHOULD BE ON OUR UNIT TEAM?
WHO IS ELIGIBLE TO
Monthly data elements are entered into the web- At a minimum, all hospital unit teams should
PARTICIPATE?
based data portal, MHA Care Counts. At the start include a physician champion, nurse champion (if
All adult and pediatric acute of the project, a readiness assessment is administered the project leader is not a nurse), data coordinator,
care, critical access, and long- through SurveyMonkey. Data collection tools are and hospital executive champion.
term acute care hospitals are available to help unit teams streamline and organize
eligible to participate. A pri- data collection and submission processes. HOW MANY PEOPLE FROM EACH HOSPITAL
mary goal of the initiative is to TEAM SHOULD TRAVEL TO THE STATE-HOSTED,
improve safety culture, which is spe- HOW MUCH TIME IS REQUIRED FOR PARTICIPATION? FACE-TO-FACE EDUCATIONAL MEETINGS?
cific to individual units. Therefore, all Approximately 10 percent of a project team leader’s A minimum of two or three members from
participating teams should be unit-based, time should be committed to the initiative. Team each hospital unit team should attend the state-
and cross-unit team formation is discouraged. leaders are usually nurse managers, but may also be level, face-to-face learning sessions, as the learning
frontline nurses, physician champions, or quality and sessions are intended to support team develop-
DOES THE NATIONAL ON THE CUSP: STOP
safety improvement leaders. Two to four hours per ment and interaction. It is recommended that at
CAUTI PROJECT TEAM COLLECT DATA, OR
month of a physician champion’s time and 5 percent least one physician, one nurse, and one infection
DOES EACH PARTICIPATING STATE COLLECT
of a data coordinator’s time should be committed to preventionist attend from each team.
DATA AND SUBMIT RESULTS?
the project as well. All unit team members should
Each participating hospital unit team is respon- participate in on-boarding calls, regular monthly Visit www.onthecuspstophai.org/on-
sible for data collection on their unit. Data is then content and coaching calls, and in three one-day the-cuspstop-cauti/about-the-project for
submitted to the MHA Care Counts database on learning sessions that occur at the beginning, middle, more information, including frequently
a monthly basis. and end of the project. asked questions.
A Supplement: On the CUSP: Stop CAUTI | www.apic.org | 9
A SUPPLEMENT TO PREVENTION STRATEGIST
E
Using “ ”
the
s
four
BY MARILYN HANCHETT
Essentials of CAUTI prevention
General activity Adaptation of interventions for this organization
(evidence-based)
Engage Rationale presented to all stakeholders. Determine which groups are already engaged, if others need
greater involvement.
Case for prevention is clear, concise, compelling.
Explain why the
interventions are important. Verify that CAUTI prevention has a high-profi le/priority
Rationale is part of Patient Safety Program. within the organization’s safety program.
Active, visible participation by senior leaders and
Consider novel, creative ways to showcase the involvement
institutional champions (all levels).
of senior leaders including medical staff .
Educate Share CAUTI data, including morbidity, mortality, Teach and reinforce correct indications for catheter use,
cost data. insertion, maintenance.
Share evidence supporting
the interventions. Educate regarding use of prevention techniques. Reinforce previous practices that should be discontinued.
Describe need for thorough, accurate medical record Teach, reinforce organization standards for documentation.
documentation.
Execute Implement CAUTI bundle. Consider use of a CAUTI checklist as part of a CAUTI
bundle approach.
Provide staff /patient/family education.
Design an
intervention toolkit. Determine need for alerts to physician and nurses re:
Conduct rigorous monitoring and off er potential catheter removal.
frequent feedback.
Add catheter review to daily rounds. Consider nurse
removal protocols to support timely discontinuation.
Evaluate Identify measures of success, report progress Describe both process and outcome measures for CAUTI.
per schedule.
Regularly assess performance Share progress toward goals at least once per month.
Investigate errors, lapses as opportunity to improve.
measures and unintended
consequences. Compare progress to other local, regional, national
Include patients/families in evaluation process. measures. Show how results demonstrate the organization’s
commitment to patient safety, overall safety culture.
Communicate, celebrate success.
(cid:129) Adapted from Pronovost PJ, Berenholtz SM, Needham DM. Translating (cid:129) Additional reference: Saint S, Howell J Krein SL, Implementation Science:
evidence into practice: a model for large scale knowledge translation. BMJ. How to Jumpstart Infection Prevention Infect Control Hosp Epidemiol. 2010
2008 Oct 6;337:a1714 November; 31(Suppl 1): S14–S17.
(cid:129) Fields have been completed using examples and are not intended as a compre-
hensive list.
10 | SPRING 2014 | Prevention Supplement