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525. Evaluation of Implementation of Guidelines for Carbapenem-resistant Enterobacteriaceae (CRE) Prevention Using the Consolidated Framework for Implementation Research (CFIR)
Abstract   Open access

525. Evaluation of Implementation of Guidelines for Carbapenem-resistant Enterobacteriaceae (CRE) Prevention Using the Consolidated Framework for Implementation Research (CFIR)

Cassie Goedken, Marylou Guihan, Charnetta R Brown, Swetha Ramanathan, Amanda Vivo, Margaret A Fitzpatrick, Eli N Perencevich, Michael Rubin, Heather Reisinger, Katie J Suda, …
Open forum infectious diseases, Vol.6(Supplement_2), pp.S252-S253
10/23/2019
DOI: 10.1093/ofid/ofz360.594
PMCID: PMC6810954
url
https://doi.org/10.1093/ofid/ofz360.594View
Published (Version of record) Open Access

Abstract

Abstract Background Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing (CP) CRE are difficult to treat, resulting in a high mortality annually. In 2017, VA released guidelines for CRE/CP-CRE laboratory testing, prevention, and management. We used the Consolidated Framework for Implementation Research (CFIR) to understand factors influencing implementation of the CRE guideline at VA Medical Centers (VAMCs). Methods Between 9/17–8/18, 43 semi-structured interviews were conducted with Multi-Drug Resistant Organism Program Coordinators, laboratorians, physicians and infection preventionists from 29 geographically representative VAMCs of varying size and CP-CRE burden. Interviews addressed perceptions of guideline dissemination, laboratory testing, training, patient education, and IT support (e.g., CRE/CP-CRE flag, lab report and template). We analyzed transcripts using a consensus-based mixed deductive-inductive coding approach to identify CFIR constructs, best practices, recommendations/feedback and implementation challenges. Results 95% of interviewees reported using VA CRE/CP-CRE guidelines, most (79%) with high confidence. Respondent comments (n = 798) were coded using CFIR constructs [Inner Setting (e.g., resources), (48%); Process (e.g., planning), (23%); Intervention Characteristics (e.g., VA guidelines) (17%); Outer Setting (e.g., patient needs) (6%); Characteristics of Individuals (e.g., self-efficacy) (6%)]. Interviewees also described Best Practices (15%) and Feedback/Recommendations (12%) including the need for improved lab testing/reporting, communication, contact isolation, staff training, patient education and cost. Conclusion Our results suggest sustained improvement in multiple areas to facilitate guideline implementation to identify, prevent, and manage CRE/CP-CRE are needed. This is critical because CRE/CP-CRE incidence and mortality rates are projected to increase. Disclosures All authors: No reported disclosures.

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