AHRQ Issues New Healthcare Associated Infections Research Protocol

August 3, 2011

The Effective Health Care Program of the Agency for Healthcare Research and Quality (AHRQ) has issued a new systematic evidence review research protocol for the purpose of identifying quality improvement (QI) strategies “that successfully increase adherence to effective preventive practices and reduce infection rates” for certain healthcare-associated infections (HAIs).

The review, cialis titled “Closing the Quality Gap: Prevention of Health Care-Assocated Infections, help ” released on August 3, 2011, focuses on surgical site infections (SSIs), central line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP), and catheter-assocuated urinary tract infections (CAUTI).

The new systematic review will update and expand upon a 2007 AHRQ Evidence Report/Technology Assessment (Evidence Report) about the prevention of HAIs. That Evidence Report was included as Volume 6 of the publication “Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies.”

The earlier 2007 AHRQ Evidence Report, based on preliminary data, concluded that “several strategies were worthy of further study and possibly wider implementation and that higher quality improvement studies of implementation were needed.”  This new AHRQ review research protocol recognizes the increase in “volume and range of activity” in the HAI field since 2007, thus warranting an update and re-examination of effective implementation strategies.

Scope of the AHRQ HAI Systematic Evidence Review

Prevention Interventions

The AHRQ review will begin its literature search by evaluating implementation studies published since 2006, the date when the 2007 Evidence Report ended.  It will place its focus on the implementation of certain preventive interventions for universal use for target patient populations as recommended by professional societies and governmental organizations.  Specifically, the review will utilize the Centers for Disease Control and Prevention (CDC) guidelines that have been developed by the CDC Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Society for Healthcare Epidemiology of America (SHEA)/ Infectious Diseases Society of America (IDSA) Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals (Compendium).

Healthcare-Associated Infections Considered

AHRQ considered whether the list of HAIs reviewed should be expanded.  It specifically considered the possibility of expanding the list to include methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile, and norovirus.

The review was not expanded to include MRSA or C. difficile since those infections are currently the subjects of current AHRQ-funded comparative effectiveness reviews.  It was decided to not include norovirus since the HICPAC guidelines were in draft form when the project started.  There was also concern about the epidemic outbreak nature of norovirus causing difficulty “to link specific QI strategies to changes in infection rates.”

Thus, the new review will cover the same four infections previously reviewed in the 2007 Evidence Report:

  • Surgical site infections (SSI)
  • Central line-associated bloodstream infections (CLABSI)
  • Ventilator-associated pneumonia (VAP)
  • Catheter-associated urinary tract infections (CAUTI)

Expansion to Other Health Care Settings

The 2007 Evidence Report focused on hospital settings.  The new review expands the list of healthcare settings to include nonhospital healthcare settings such as ambulatory surgery centers, free-standing dialysis centers, and long-term care facilities.

RAND Health Recommendations to be Applied

AHRQ plans to apply the recommendations of a report prepared by RAND Health in its review.  The RAND Health report, specifically prepared for AHRQ, identified “criteria for assessing the impact of context on the effectiveness of patient safety practices, which are a type of quality improvement strategy.”

Quality Improvement Strategies, Key Questions

The review seeks to answer two key questions pertaining to the link between quality improvement strategies and their impact on the reduction of healthcare-associated infections.

First, the review seeks to  determine which quality improvement strategies are effective in reducing SSIs, CLABSIs, VAP, and CAUTIs.

Second, the review will determine “the impact of the health care context on the effectiveness of quality improvement strategies, including reduced infections and increased adherence to preventive interventions.”

To read the AHRQ Research Protocol, click here.

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