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Unique Factors Rural Veterans’ Affairs Hospitals Face When Implementing Health Care-Associated Infection Prevention Initiatives

Authors

  • Molly Harrod PhD,

    Corresponding author
    1. Center for Clinical Management Research, Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
    • For further information, contact: Molly Harrod, PhD, VA Ann Arbor Healthcare System, Center for Clinical Management Research (152), 2215 Fuller Road, Ann Arbor, MI 48105, e-mail: Molly.Harrod@va.gov.

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  • Milisa Manojlovich PhD,

    1. School of Nursing, University of Michigan, Ann Arbor, Michigan
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  • Christine P. Kowalski MPH,

    1. Center for Clinical Management Research, Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
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  • Sanjay Saint MD,

    1. Center for Clinical Management Research, Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
    2. Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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  • Sarah L. Krein PhD

    1. Center for Clinical Management Research, Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
    2. School of Nursing, University of Michigan, Ann Arbor, Michigan
    3. Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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  • Funding: This project was funded by the Veterans Affairs Office of Rural Health/VHA Midwest Rural Health Resource Center and by the National Institute of Nursing Research (R01- NR010700). The authors declare no conflicts of interest with respect to authorship and/or publication of this article. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

  • Acknowledgments: The authors would like to thank Sandeep Vijan for his assistance with the site visit data collection, and clinical input. We also thank Peter Kaboli for his valuable feedback and suggestions on an earlier version of this manuscript. Thank you also to the participants of this study who shared their time, knowledge, and expertise with us.

Abstract

Purpose

Health care-associated infection (HAI) is costly to hospitals and potentially life-threatening to patients. Numerous infection prevention programs have been implemented in hospitals across the United States. Yet, little is known about infection prevention practices and implementation in rural hospitals. The purpose of this study was to understand the infection prevention practices used by rural Veterans’ Affairs (VA) hospitals and the unique factors they face in implementing these practices.

Methods

This study used a sequential, mixed methods approach. Survey data to identify the HAI prevention practices used by rural VA hospitals were collected, analyzed, and used to inform the development of a semistructured interview guide. Phone interviews were conducted followed by site visits to rural VA hospitals.

Findings

We found that most rural VA hospitals were using key recommended infection prevention practices. Nonetheless, a number of challenges with practice implementation were identified. The 3 most prominent themes were: (1) lack of human capital including staff with HAI expertise; (2) having to cultivate needed resources; and (3) operating as a system within a system.

Conclusions

Rural VA hospitals are providing key infection prevention services to ensure a safe environment for the veterans they serve. However, certain factors, such as staff expertise, limited resources, and local context impacted how and when these practices were used. The creative use of more accessible alternative resources as well as greater flexibility in implementing HAI-related initiatives may be important strategies to further improve delivery of these important services by rural VA hospitals.

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