Implementation strategies for hospital-based probiotic administration in a stepped-wedge cluster randomized trial design for preventing hospital-acquired Clostridioides difficile infection.

Autor: Bresee LC; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.; O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada., Lamont N; W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada., Ocampo W; W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada., Holroyd-Leduc J; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.; O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada.; Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada., Sabuda D; Pharmacy Services, Alberta Health Services, Calgary, AB, Canada., Leal J; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.; O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada.; Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada.; Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada., Dalton B; Pharmacy Services, Alberta Health Services, Calgary, AB, Canada., Kaufman J; W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada., Missaghi B; Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.; Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada.; Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada., Kim J; Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.; Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada., Larios OE; Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.; Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada.; Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada., Henderson E; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.; O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada.; Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada.; Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada., Raman M; Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.; Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada., Fletcher JR; Department of Health and Physical Education, Mount Royal University, Calgary, AB, Canada., Faris P; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.; Department of Analytics, Alberta Health Services, Calgary, AB, Canada., Kraft S; W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada., Shen Y; Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada., Louie T; Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.; Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada.; Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.; Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada., Conly JM; O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada. John.Conly@albertahealthservices.ca.; W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada. John.Conly@albertahealthservices.ca.; Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada. John.Conly@albertahealthservices.ca.; Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada. John.Conly@albertahealthservices.ca.; Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. John.Conly@albertahealthservices.ca.; Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada. John.Conly@albertahealthservices.ca.; Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada. John.Conly@albertahealthservices.ca.; AGW5 - Special Services Bldg, Foothills Medical Centre, 1403 29th Street NW, Calgary, AB, Canada, T2N 2T9. John.Conly@albertahealthservices.ca.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2023 Dec 11; Vol. 23 (1), pp. 1386. Date of Electronic Publication: 2023 Dec 11.
DOI: 10.1186/s12913-023-10350-9
Abstrakt: Background: Clostridioides difficile infection (CDI) is associated with considerable morbidity and mortality in hospitalized patients, especially among older adults. Probiotics have been evaluated to prevent hospital-acquired (HA) CDI in patients who are receiving systemic antibiotics, but the implementation of timely probiotic administration remains a challenge. We evaluated methods for effective probiotic implementation across a large health region as part of a study to assess the real-world effectiveness of a probiotic to prevent HA-CDI (Prevent CDI-55 +).
Methods: We used a stepped-wedge cluster-randomized controlled trial across four acute-care adult hospitals (n = 2,490 beds) to implement the use of the probiotic Bio-K + ® (Lactobacillus acidophilus CL1285®, L. casei LBC80R® and L. rhamnosus CLR2®; Laval, Quebec, Canada) in patients 55 years and older receiving systemic antimicrobials. The multifaceted probiotic implementation strategy included electronic clinical decision support, local site champions, and both health care provider and patient educational interventions. Focus groups were conducted during study implementation to identify ongoing barriers and facilitators to probiotic implementation, guiding needed adaptations of the implementation strategy. Focus groups were thematically analyzed using the Theoretical Domains Framework and the Consolidated Framework of Implementation Research.
Results: A total of 340 education sessions with over 1,800 key partners and participants occurred before and during implementation in each of the four hospitals. Site champions were identified for each included hospital, and both electronic clinical decision support and printed educational resources were available to health care providers and patients. A total of 15 individuals participated in 2 focus group and 7 interviews. Key barriers identified from the focus groups resulted in adaptation of the electronic clinical decision support and the addition of nursing education related to probiotic administration. As a result of modifying implementation strategies for identified behaviour change barriers, probiotic adherence rates were from 66.7 to 75.8% at 72 h of starting antibiotic therapy across the four participating acute care hospitals.
Conclusions: Use of a barrier-targeted multifaceted approach, including electronic clinical decision support, education, focus groups to guide the adaptation of the implementation plan, and local site champions, resulted in a high probiotic adherence rate in the Prevent CDI-55 + study.
(© 2023. The Author(s).)
Databáze: MEDLINE
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