Table 2.
Quantitative analysis of CRE guideline implementation by CFIR inner setting constructs and open-code responsesa
| CFIR variables (definitions) | By variable | Total, N (%) | Positive [+], N (%) | Negative [–], N (%) | P value (Fisher’s exact test) | Interpretation |
|---|---|---|---|---|---|---|
| Comparison of screening vs non-screening sites | ||||||
|
1. Leadership engagement Commitment, involvement and accountability of local leaders and managers with the guideline implementation (n = 51) |
Not Screening | 22 (43.1) | 15 (68.2) | 7 (31.8) | 0.0015 | Sites screening for CRE report more leadership involvement in implementing CRE policies compared to sites not screening for CRE, 100% vs. 68.2% |
| Screening | 29 (56.9) | 29 (100) | 0 (0) | |||
|
2. Relative priority CRE is treated as seriously as other health associated infections (n = 42) |
Not screening | 18 (42.9) | 10 (55.6) | 8 (44.4) | 0.01 | Sites screening for CRE report CRE is treated as seriously as other HAIs compared to sites not screening for CRE, 91.7% vs. 55.6% |
| Screening | 24 (57.1) | 22 (91.7) | 2 (8.3) | |||
|
3. Available resources Money, equipment, testing supplies, training, education, isolation space, staff time, IT support, and previous workarounds to facilitate guideline implementation are available (n = 122) |
Not screening | 51 (41.8) | 23 (45.1) | 28 (54.9) | < 0.0001 | Sites not screening for CRE report fewer available resources as compared to sites screening for CRE, 81.7% vs. 45.1% |
| Screening | 71 (58.2) | 58 (81.7) | 13 (18.3) | |||
|
4. CRE reported incidence episodesb Reported CRE incidence (Y/N) (n = 33) |
Not screening | 19 (57.6) | 1 (5.3) | 18 (94.7) | 0.005 | Sites that screen for CRE reported more CRE than sites than non-screening sites, 50% vs. 5.3% |
| Screening | 14 (42.4) | 7 (50) | 7 (50) | |||
| Comparison of sites with CRE cases vs. no CRE cases | ||||||
|
1. Communication breakdownb Discussions of team communication or breakdowns (n = 53) |
CRE | 27 (50.9) | 27 (100) | 0 (0) | 0.02 | VAMCs with no CRE cases report more communication breakdown than sites with any CRE cases, 100% vs. 80.8% |
| No CRE | 26 (49.1) | 21 (80.8) | 5 (19.2) | |||
|
2. Access to knowledge and information Guideline or training materials (e.g., policies) locally disseminated to relevant stakeholders at each facility (n = 25) |
CRE | 9 (32.1) | 8 (88.9) | 1 (11.1) | 0.016 | Sites with any CRE cases report better access to knowledge and information than sites with no CRE cases, 88.9 % vs. 36.8% |
| No CRE | 19 (67.9) | 7 (36.8) | 12 (63.2) | |||
aFisher’s exact test was used to compare the number of positive vs. negative comments for all CFIR constructs and open codes by screening vs. non-screening sites and any (vs. no) CRE-positive cultures
This table focuses on positive results to assist MPCs in implementing the guideline. For example, responses that endorsed a “lack of resources” as a barrier to implementation efforts were coded “positive” (as in “lack of resources was a barrier to implementation of the guidelines”)
bOpen codes