The incidence of infection with antimicrobial-resistant pathogens has been increasing dramatically in US hospitals. This trend poses serious quality and cost implications for care delivery. Addressing this, the CDC and National Foundation for Infectious Diseases (NFID) have proposed two sets of strategies, each consisting of five goals, to (1) Optimize antibiotic use; and (2) Prevent the spread of antimicrobial-resistance (AMR) and control transmission. The objective of this study is to explore both macro- and micro-level organizational factors that facilitate the implementation of CDC/NFID strategies.
This study surveyed 448 Infection Control Professionals from a national stratified random sample of hospitals. Macro-level organizational structural properties include degree of inter-departmental coordination, centralization of decision-making hierarchy, and formalization of protocols. Micro-level process measures include organizational culture, communication mechanisms, and information/technology (IT) use. Generalized estimating equations are used to model relationships between dependent and predictor measures, accounting for correlations resulting from the clustering of responses. The degree to which the two sets of CDC/NFID strategies were implemented is estimated as a function of the organizational factors, controlling for hospital characteristics.
Formalization (p<0.0001), centralization (p<0.0001), culture (p=0.0007), communication (p<0.0001), and IT use (p<0.0001) increased optimal antibiotic use within hospitals. However, coordination among clinical departments in providing input into designing quality monitoring and feedback had the opposite effect (p<0.0179). Formalization (p<0.0001), centralization (p=0.0067), communication (p<0.0001), and IT use (p<0.0001) enhanced the implementation of strategies that prevent and control AMR spread. Coordination did not affect the implementation of prevention strategies.
Both macro- and micro-level factors had a major impact on the implementation of AMR strategies. On a macro level, formalization eliminates staff role conflict while centralization of authority minimizes ambiguity. However, coordination among departments in designing quality monitoring system had a negative effect on implementation efforts as the decentralized nature of participation by multiple stakeholders may have distracted from the main goal. On a micro-level, culture and communication promote internal trust among participants, which can transform into consensus. IT use supports these organizational processes. Understanding factors that facilitate implementation can lend important insights into promoting sustainability of AMR control strategies within hospitals.