title: Structural and process factors affecting the implementation of antimicrobial resistance prevention and control strategies in U.S. hospitals.
abstract: BACKGROUND
  To address increases in the incidence of infection with antimicrobial-resistant pathogens, the National Foundation for Infectious Diseases and Centers for Disease Control and Prevention proposed two sets of strategies to (a) optimize antibiotic use and (b) prevent the spread of antimicrobial resistance and control transmission. However, little is known about the implementation of these strategies.
  
  
  OBJECTIVE
  Our objective is to explore organizational structural and process factors that facilitate the implementation of National Foundation for Infectious Diseases/Centers for Disease Control and Prevention strategies in U.S. hospitals.
  
  
  METHODS
  We surveyed 448 infection control professionals from a national sample of hospitals. Clinically anchored in the Donabedian model that defines quality in terms of structural and process factors, with the structural domain further informed by a contingency approach, we modeled the degree to which National Foundation for Infectious Diseases and Centers for Disease Control and Prevention strategies were implemented as a function of formalization and standardization of protocols, centralization of decision-making hierarchy, information technology capabilities, culture, communication mechanisms, and interdepartmental coordination, controlling for hospital characteristics.
  
  
  RESULTS
  Formalization, standardization, centralization, institutional culture, provider-management communication, and information technology use were associated with optimal antibiotic use and enhanced implementation of strategies that prevent and control antimicrobial resistance spread (all p < .001). However, interdepartmental coordination for patient care was inversely related with antibiotic use in contrast to antimicrobial resistance spread prevention and control (p < .0001).
  
  
  CONCLUSIONS
  Formalization and standardization may eliminate staff role conflict, whereas centralized authority may minimize ambiguity. Culture and communication likely promote internal trust, whereas information technology use helps integrate and support these organizational processes. These findings suggest concrete strategies for evaluating current capabilities to implement effective practices and foster and sustain a culture of patient safety.
authors.affiliation: Department of Health Administration and Policy, College of Public Health and College Medicine, University of Oklahoma, USA. ann-chou@ouhsc.edu
authors.forename: Ann F
authors.initials: AF
authors.lastname: Chou
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: McCoy
authors.forename: Deanna R
authors.initials: DR
authors.lastname: Willis
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Doebbeling
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology; D002487:Centers for Disease Control and Prevention, U.S.; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D004352:Drug Resistance, Microbial; D019983:Guideline Adherence / Q000458:organization & administration* / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006739:Hospital Administration / Q000941:ethics / Q000379:methods* / Q000592:standards; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000458:organization & administration; D007857:Leadership; D017146:Models, Organizational; D010348:Patient Care Team; D017064:Process Assessment, Health Care / Q000458:organization & administration*; D017751:Safety Management / Q000592:standards; D014481:United States / Q000453:epidemiology
chemical_list: D000890:Anti-Infective Agents