title: Reducing health care-associated infections (HAIs): lessons learned from a national collaborative of regional HAI programs.
abstract: BACKGROUND
  Health care-associated infections (HAIs) are a leading cause of death in United States health care settings, with an overall estimated annual incidence of 1.7 million. As antimicrobial resistance has increased, so too have efforts to reduce HAI rates. The objective of this study was to identify commonly cited lessons learned across a wide variety of HAI projects and hospital settings.
  
  
  METHODS
  Thirty-three hospitals participated in 5 different regional collaboratives supported by the Agency for Healthcare Research and Quality (AHRQ). Data on hospitals' successes, challenges, and lessons learned were collected via key informant interviews and structured, standardized case report forms.
  
  
  RESULTS
  Seven commonly cited themes were identified: foster change by first understanding resistance; commit to regular strategic communication and join a collaborative; start small and tailor implementation to local needs and cultures; engage frontline staff by involving them in the project and enlisting champions; educate and reeducate; convince administration to provide leadership, funds, and dedicated staff and assign accountability; and provide timely, relevant feedback and celebrate successes.
  
  
  CONCLUSIONS
  Despite the diversity of hospital settings, cultures, personnel, and HAI reduction projects, we found that hospitals encounter similar challenges and facilitators across projects. We offer a model of 7 process elements shown to be important to successful implementation.
authors.affiliation: Indiana University Center for Health Services and Outcomes Research, Indianapolis, IN 46202, USA. amwelsh@hotmail.com
authors.forename: Catherine Amber
authors.initials: CA
authors.lastname: Welsh
authors.forename: Mindy E
authors.initials: ME
authors.lastname: Flanagan
authors.forename: Shawn C
authors.initials: SC
authors.lastname: Hoke
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Doebbeling
authors.forename: Loreen
authors.initials: L
authors.lastname: Herwaldt
mesh_terms: D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control*; D003695:Delivery of Health Care; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000458:organization & administration*; D014481:United States / Q000453:epidemiology