title: The national response for preventing healthcare-associated infections: infrastructure development.
abstract: BACKGROUND
  In 2009, the US Department of Health and Human Services (HHS) launched the Action Plan to Prevent Healthcare-associated Infections (HAIs). The Action Plan adopted national targets for reduction of specific infections, making HHS accountable for change across the healthcare system over which federal agencies have limited control.
  
  
  OBJECTIVE
  This article examines the unique infrastructure developed through the Action Plan to support adoption of HAI prevention practices.
  
  
  METHODS
  Interviews of federal (n=32) and other stakeholders (n=38), reviews of agency documents and journal articles (n=260), and observations of interagency meetings (n=17) and multistakeholder conferences (n=17) over a 3-year evaluation period.
  
  
  METHODS
  We extract key progress and challenges in the development of national HAI prevention infrastructure--1 of the 4 system functions in our evaluation framework encompassing regulation, payment systems, safety culture, and dissemination and technical assistance. We then identify system properties--for example, coordination and alignment, accountability and incentives, etc.--that enabled or hindered progress within each key development.
  
  
  RESULTS
  The Action Plan has developed a model of interagency coordination (including a dedicated "home" and culture of cooperation) at the federal level and infrastructure for stimulating change through the wider healthcare system (including transparency and financial incentives, support of state and regional HAI prevention capacity, changes in safety culture, and mechanisms for stakeholder engagement). Significant challenges to infrastructure development included many related to the same areas of progress.
  
  
  CONCLUSIONS
  The Action Plan has built a foundation of infrastructure to expand prevention of HAIs and presents useful lessons for other large-scale improvement initiatives.
authors.affiliation: *RAND Corporation, Santa Monica, CA †IMPAQ International, Washington, DC ‡IMPAQ International, Columbia, MD §Geffen School of Medicine, University of California, Los Angeles, CA.
authors.forename: Peter
authors.initials: P
authors.lastname: Mendel
authors.forename: Sari
authors.initials: S
authors.lastname: Siegel
authors.forename: Kristin J
authors.initials: KJ
authors.lastname: Leuschner
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Gall
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Weinberg
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Kahn
mesh_terms: D003428:Cross Infection / Q000517:prevention & control*; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007373:Interinstitutional Relations; D009936:Organizational Innovation; D014481:United States; D014483:United States Dept. of Health and Human Services / Q000458:organization & administration