title: Implementing quality improvement strategies to reduce healthcare-associated infections: A systematic review.
abstract: BACKGROUND
  Comprehensive incidence estimates indicate that 1.7 million healthcare-associated infections (HAIs) and 99,000 HAI-associated deaths occur in US hospitals. Preventing HAIs could save $25.0 to $31.5 billion. Identifying effective quality improvement (QI) strategies for promoting adherence to evidence-based preventive interventions could reduce infections.
  
  
  METHODS
  We searched MEDLINE, CINAHL, and EMBASE from 2006-2012 for English-language articles with ≥ 100 patients that described an implementation strategy to increase adherence with evidence-based preventive interventions and that met study design criteria. One reviewer abstracted and appraised study quality, with verification by a second. QI strategies included audit and feedback; financial incentives, regulation, and policy; organizational change; patient education; provider education; and provider reminder systems.
  
  
  RESULTS
  We evaluated data on HAIs from 30 articles reporting adherence and infection rates that accounted for confounding or secular trends. Many of the measures improved significantly, especially adherence. Results varied by QI strategy(s).
  
  
  CONCLUSIONS
  Moderate strength of evidence supports improvement in adherence and infection rates when audit and feedback plus provider reminder systems or audit and feedback alone is added to organizational change and provider education. Strength of evidence is low when provider reminder systems alone are added to organizational change and provider education. There were no studies on HAIs in nonhospital settings that met the selection criteria.
authors.affiliation: Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-Based Practice Center and Technology Evaluation Center, Blue Cross Blue Shield Association, Chicago, IL. Electronic address: barbara.mauger@bcbsa.com.
authors.forename: Barbara
authors.initials: B
authors.lastname: Mauger
authors.affiliation: Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-Based Practice Center and Technology Evaluation Center, Blue Cross Blue Shield Association, Chicago, IL.
authors.forename: Anne
authors.initials: A
authors.lastname: Marbella
authors.affiliation: Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-Based Practice Center and Technology Evaluation Center, Blue Cross Blue Shield Association, Chicago, IL.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Pines
authors.affiliation: Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-Based Practice Center and Technology Evaluation Center, Blue Cross Blue Shield Association, Chicago, IL.
authors.forename: Ryan
authors.initials: R
authors.lastname: Chopra
authors.affiliation: Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-Based Practice Center and Technology Evaluation Center, Blue Cross Blue Shield Association, Chicago, IL.
authors.forename: Edgar R
authors.initials: ER
authors.lastname: Black
authors.affiliation: Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-Based Practice Center and Technology Evaluation Center, Blue Cross Blue Shield Association, Chicago, IL.
authors.forename: Naomi
authors.initials: N
authors.lastname: Aronson
mesh_terms: D003428:Cross Infection / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control*; D019983:Guideline Adherence; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D058996:Quality Improvement
keywords: Audit and feedback; Catheter-associated urinary tract infection; Central line-associated blood stream infection; Education; Implementation; Organizational change; Prevention; Reminder systems; Surgical site infection; Ventilator-associated pneumonia