QUERI – Quality Enhancement Research Initiative

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Combating Antimicrobial Resistance through Rapid Implementation of Available Guidelines and Evidence (CARRIAGE)

Salt Lake City, UT, Hines, IL, and Iowa City, IA

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Combating Antimicrobial Resistance through Rapid Implementation of Available Guidelines & Evidence logoThe goal of the Combating Antimicrobial Resistance through Rapid Implementation of Available Guidelines & Evidence (CARRIAGE) QUERI program is to address the growing public health crisis of anti­microbial resistance through strate­gies that support the uptake of new and existing evidence-based practices, policies, and programs targeting the improved use of antibiotics and the prevention of healthcare-associated infections. CARRIAGE QUERI is a series of related projects unified around the common goal of arresting and potentially reversing the spread of antimicrobial resistance in VA healthcare facilities and beyond. Specific objectives are to:

  • Foster improved healthcare worker handwashing practice by repairing the broken audit-and-feedback mechanism in VA acute-care hospitals via a VISN-wide quality improvement project;
  • Support and enhance the implementation of new VA guidelines to detect and prevent the spread of highly resistant carbapenem-resistant Enterobacteriaceae (CRE) in VA hospitals; and
  • Promote judicious inpatient antibiotic use through a novel self-stewardship "timeout" project that prompts VA providers to evaluate the continued need for antibiotics.

Expected Findings and Impacts:

The CARRIAGE QUERI program is expected to have substantial and long-lasting impact in improving VA quality of care and patient safety, both by leveraging the current investments of its operational partners in the form of national initiatives or guidelines – and by informing future infection prevention and patient safety efforts, including the implemen­tation of future VA-wide practice guidelines or bundles. Better control of the spread of antimicrobial-resistant organisms within VA healthcare facilities is expected through:

  • Improved handwashing compliance via a novel audit method that can be readily imple­mented throughout the VA system;
  • More appropriate and judicious use of broad-spectrum antibiotics via self-stewardship and decision-support for frontline VA providers; and
  • Identification and promotion of "best practices" that facilitate the success of national VA infection prevention policy implementation.

Principal Investigators: Michael Rubin, MD, PhD (michael.rubin2@va.gov); Charlesnika Evans, MPH, PhD; and Eli Perencevich, MD, MS.

Principal Operational Partners: National Infectious Diseases Service (NIDS), MDRO Program Office, National Center for Patient Safety (NCPS), VA Antimicrobial Stewardship Task Force, and the National Center for Occupational Health and Infection Control (COHIC).