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Organizational readiness assessment in acute and long-term care has important implications for antibiotic stewardship for asymptomatic bacteriuria

      Highlights

      • The ORCA survey measures organizational readiness to implement best practices.
      • We used the ORCA to measure barriers to an antibiotic stewardship intervention.
      • Providers had strong buy-in to the evidence for managing asymptomatic bacteriuria.
      • Inadequate resources and support were cited as barriers to stewardship.

      Background

      Prior to implementing an antibiotic stewardship intervention for asymptomatic bacteriuria (ASB), we assessed institutional barriers to change using the Organizational Readiness to Change Assessment.

      Methods

      Surveys were self-administered on paper in inpatient medicine and long-term care units at 4 Veterans Affairs facilities. Participants included providers, nurses, and pharmacists. The survey included 7 subscales: evidence (perceived strength of evidence) and six context subscales (favorability of organizational context). Responses were scored on a 5-point Likert-type scale.

      Results

      One hundred four surveys were completed (response rate = 69.3%). Overall, the evidence subscale had the highest score; the resources subscale (mean 2.8) was significantly lower than other subscales (P < .001). Scores for budget and staffing resources were lower than scores for training and facility resources (P < .001 for both). Pharmacists had lower scores than providers for the staff culture subscale (P = .04). The site with the lowest scores for resources (mean 2.4) also had lower scores for leadership and lower pharmacist effort devoted to stewardship.

      Conclusions

      Although healthcare professionals endorsed the evidence about nontreatment of ASB, perceived barriers to antibiotic stewardship included inadequate resources and leadership support. These findings provide targets for tailoring the stewardship intervention to maximize success.

      Key Words

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      References

        • Nicolle LE
        • Bradley S
        • Colgan R
        • Rice JC
        • Schaeffer A
        • Hooton TM
        Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults.
        Clin Infect Dis. 2005; 40: 643-654
        • Nicolle LE
        • Gupta K
        • Bradley SF
        • et al.
        Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America.
        Clin Infect Dis. 2019; 68: e83-e110
        • Preventive Services Task Force US
        Screening for asymptomatic bacteriuria in adults: US Preventive Services Task Force recommendation statement.
        JAMA. 2019; 322: 1188-1194
        • Belton PJ
        • Litofsky NS
        • Humphries WE
        Effect of empiric treatment of asymptomatic bacteriuria in neurosurgical trauma patients on surgical site and Clostridium difficile infection.
        Neurosurgery. 2018; 0: 1-8
        • Flokas ME
        • Andreatos N
        • Alevizakos M
        • Kalbasi A
        • Onur P
        • Mylonakis E
        Inappropriate management of asymptomatic patients with positive urine cultures: a systematic review and meta-analysis.
        Open Forum Infect Dis. 2017; 4: ofx207
        • Spivak ES
        • Burk M
        • Zhang R
        • et al.
        Management of bacteriuria in Veterans Affairs hospitals.
        Clin Infect Dis. 2017; 65: 910-917
        • Weiner BJ
        • Amick H
        • Lee SY
        Conceptualization and measurement of organizational readiness for change: a review of the literature in health services research and other fields.
        Med Care Res Rev. 2008; 65: 379-436
        • Helfrich CD
        • Li YF
        • Sharp ND
        • Sales AE
        Organizational readiness to change assessment (ORCA): development of an instrument based on the Promoting Action on Research in Health Services (PARIHS) framework.
        Implement Sci. 2009; 4: 38
        • Harris M
        • Jones P
        • Heartfield M
        • et al.
        Changing practice to support self-management and recovery in mental illness: application of an implementation model.
        Aust J Prim Health. 2015; 21: 279-285
        • Tukey MH
        • Clark JA
        • Bolton R
        • et al.
        Readiness for implementation of lung cancer screening. A national survey of Veterans Affairs pulmonologists.
        Ann Am Thorac Soc. 2016; 13: 1794-1801
        • Elango S
        • Szymczak JE
        • Bennett IM
        • Beidas RS
        • Werner RM
        Changing antibiotic prescribing in a primary care network: the role of readiness to change and group dynamics in success.
        Am J Med Qual. 2018; 33: 154-161
        • Scales K
        • Zimmerman S
        • Reed D
        • et al.
        Nurse and medical provider perspectives on antibiotic stewardship in nursing homes.
        J Am Geriatr Soc. 2017; 65: 165-171
        • Trautner BW
        • Grigoryan L
        • Petersen NJ
        • et al.
        Effectiveness of an antimicrobial stewardship approach for urinary catheter-associated asymptomatic bacteriuria.
        JAMA Intern Med. 2015; 175: 1120-1127
        • Trautner BW
        • Prasad P
        • Grigoryan L
        • et al.
        Protocol to disseminate a hospital-site controlled intervention using audit and feedback to implement guidelines concerning inappropriate treatment of asymptomatic bacteriuria.
        Implement Sci. 2018; 13: 16
        • Phillips CD
        • Adepoju O
        • Stone N
        • et al.
        Asymptomatic bacteriuria, antibiotic use, and suspected urinary tract infections in four nursing homes.
        BMC Geriatr. 2012; 12: 73
        • Grigoryan L
        • Naik AD
        • Horwitz D
        • et al.
        Survey finds improvement in cognitive biases that drive overtreatment of asymptomatic bacteriuria after a successful antimicrobial stewardship intervention.
        Am J Infect Control. 2016; 44: 1544-1548
        • Drekonja DM
        • Grigoryan L
        • Lichtenberger P
        • et al.
        Teamwork and safety climate affect antimicrobial stewardship for asymptomatic bacteriuria.
        Infect Control Hosp Epidemiol. 2019; 40: 963-967
        • Advani SD
        • Gao CA
        • Datta R
        • et al.
        Knowledge and practices of physicians and nurses related to urine cultures in catheterized patients: an assessment of adherence to IDSA guidelines.
        Open Forum Infect Dis. 2019; 6
        • Drekonja DM
        • Abbo LM
        • Kuskowski MA
        • Gnadt C
        • Shukla B
        • Johnson JR
        A survey of resident physicians' knowledge regarding urine testing and subsequent antimicrobial treatment.
        Am J Infect Control. 2013; 41: 892-896
        • Trautner BW
        • Petersen NJ
        • Hysong SJ
        • Horwitz D
        • Kelly PA
        • Naik AD
        Overtreatment of asymptomatic bacteriuria: identifying provider barriers to evidence-based care.
        Am J Infect Control. 2014; 42: 653-658
        • Trautner BW
        • Greene MT
        • Krein SL
        • et al.
        Infection prevention and antimicrobial stewardship knowledge for selected infections among nursing home personnel.
        Infect Control Hosp Epidemiol. 2017; 38: 83-88
        • Centers for Disease Control and Prevention, US Department of Health and Human Services
        Core elements of hospital antibiotic stewardship programs.
        Centers for Disease Control and Prevention website, 2014 (Published 2014. Available at:) (Accessed September 13, 2019)
        • The Joint Commission
        New antimicrobial stewardship standard.
        Joint Commission Perspect. 2016; 36: 1-8
        • Appaneal HJ
        • Luther MK
        • Timbrook TT
        • LaPlante KL
        • Dosa DM
        Facilitators and barriers to antibiotic stewardship: a qualitative study of pharmacists' perspectives.
        Hosp Pharm. 2019; 54: 250-258
        • Lim CJ
        • Kwong M
        • Stuart RL
        • et al.
        Antimicrobial stewardship in residential aged care facilities: need and readiness assessment.
        BMC Infect Dis. 2014; 14: 410
        • Bourgeois LJ.
        On the measurement of organizational slack.
        Acad Manag Rev. 1981; 6: 29-39
        • Hagedorn HJ
        • Heideman PW.
        The relationship between baseline Organizational Readiness to Change Assessment subscale scores and implementation of hepatitis prevention services in substance use disorders treatment clinics: a case study.
        Implement Sci. 2010; 5: 46
        • Powell BJ
        • Waltz TJ
        • Chinman MJ
        • et al.
        A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project.
        Implement Sci. 2015; 10: 21
        • Gagnon MP
        • Attieh R
        • Ghandour el K
        • et al.
        A systematic review of instruments to assess organizational readiness for knowledge translation in health care.
        PLoS One. 2014; 9e114338
        • Miake-Lye IM
        • Delevan DM
        • Ganz DA
        • Mittman BS
        • Finley EP
        Unpacking organizational readiness for change: an updated systematic review and content analysis of assessments.
        BMC Health Serv Res. 2020; 20: 106
        • Noe TD
        • Kaufman CE
        • Kaufmann LJ
        • Brooks E
        • Shore JH
        Providing culturally competent services for American Indian and Alaska Native veterans to reduce health care disparities.
        Am J Public Health. 2014; 104: S548-S554