Trial of Positive Deviance in Inpatient Wards to Reduce Hospital Infections

NCT02244905 | Completed

• 2 other identifiers: STU 072011-079Grant # 137911
• Study Type: interventional
• Target: 16,876
• Locations: 0 countries
• Sites: N/A

Brief Summary

Healthcare-associated infections (HAI) are a significant public health burden. Even with existence of recommendations on technical strategies to prevent these infections, there is a need for strategies to increase staff engagement within the local organizational and cultural context. Positive deviance is one such approach that engages people in improvement efforts. Positive Deviance is based on the observation that in every community there are certain individuals or groups whose uncommon behaviors and strategies enable them to find better solutions to problems than their peers, while having access to the same resources and facing similar or worse challenges. In the proposed study, the investigators plan to test the effectiveness of using positive deviance based horizontal infection prevention approach to achieve overall reduction of HAIs among hospital inpatients. The investigators hypothesized that a broad and horizontal approach to reduce opportunities for acquisition of nosocomial pathogens using PD will lead to greater reduction of HAI among hospital inpatients compared to standard-of-care infection control approach. The investigators objective was to test the investigators hypothesis and evaluate whether there is greater decline in rate of HAI in the experimental group of wards compared to the control group of wards.

Conditions

Healthcare-associated Infections

Keywords

Positive Deviance; Infection Control; Healthcare-Associated Infections; Staff Engagement; Cluster Randomized Controlled Trial

Outcome Measures

Primary Outcomes (1)

• Number of HAI per 1000 patient-days per month.

  The primary study outcome is the incidence density of HAI \[a composite of central line associated bloodstream infection (CLABSI), hospital-acquired pneumonia (HAP), catheter-associated urinary tract infection (CAUTI) and C.difficile infection (CDI)\] per 1000 patient-days per month.

  24 Months

Study Arms (2)

Positive Deviance Intervention Arm

EXPERIMENTAL

Three hospital wards received Positive Deviance intervention.

Behavioral: Positive Deviance; Other: Standard-of-Care Infection Control approach

Control Arm

OTHER

Three hospital wards randomized to control arm received the Standard-of-Care Infection Control approach.

Other: Standard-of-Care Infection Control approach

Interventions

Positive Deviance BEHAVIORAL

The recipients of the Positive Deviance intervention are the staff members of the three wards in the intervention arm, while the outcomes are measured among the patients receiving care in the three wards in the intervention arm. Key components of the intervention were invitation to participate voluntarily, open-ended dialogues with staff members to discover barriers and seek solutions to prevent HAI, discussion of outcomes, and encouragement to prioritize and implement the solutions generated.

Positive Deviance Intervention Arm

Standard-of-Care Infection Control approach OTHER

Standard-of-Care Infection Control approach

Control Arm; Positive Deviance Intervention Arm

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• For Intervention: All staff members employed in the study wards assigned to the intervention arm.
• For Primary Outcome Assessment:
• All patients admitted to any of the six study wards included in the study over the 24-month study period.

You may not qualify if:

• None

Sponsors & Collaborators

• University of Texas Southwestern Medical Center: lead

MeSH Terms

Conditions

Cross Infection

Condition Hierarchy (Ancestors)

Infections; Iatrogenic Disease; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Pranavi Sreeramoju, MD

  University of Texas Southwestern Medical Center

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 15, 2014
• First Posted: September 19, 2014
• Study Start: August 1, 2011
• Primary Completion: March 1, 2013
• Study Completion: August 1, 2014
• Last Updated: March 17, 2020

Record last verified: 2020-03