Evaluating implementation of methicillin-resistant Staphylococcus aureus (MRSA) prevention guidelines in spinal cord injury centers using the PARIHS framework: a mixed methods study

Implementation Science, 2015 · DOI: 10.1186/s13012-015-0318-x · Published: August 21, 2015

Simple Explanation

This study evaluated the implementation of MRSA prevention guidelines in Spinal Cord Injury and Disorder (SCI/D) Centers within the Veterans Affairs (VA) healthcare system. The researchers used the PARiHS framework to understand how well the guidelines were being followed and what factors helped or hindered their implementation. The study found that successful implementation requires effective guideline dissemination, frequent provider education, strong leadership support, and addressing barriers unique to the recommendations.

Study Duration

Approximately 2–3 years

Participants

295 SCI/D providers

Evidence Level

Mixed methods study

Key Findings

1
Approximately 36% of SCI/D providers surveyed had not seen, did not remember seeing, or had never heard of the MRSA SCI/D guidelines.
2
42.3% of providers reported that the MRSA SCI/D guidelines were fully implemented in their SCI/D Center.
3
Facilitators included enhanced leadership support and provider education, focused guideline dissemination, and strong perceived evidence.

Research Summary

The study used mixed methods to evaluate the implementation of MRSA prevention guidelines in VA SCI/D Centers using the PARiHS framework. Findings revealed barriers such as lack of awareness among physical therapists and physician assistants, and challenges in cohorting/isolating MRSA-positive patients. Successful implementation requires guideline dissemination, provider education, strong leadership support, and addressing barriers unique to the recommendations.

Practical Implications

Targeted Dissemination

Guideline dissemination should reach all SCI/D providers, including those in inpatient, outpatient, and other care settings.

Systematic Education

Provider education should be frequent and systematic, focusing on SCI/D-specific recommendations for MRSA prevention.

Leadership Support

Strong leadership support is crucial for successful implementation, along with addressing unique barriers to the recommendations.

Study Limitations

1
Lower than expected survey response rate, particularly among physicians.
2
Relatively small group of providers interviewed qualitatively.
3
Cross-sectional nature of the research design and reliance on self-reported data may have introduced biases.

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