States Targeting Reduction in Infections via Engagement (STRIVE).
The States Targeting Reduction in Infections via Engagement (STRIVE) initiative was 3-year hospital-based program using a multimodal, evidence-based intervention targeted at reducing healthcare-associated infections (HAI) and strengthening state-hospital relationships to improve infection control efforts. The intervention recruited hospitals with a high burden of HAI; a total of 337 hospitals across 23 states and the District of Columbia participated in the program. The STRIVE intervention consistent of four components: (1) baseline assessment of each participating hospital conducted by a state partner, (2) tiered approach to HAI prevention, (3) educational content, and (4) on-site technical assistance.
- Central-line Associated Blood Stream Infection (CLABSI)
Over the three-year study period, no substantial reduction in CLABSI rates were observed; unadjusted rates decreased from 0.88 to 0.80 infections per 1,000 catheter-days. The authors did observe reductions in central-line catheter use during the study period (24.05 to 22.07 central line-days per 100 patient-days); however, this trend was also documented in the pre-intervention period.
- Catheter-Associated Urinary Tract Infection (CAUTI)
Baseline CAUTI rates at participating hospitals were low. Over the three-year study period, the unadjusted CAUTI rate decreased slightly; unadjusted rates decreased from 1.12 to 1.04 infections per 1,000 catheter-days. Unadjusted urinary catheter use decreased from 21.46 to 19.83 catheter-days per 100 patient-days.
- Clostridioides Difficile Infection (CDI)
The authors observed a statistically significant reduction in Clostridioides difficile infection (CDI) over the three-year period, from 7.0 cases days to 5.7 cases per 10,000 patient-days. However, these decreases mirrored national trends in CDI reduction and are likely attributed to recent emphasis on CDI clinical guidelines, mandated CDI reporting, and the inclusion in value-based purchasing, rather than the STRIVE intervention.
- Methicillin-Resistant Staphylococcus Aureus (MRSA) Infection.
Baseline MRSA rates at participating hospitals were low. Over the three-year period, the unadjusted MRSA rate decreased slightly from 0.075 to 0.071 cases per 1,000 patient-days.
- State Partner Relationships and HAI Prevention Efforts
While STRIVE did not result in quantitative improvements in CAUDI, CLABSI, CDI or MRSA rates, the initiative did strengthen relationships between hospitals and state health departments. Through the baseline assessment, state partners were able to identify gaps in HAI prevention efforts and opportunities to improve partner-hospital relationships. State partners also reported improvements in hospital-level prevention activities over the three-year period, as well as improvements to state partner-hospital relationships.
Ann Intern Med. 2019;171(7_Suppl):s1-s82.