# Reducing VA Healthcare-Associated Infections through Antibiotic StEwardship (RAISE)

> **NIH VA I50** · WM S. MIDDLETON MEMORIAL VETERANS HOSP · 2021 · —

## Abstract

Background: Clostridium difficile infections (CDI) are increasing in incidence and severity, and the Veteran
population is at elevated risk of this healthcare-associated infection. Despite prevention initiatives in VA, CDI
rates (adjusted for facility complexity and patient mix) have continued to vary widely across VA sites. Antibiotic
stewardship (AS) programs have been shown to reduce hospital-onset CDI rates, and so they are a key
component of CDI prevention programs. However, it is unknown which AS strategies are most effective in
reducing CDI specifically and how to implement these AS strategies effectively.
Specific Aims: Our long-term goal is to use implementation science to develop and evaluate interventions to
reduce healthcare-associated infections like CDI. We aim to understand the contextual and work system
factors that are part of AS interventions and their impact on clinical outcomes. The Agency for Healthcare
Research and Quality (AHRQ) has committed funding to our academic affiliate (PI: Safdar) to conduct a
randomized controlled trial to 1) measure the impact of a core AS intervention (preprescription authorization,
PPA) on reducing CDI rates and 2) use a systems engineering framework to evaluate the contextual,
implementation, and work system factors that contribute to clinical outcomes. This Partnered Evaluation
Initiative will leverage AHRQ funding to evaluate the clinical and implementation outcomes of a second core
AS intervention with the goal of reducing CDI. Here, we will evaluate a prospective audit with feedback (PAF)
AS intervention and its implementation in a VA context in order to produce implementation strategies for the
specific needs of VA facilities. Our aims for this project are:
 1: Evaluate implementation outcomes of a PAF intervention using a blend of the Integrated Promoting
 Action on Research in Health Services (PARiHS) and Systems Engineering Initiative for Patient Safety
 (SEIPS) models.
 2: Explore the impacts of a core AS intervention (PAF) on clinical outcomes - including CDI rates - in
 VA settings.
 3: Develop and disseminate sustainable recommendations for AS in VA aimed at reduction of CDI.
Methods: We will use Mentored Implementation methods to help six VA inpatient units optimize and implement
PAF interventions to reduce the use of fluoroquinolones. We will use systems engineering frameworks to
evaluate the fidelity, acceptability, and feasibility of the implementations as part of a multiple case study design
at each participating unit. We will also conduct an interrupted time series analysis at each site using pre- and
post-intervention data to measure the impact of the intervention on clinical outcomes such as CDI rates and
antibiotic usage.
Impacts: This project will use the iPARiHS and SEIPS frameworks to undertake a complete work systems
analysis – systematically examining implementation barriers and facilitators to AS interventions. By partnering
this project with the AHRQ-funded trial, we...

## Key facts

- **NIH application ID:** 10181069
- **Project number:** 5I50HX003040-02
- **Recipient organization:** WM S. MIDDLETON MEMORIAL VETERANS HOSP
- **Principal Investigator:** NASIA SAFDAR
- **Activity code:** I50 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-10-01 → 2022-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10181069

## Citation

> US National Institutes of Health, RePORTER application 10181069, Reducing VA Healthcare-Associated Infections through Antibiotic StEwardship (RAISE) (5I50HX003040-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10181069. Licensed CC0.

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