# Combating Antimicrobial Resistance through Rapid Implementation of Available Guidelines and Evidence (CARRIAGE)

> **NIH VA IP1** · VA SALT LAKE CITY HEALTHCARE SYSTEM · 2020 · —

## Abstract

Background: Annually, at least two million illnesses and 23,000 deaths are caused by antibiotic-resistant
bacteria in the US alone, with an annual impact of $20-35 billion in excess health care costs. The emergence
of antibiotic resistance means the treatment of infections is becoming increasingly difficult, expensive, and, in
some cases, nonexistent. Judicious use of antibiotics is essential to slow the emergence of resistance and
extend the useful life of effective antibiotics, but prevention of resistance also requires efforts to control
pathogen transmission across healthcare settings and reduce healthcare-associated infections. VA is not
immune to this rising threat to patient safety, but our national, integrated healthcare system for Veterans offers
unique opportunities to significantly alter the course of events and improve the outlook for our future through
novel implementation and quality improvement efforts.
Objectives: The goal of this QUERI program is to address the growing concern of antimicrobial resistance
through strategies targeting improved use of antibiotics and prevention of healthcare-associated infections
(HAI) across VA patient care settings. In doing so, we will address the priority goals of our VA operational
partners, the QUERI Strategic Plans, the 2014 VHA Blueprint for Excellence, and the goals of the National
Action Plan for Combating Antibiotic-resistant Bacteria as put forth by President Obama. Our specific
objectives are to (a) promote judicious inpatient antibiotic use through a novel antibiotic self-stewardship
"timeout" project that prompts VA providers to evaluate the continued need for antibiotics; (b) support and
enhance the implementation of new VA guidelines to detect and prevent the spread of carbapenem-resistant
Enterobacteriaceae in VA hospitals; (c) foster improved handwashing practice by repairing the broken audit-
and-feedback mechanism in VA acute-care hospitals via a VISN-wide quality improvement project; and (d)
evaluate and enhance the implementation of the national C. difficile bundle at VA acute-care facilities;
Methods: Program projects will vary in study timeframe and start date over the five-year QUERI program
timeframe. Research designs utilized across projects will include the experimental stepped wedge design for
implementation of interventions, prospective observational designs of practice implementation of large-scale
policy initiatives, and rigorous evaluation of VA national policies. The program will employ complementary
implementation strategies and theories guided by an Implementation Core consisting of a team of notable VA
implementation scientists with proven track records in designing and executing programs to control
antimicrobial resistance and HAIs. Specific implementation strategies will include audit and feedback, clinical
decision support, external facilitation, provider education and activation, and adherence engineering. The
Promoting Action on Research in Health Services ...

## Key facts

- **NIH application ID:** 9205309
- **Project number:** 1IP1HX001993-01A1
- **Recipient organization:** VA SALT LAKE CITY HEALTHCARE SYSTEM
- **Principal Investigator:** CHARLESNIKA T EVANS
- **Activity code:** IP1 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2016-10-01 → 2021-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9205309

## Citation

> US National Institutes of Health, RePORTER application 9205309, Combating Antimicrobial Resistance through Rapid Implementation of Available Guidelines and Evidence (CARRIAGE) (1IP1HX001993-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9205309. Licensed CC0.

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