# Understanding and Addressing Variation in Healthcare-Associated Infections After Durable Ventricular Assist Device Therapy

> **NIH AHRQ R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2020 · $446,870

## Abstract

Project Summary/Abstract
Durable ventricular assist devices (VADs) provide long-term mechanical circulatory support as a bridge to
cardiac transplantation or as permanent therapy, and have the potential to benefit more than 250K patients with
advanced heart failure (HF) refractory to guideline-directed medical therapy. Upwards of six out of every 10
VAD patients develop a healthcare-associated infection (HAI) following implant. Broader adoption of durable
VAD therapy is hindered by HAIs given their association with mortality (5.6-fold increased risk of 1-year
mortality) and healthcare expenditures ($264K – $869K per patient).
Most studies evaluating HAIs in the setting of VAD therapy have been limited to post-hoc analyses of small
trials, or single center experiences. While some argue that centers with lower HAI rates select healthier
patients, others counter that improved practices (e.g., standardizing empirical and targeted antimicrobial
therapy) or enhanced provider teamwork are more predictive of improved outcomes. While evidence-based
HAI prevention guidelines and implementation tools (e.g., checklists) exist, these approaches are not
comprehensive (e.g., neglecting device-specific determinants) or customizable to local context, thus limiting
usability, adoption, and likelihood of significant effectiveness for preventing HAIs. Understanding the barriers
and facilitators within individual centers for maximizing adoption of prevention measures would serve as the
foundation for targeted strategies. Without this knowledge, evidence-based, action-oriented recommendations
will have limited local adoption and ultimately effectiveness in preventing HAIs after VAD implantation.
Our long-term goal is to develop and subsequently promote wide-scale adoption of evidence-based HAI
prevention practices following durable VAD implantation. The objective of this proposal is to identify prevention
recommendations for the most significant HAIs after VAD implantation. To achieve this objective, we will
undertake a mixed methods study of adult patients receiving VADs in the U.S. from 2009 – 2017 and develop a
modular toolkit of evidence-based recommendations. To determine best practices for preventing HAIs, we will
examine center-level differences in HAI rates to identify strategies used by centers with low rates, and barriers
to lowering HAI rates among centers with high rates. We will use a novel dataset including administrative
claims and detailed clinical data, along with in-depth center surveys, to address the following aims: (i) identify
determinants of center-level variability in HAI rates, (ii) develop a comprehensive understanding of barriers and
facilitators for achieving low center HAI rates, and (iii) develop, iteratively enhance, and disseminate a best
practices toolkit for preventing HAIs that accommodates various center contexts.
Our studies will have a positive impact on clinical practice by identifying targets for an interventional study.
Moreove...

## Key facts

- **NIH application ID:** 9948644
- **Project number:** 5R01HS026003-03
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** DONALD S LIKOSKY
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $446,870
- **Award type:** 5
- **Project period:** 2018-09-01 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9948644

## Citation

> US National Institutes of Health, RePORTER application 9948644, Understanding and Addressing Variation in Healthcare-Associated Infections After Durable Ventricular Assist Device Therapy (5R01HS026003-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9948644. Licensed CC0.

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