To help speed implementation and translation of research findings into practice across the nation, tools, such as online materials, training videos, etc., can be created. Materials developed to train the sites participating in the PCT are good starting places for materials for a broader audience. But again, a health system leader must first recognize the need for the tool, then champion its implementation (pointing to the need to involve these stakeholders in study design).

Case Example: REDUCE MRSA and ABATE Infection Trials

The REDUCE MRSA trial was a large, cluster-randomized pragmatic trial of 43 hospitals (74 adult ICUs) that demonstrated that universal bathing with chlorhexidine and universal nasal decolonization with mupirocin significantly reduced MRSA clinical cultures and all-cause bloodstream infections in adult ICUs.

To support broad implementation and facilitate rapid integration of techniques into routine care in ICUs across the country, investigators made the toolkit with educational materials and documentation widely available (Universal ICU Decolonization: An Enhanced Protocol), offered standardized support, and encouraged local adaptation and collaboration. Septimus et al. note several contributing factors that influenced the success of implementation: “(1) a well-designed toolkit with proven success in a pragmatic clinical trial; (2) a program team, experienced in implementing evidence-based practices, that is responsive to local needs; and (3) an established infrastructure for implementing large quality improvement projects (Septimus et al. 2016)."

The implementation of the REDUCE MRSA trial was informed by Pronovost’s five key components of effective translation of knowledge into practice:

• A focus on systems rather than the care of individual patients
• Engagement of local interdisciplinary teams to assume ownership of the improvement project
• Creation of centralized support for the technical work
• Encouraging local adaption of the intervention
• Creating a collaborative culture within the local unit and larger system (Pronovost et al. 2008; Septimus et al. 2016)

Most importantly, the successful and rapid implementation of the toolkit used in REDUCE MRSA demonstrates the ability to rapidly integrate research into clinical care, which is, in essence, the foundation of a learning health system.

The diffusion, dissemination, implementation, and sustainability strategy for REDUCE MRSA is described in the table below.

The Active Bathing to Eliminate Infection (ABATE) Trial is a sister trial of REDUCE MRSA. The goal was to determine if using antiseptic bathing for all patients and nasal ointments for patients harboring methicillin-resistant Staphylococcus aureus (MRSA) reduces multidrug-resistant organisms and bloodstream infections. The setting for this trial was not ICUs, as with the REDUCE MRSA trial, but rather was conducted in non-ICU settings. Because the trial’s results are pending, the team is holding off on implementation outside of the ICU until an answer is known.

The diffusion, dissemination, implementation, and sustainability strategy for the ABATE Infection trial is described in the table below.