This document outlines a proposed intervention program to reduce healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) infections through a multifaceted approach. The program will use educational seminars, hand hygiene posters, and policy changes to improve provider practices around hand hygiene and antibiotic use. Pre- and post-intervention surveys will evaluate changes in knowledge, attitudes, and behaviors. The goal is to determine the most effective prevention strategies and lower MRSA prevalence through a year-long, mixed methods study at a Florida healthcare facility.

1. A MULTIFACETED APPROACH TO REDUCE HEALTHCARE-
ASSOCIATED INFECTION AND ANTIMICROBIAL RESISTANCE:
A COMPARATIVE STUDY OF METHICILLIN-RESISTANCE IN A
TERTIARY HEALTHCARE FACILITY IN FLORIDA
PRESENTED
BY
ERIC BENJAMIN
(WALDEN UNIVERSITY)

2. Program Summary
• The findings of majority research has revealed that the
development and prevalence of Methicillin-resistant
Staphylococcus Aureus (MRSA) are caused by preventable
multiple behavioral factors. For instance, inadequate hand
hygiene, indiscriminate use of antibiotics, inappropriate use of
invasive devices, patients attitude to medication, and
prolonged hospitalization (Centers for Disease Control and
Prevention [CDC], 2014)
• Despite the trend in research to identify the factors responsible
for the prevalence MRSA-resistant infections, little have been
achieved in addressing the problem, perhaps due to less
emphasis in implementation strategies (Cassir, Rolain, &
Brouqui, 2014)

3. Program Summary Cont’d
• The act and challenge of health promotion require a solid
understanding of the factors associated with the identified
problem, and the strategies capable of preventing or
addressing the problem (Laureate Ed., 2014)
• The ultimate goal of this intervention program is to use a
multidimensional evidence-based approach to reduce the
prevalence of healthcare-acquired MRSA-resistant infections
in the community

4. • To improve the behavior of health care providers using timely
and provocative hand hygiene posters/images
• To explore perceived barriers, motivators, enabling factors and
health care providers’ willingness to comply to hand hygiene
protocols
• To develop an explanatory theory that associates reduced
MRSA prevalence with indicators such as hand hygiene
compliance rate, level of awareness through education,
improved antibiotic use, and policy change
• To determine the best evidence-based infection prevention and
control measures through evaluation of program performance
Objectives

5. Intervention Approaches
A qualitative and quantitative observational intervention that
will:
• Regularize training of health care providers on proper use of
invasive devices
• Design and post hand hygiene images at strategic areas as a
reminder
• Advocate policy change (e.g, enact and enforce laws for
penalizing hand hygiene protocol violators)
• Enroll community health centers to participate in the CDC’s
infection tracking system
• Use reports of antibiotic resistance patterns to educate
physicians on best prescription practices

6. Intervention Approaches Cont’d
• Train focal persons to provide the general population with
valuable hygiene information
• Use a questionnaire to generate program pretest and posttest
data
• Use process evaluation to determine how well intervention
measures (hand hygiene promotion and antibiotic regulation
activities) are well implemented (McKenzie, Neiger, &
Thackeray, 2014)
• Use outcome evaluation to measure the extent to which the
implemented measures impacted (change in attitude,
knowledge, and behavior) to bring about achievement of
program objectives (McKenzie et al., 2014)

7. Intervention Approaches Cont’d
According to McKenzie et al. (2014), the process and outcome
evaluation must be performed together to determine the value
or the worth of the intervention program adequately
• Use the pretest-posttest theory model to measure the expected
changes by comparing performance before and after
implementation of the intervention strategies

8. Program Dissemination Plan
The intervention program is intended to run for a period of one
year (5/2016-05/2017). The activities include:-
• Recruitment of planning committee and assigning roles from
5/2016 to 6/2016
• Administering pretest questionnaire to generate data on the
relationship of cause-and-effect between behavior and the
prevalence of MRSA-resistant infections by 07/2016
• Engagement and discussion with program designers on how
best to execute the program by 08/2016
• Map out positive and negative possible pathways to
intervention effects 09/2016
• Develop and place hand hygiene posters at strategic areas as
reminders by 10/2016

9. Program Dissemination Plan Cont’d
• Conduct educational seminar on efficient use of antibiotics by
02/11/2016
• Organize a prize giving interdepartmental infection control
quiz by 18/11/2016
• collaborate with policy-makers to advocate policy change
over program observations by 10/12/2016
• Promulgate disciplinary laws that will be applied on hand
hygiene protocol defaulters by 30/12/2016
• Recruit internal and external program evaluators that will
analyze program performance by 03/2017
• Administer posttest questionnaire to obtain data associated
with positive and negative behavior by 05/04/2017

10. Program Dissemination Plan Cont’d
• Analyze and compare pretest-posttest program data to
determine program outcome by 30/04/2017
• Document and publish findings to inform further research by
05/2017

11. Budget with Justification
Item Category Type Quantity Unit Cost ($) Actual
Amount ($)
Proposed
Amount ($)
Variance
Consultant Program
Evaluator (Dr.
Paul Smith
1 1,850/ visit 3,700 4,000 300
Equipment Laptop
computers,
colored printers
4 computers and
1 centralized
printer
2,500/4,000 14,000 16,000 2,000
Communication Hand Hygiene
Posters 3000 copies 1.5 4,500 5,000 500
Training/Educati
on
Seminars (4x) Quarterly 100 400 600 200
Supplies Paper, Toner,
Ink, Pens,
Cartridges
12 months 200/month 2,400 4000 1,600
Incentives Staff time,
Refreshments, &
Trans
12 months
1200/month 14,400 18,000 3,600
Other Postage, Internet
Browsing, Phone
calls
12 months 50/month 600 1,000 400
Total 40,000 48,000 8,600

12. Sustainability Plan
The continuity of the intervention program will be achieved by:
•Preparing financial and program outcome report and distribute
to stakeholders, program funders, and evaluators on quarterly
basis. According to McKenzie et al. (2014), through such a
comprehensive report, and program framework, policy makers,
and program funders will continue to sponsor the program.

13. Social Change Impact
• Training of health care providers on proper use of invasive
devices and antibiotics will help check the rapid development
of resistant pathogens
• Cost associated with wastage of healthcare resources will
reduce
• Outcome will help policy-makers make informed decisions
and recommendations to regulate professional practice
• Publication of the result will help enlighten members of the
public on the importance of hand hygiene to disease
prevention
• Overall, healthcare-acquired MRSA-infections and the associated burden
will reduce. Norman (2009), stated that health promotion research is
pivotal to driving actions aimed at bringing about social change related to
community health.

14. References
Cassir, N., Rolain, J., & Brouqui, P. (2014).A new strategy to
fight antimicrobial resistance: the revival of old antibiotics,
Frontiers in Microbiology, 5(551), 1-
8.doi:10.3389/fmicb.2014.00551
Centers for Disease Control and Prevention (2014).Vital signs:
Making health care safer. Retrieved from
www.cdc.gov/vitalsigns
Laureate Education (Producer). (2014). Research in public
health: Foundations of research in public health [Video file].
Baltimore, MD: Author
McKenzie, J., Neiger, B., & Thackeray, R. (2013).Planning,
implementing, and evaluating health promotion programs: A
primer (6th ed.). San Francisco, CA: Pearson.

15. References Cont’d
Norman, C. (2009).Health promotion as a systems science and
practice, Journal of Evaluation in Clinical Practice, 15(2009),
868-872.doi:10.1111/j.1365-2753.2009.01273.x