Our surveys of nurses modeled after the Capability, Opportunity, and Motivation Model of Behavior (COM-B model) revealed that opportunity and motivation factors heavily influence urine-culture practices (behavior), in addition to knowledge (capability). Understanding these barriers is a critical step towards implementing targeted interventions to improving urine-culture practices.

Objectives: Across many Asian countries, family caregivers provide a wide range of patient care activities while staying in the patient’s room. This unique care arrangement has been reported as a factor contributing to the spread of outbreaks including Middle East respiratory syndrome and coronavirus disease 2019 (COVID-19) in many Asian countries. We sought to understand the context in which direct patient care activities are provided by family caregivers and/or private caregivers in hospitals across Bangladesh, Indonesia, and South Korea from the infection prevention and control (IPC) perspective. Methods: We used a multimethod design with both quantitative and qualitative approaches. In total, 432 patients were surveyed from 5 tertiary-care hospitals across 3 selected countries, and 64 participants from 2 groups were interviewed: group A comprised patients, family caregivers and private caregivers and group B comprised healthcare workers. Survey data were analyzed descriptively, and the interview data were analyzed using thematic analysis. Results: The study findings highlight the different landscapes of care provision in the selected countries. Both the interviews and surveys highlighted 2 aspects of family caregiving. (1) Family caregivers inhabit in the patient zone for long periods, resulting in overcrowding, and (2) they provide a wide ranges of physically associated care activities, including those associated with the risk of healthcare-associated infections (HAIs). Despite the high number of family caregivers and their in-depth involvement in direct patient care, education and support provided to family caregivers around IPC/HAI were insufficient and varied. Also, challenges related to maintaining adequate hygiene in the environment for minimum IPC were reported. Conclusions: This study has elucidated the current landscape of family involvement in inpatient care provision and acknowledges their contribution to high risks of HAI, as well as their current lack of IPC knowledge and practice. These findings reveal that future updates in IPC strategy should acknowledge this arrangement with family caregivers and should address this role with IPC measures.

Background: Antimicrobial stewardship programs (ASPs) seek to reduce the prevalence of antimicrobial-resistant and healthcare-associated infections. There are limited infectious disease (ID) physicians and pharmacists to support these ASPs, particularly in rural areas. The Veterans Health Administration has a robust telehealth program in place. Our previous work has demonstrated the feasibility of using telehealth modalities to support ASPs at rural Veterans Affairs medical centers (VAMCs) by pairing them with an ID expert from a larger, geographically distant, VAMC. This program, dubbed the Videoconference Antimicrobial Stewardship Team (VAST), emphasizes discussion of patients undergoing treatment for an active infection and additional relevant clinical topics with a multidisciplinary team at the rural VA. VAST implementation is ongoing at VAMCs. To understand and compare the qualitative differences in implementation, we used process maps to describe the VAST at 3 VAMC dyads. Methods: Team members from each dyad participated in interviews at 3, 6, and 9 months after beginning their VAST sessions. Questions addressed several aspects of VAST implementation and included identifying cases and topics to discuss; advance preparation for meetings; the frequency and general structure of VAST meetings; and documentation including workload capture. The research team used the responses to develop process maps to permit visual display and comparison of VAST implementation. Results: The first dyad began in January 2022 and the third in March 2022. The sessions had 3 phases: preparation, team meeting, and documentation of experts’ recommendations. Tasks were shared between VAST champions at the rural VAMC and the ID experts (Fig. 1). The preparation phase showed the most variation among the 3 dyads. In general, champions at the rural VA identified cases and topics for discussion that were sent to the ID expert for review. The approaches used to find cases and the type of preparatory work by the ID expert differed. Team meetings differed in both frequency and participation by professionals from the rural site. Documentation of expert recommendations processes appeared similar among the dyads. Discussion: Each of the 3 dyads implemented VAST differently. These results suggest that the overall structure of the VAST is readily adaptable and that each site tailored VAST to suit the clinical needs, workflow, and culture of their partner facility. Future work will seek to determine which aspects in the preparation, team meeting, or documentation phases are associated with successful ASPs, including assessment of quantitative and qualitative outcomes.

Disclosures: None

Background: Identification of predictors of antibiotic use can inform targeted antimicrobial stewardship initiatives and can account for sources of bias in before-and-after interventional stewardship studies. To date, no study has identified clinical predictors of antimicrobial use within intensive care units (ICUs), where antimicrobial resistance is most prevalent and problematic. Methods: As part of an ongoing prospective, single-arm, pilot feasibility trial of an ICU diagnostic stewardship intervention, we performed a nested retrospective cohort study to explore associations between patient clinical variables and ICUs antimicrobial use and resistance rates (AURs). We included all patients hospitalized in 3 ICUs (surgical, medical, and cardiac) from 2017 to 2021 at Michigan Medicine, a large, tertiary-care, academic medical center. Data were extracted from the electronic medical record using a structured query. Admission-level data were captured, including patient demographics, medical comorbidities, International Classification of Disease, Tenth Revision (ICD-10) admission diagnoses, as well as calendar day-level data including vital signs, clinical and microbiologic laboratory data, measures of acute severity of illness, ventilator–supplemental oxygen metrics, and procedural interventions using current procedural terminology (CPT) codes. ICU AURs were defined as total antibiotic days of therapy per patient per 100 ICU days. Associations between clinical variables and ICU AURs were calculated as rate ratios (RRs). Multiple imputation using fully conditional specification was performed to create 25 imputation data sets. Negative binomial regression models were constructed for each data set using backward selection. Variables retained in >50% of models were included in a final multivariate model. Results: In total, 15,177 ICU patient admissions were captured. Age, sex assigned at birth, and race did not independently associate with ICU AURs. Comorbidities, medical interventions, admission diagnoses, and laboratory data that independently associated with ICU-AURs are shown in Table 1. The clinical variables most strongly associated with increased ICU-AURs were pneumonia (RR, 1.55; 95% CI, 1.451.64), bacteremia (RR, 1.35; 95% CI, 1.25– 1.46), intraabdominal infection (RR, 1.35; 95% CI, 1.18–1.55), SOFA score (RR, 1.27; 95% CI, 1.14–1.42), abnormal WBC (RR, 1.26; 95% CI, 1.20–1.32), and immunocompromised status (RR, 1.20; 95% CI, 1.10–1.31). Clinical variables most strongly associated with decreased ICU-AURs were cardiac ICU (RR, 0.56; 95% CI, 0.52–0.60), COVID-19 (RR, 0.62; 95% CI, 0.56–0.70), and receipt of an invasive nonsurgical procedure (RR, 0.90; 95% CI, 0.82–0.98). Conclusions: In this single-center retrospective cohort study, several clinical variables were independently associated with ICU-AURs. These results may be used to identify patient subgroups for potentially high-yield ICU-based stewardship interventions and to account for sources of bias in before-and-after studies of ICU-based stewardship interventions.

Disclosures: None

Objectives: Infection control and prevention (IPC) is one of the most important factors in decreasing multidrug-resistant organism (MRDO) transmission. We evaluated the effectiveness of the IPC program in reducing the spread of MDROs at the Department of Neonatology of Hung Vuong Hospital. Methods: This research was conducted from April 2020 to September 2020 in the neonatology department in 3 phases: (1) We determined the compliance rate of hand hygiene and high-touch surfaces cleaning (via camera monitoring). (2) We conducted the following interventions: We developed specific cleaning protocols for the neonatology department. We provided training regarding MRDO transmission control and prevention for healthcare workers. We implemented a counseling program for active screening and isolation for hospitalized children; added isolation rooms for children with MRDO asymptomatic infections. And we improved feedback efficiency through an online group between the infection control and prevention team and the department of neonatology. (3) We re-evaluated compliance with hand hygiene practices and cleaning of high-touch surfaces, then we compared the rates of positive MRDO cultures before and after these interventions. Results: Before the interventions, 453 hand hygiene observations were recorded and 322 high-touch-surface cleaning observations were recorded. The hand hygiene compliance rate improved significantly from 33.2% to 85.5% (PR, 11.9; 95% CI, 7.4–19.3; P< .01). The high-touch-surface cleaning rate increased from 82.4% to 93.5% (PR, 3.1, 95% CI, 1.5–6.4; P < .01). The rate of high-touch surfaces being cleaned with proper technique increased from 38.5% to 87.9% (PR, 11.6; 95% CI, 6.3–21.3; P < .01). In total, 103 swab samples were positive for MRDOs by culture before and after the intervention. The rate of positive MRDO cultures decreased from 80.8% to 64.7% (P = .017). Conclusions: Enhancing hand hygiene and high-touch-surface cleaning compliance helped reduce MRDO transmission in the Department Neonatology of Hung Vuong Hospital.

Deploying therapeutics for coronavirus disease 2019 (COVID-19) has proved challenging due to evolving evidence, supply shortages, and conflicting guideline recommendations. We conducted a survey on remdesivir use and the role of stewardship. Use differs significantly from guidelines. Hospitals with remdesivir restrictions were more guideline concordant. Formulary restrictions can be important for pandemic response.

Background: Antimicrobial stewardship programs (ASPs) often rely on International Classification of Diseases, Tenth Revision (ICD-10) codes to assess antibiotic appropriateness for provider feedback. Concordance between encounter ICD-10 codes and documented indication for antibiotics based on manual chart review varies greatly (74%–95%) in the inpatient setting. Data on concordance between documented indication and ICD-10 code in the outpatient setting are scarce. Methods: We conducted a retrospective cohort study of 650 randomly selected outpatient encounters with antibiotic prescriptions from walk-in and retail clinics between July 15 and September 15, 2021, at Vanderbilt University Medical Center. We performed chart review to compare documented antibiotic indication to the 3 most frequent encounter-associated ICD-10 codes. Also, 12 encounters were excluded due to insufficient available written documentation. The 95% CI for proportion of encounters with concordant antibiotic indications was calculated using Stata version 15.1 software. Results: Of the 638 antibiotic prescriptions with written documentation available for chart review, 204 (32%) were for amoxicillin, 102 (16%) were for amoxicillin-clavulanate, 61 (10%) were for cefdinir, and 56 (9%) were for azithromycin. Overall, 540 (84.6%; 95% CI, 81.6%–87.4%) of 638 encounters had concordant antibiotic indication based on documentation in the note and associated ICD-10 for the encounter. Of the 540 encounters with concordant ICD-10 and documented indications, 348 (64%), 130 (24%), and 35 (6%) were listed as the first, second, and third ICD-10 codes, respectively. An additional 27 (5%) had a concordant ICD-10 code listed beyond the third position. In total, 125 (19.6%) of 638 encounters did not have the intended antibiotic indication as documented in the note in the 3 most frequent encounter-associated ICD-10 codes (whether a lower position or incongruent ICD-10 code with documentation). Of those 125 encounters, 42 (34%) had a documented diagnosis of strep pharyngitis, 16 (13%) had a documented diagnosis of skin or soft-tissue infection, 11 (9%) had a documented diagnosis of urinary tract infection, and 11 (9%) had a documented diagnosis of acute otitis media. Conclusions: Our data suggest that outpatient antimicrobial prescriptions correlate relatively well with encounter ICD-10 codes. However, most ASP prescribing goals aim to reduce inappropriate prescribing to 10% or fewer of prescriptions based on indication. Therefore, providers may not trust individual prescribing feedback that is based on data that is only correct 85% of the time. For ASPs to accurately assess prescribing and provide trusted, meaningful recommendations and specific feedback to individual prescribers, more reliable and valid data are needed. We intend to evaluate whether requiring outpatient antibiotic indications on prescriptions increases data reliability and validity.

Disclosures: None

Objectives: COVID-19 has highlighted the importance of the hierarchy of controls and early implementation of transmission-based precautions during outbreaks in residential aged-care facilities (RACFs). The RACF outreach team is a service provided by the Sydney Local Health District (SLHD) that provides RACFs with expert clinical care and advice, along with outbreak management and infection control and prevention education. Methods: The RACF outreach team developed 2 unique IPC management tools designed to assist RACFs during the COVID-19 pandemic: (1) the comprehensive initial review and (2) first-responder assessment tool designed to assist the team in identifying high-risk issues during afterhours shifts. The tool reviews 5 key components in outbreak management: screening, PPE usage, resident care, communication and signage, and infection control and prevention. The outreach team provides an IPC report of the comprehensive initial review, which provides site-specific advice regarding zoning, cohorting, implementation of donning and doffing stations, safe staffing and workflows, ventilation, personal protective equipment (PPE) use, and PPE safety. The recommendations supplied in the SLHD IPC report are provided to facilities and are implemented at the facility level. These reviews are followed up in meetings of the outbreak management team conducted virtually via Zoom videoconferencing. These meetings include an RACF senior manager and a representative from the local PHU, the outreach service, the Australian Commonwealth, the Aged Care Commission, an SLHD executive manager, and an infectious diseases practitioner. Results: Since the outbreak of the SARS-CoV-2 ο (omicron) variant began in Sydney, Australia, in November 2021, 58 facilities with >2,500 residents have been reviewed, and 57 of these facilities had a COVID-19 outbreak at some point during the pandemic. Conclusions: The RACFs in SLHD continue to report death rates <5% among all SARS-COV-2–positive residents.

Tackling antimicrobial resistance (AMR) through antimicrobial stewardship (AMS) interventions is a key objective within the World Health Organization (WHO)’s Global Action on AMR. We outline the reasons why global collaborations for AMS are needed. We provide examples of global collaborations, and we offer considerations when starting on a global health journey focused on AMS.

Objectives: Candidemia has become one of the leading causes of healthcare-associated bloodstream infection, particularly in the intensive care unit. The management of candidemia remains challenging. We reassessed the protective effectiveness of a comprehensive care bundle on the management of candidemia and the effects of compliance with each element on the outcomes of patients. Methods: This network meta-analysis was conducted using the frequentist method. The participants included adult patients both infected with candidemia and who received bundle care. The primary outcome was the all-cause mortality among the patients included. Results: Studies in which a care bundle was created for patients with candidemia were identified, and 5 eligible studies with 5,808 participants were enrolled for further analysis. The random-effects model of the overall odds ratio (OR) revealed a significant reduction in the risk of all-cause mortality compared with that of the controls (OR, 0.599; 95% CI, 0.378–0.949; P = .025), as well as a reduction in the risk of developing persistent candidemia compared with the controls (OR, 0.483; 95% CI, 0.245–0.952; P = .008). In addition, no single element reached a protective effectiveness to improve the clinical outcome. Conclusions: This meta-analysis demonstrated that the combination of core elements in the care bundle resulted in protective effects, in that the all-cause mortality rates and incidence rates were effectively reduced among patients with persistent candidemia.

Background: Antibiotics are frequently prescribed in patients with COVID-19 infections to treat secondary bacterial pneumonia. The pneumonia panel (PNP) is a molecular diagnostic tool that rapidly detects 33 bacterial and viral targets. The utility of this panel in COVID-19 patients and how it may direct antibiotic use is unknown. We sought to understand the utilization of PNP in patients with COVID-19 pneumonia over time by comparing clinical parameters, microbiologic results, and antibiotic use between May–December 2020 and January–July 2022. Methods: We implemented the PNP in May 2020 with antimicrobial stewardship guidance, provider education, and order restriction to critical care and infectious disease clinicians. From February–July 2021 prescribers received regular structured antimicrobial stewardship feedback regarding PNP results; from August 2021 to January 2022, no antimicrobial stewardship feedback was provided; from February to July 2022, intermittent feedback was provided. We compared PNP and culture results from sputum or bronchoalveolar lavage samples and antibiotic use and modification within 24 hours of PNP result from patients with confirmed COVID-19 pneumonia between May–December 2020 and January–July 2022. Clinical data and antibiotic use were abstracted through chart review. We excluded patients who died within 72 hours of PNP, those who had concurrent nonpulmonary infections, and those whose COVID-19 test was >30 days prior. Results: We included 114 patients in 2020 and 71 patients in 2022. The overall median age was 61 years, 71% were male, and 66% were mechanically ventilated without statistical differences between the cohorts, including their comorbidities. Acute or worsening hypoxia remained the predominant indication for PNP (77% in 2020 vs 75% in 2022, NS). The median number of days between admission and PNP was 4 (IQR, 1–8) in 2020 versus 3 (IQR, 1–7), and the difference was not significant. PNP and culture results in Table 1 show that Staphylococcus aureus and Hemophilus influenzae were the pathogens most commonly identified. Table 2 describes empiric prescribing and modifications for commonly prescribed antibiotics. Prescribers used empiric cefepime and ceftriaxone more in 2020 and vancomycin more in the 2022 group; however, these were not statistically significant. Cefepime de-escalation was more common in 2022 (53% vs 28%; P = .03). Antibiotic modifications within 24 hours of PNP remained similar in 2020 vs 2022. Although vancomycin cessation was more common in 2020 (78%) versus 2022 (57%), the difference was not statistically significant. Conclusions: With ASP guidance, PNP may be a useful tool to stop or target antibiotics for secondary bacterial pneumonia in COVID-19 pneumonia. Early vancomycin cessation (prior to culture results) may be an enduring consequence of PNP implementation.

Disclosures: None

Background: Most antibiotic use occurs in ambulatory settings. Antibiotic prescribing for children living in the United States in medically underserved areas or in populations is not well understood.

Objective: To characterize antibiotic prescribing for children in a practice-based research network (PBRN).

Design and Methods: In this retrospective cohort study, we characterized oral antibiotic prescribing in a large PBRN. Patients aged 0–17 years with at least 1 in-person visit between January 1, 2014, and December 31, 2018, at 1 of 25 primary-care clinics located within the WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) region of the Practice and Research Network (WPRN) were included. Data were extracted from DataQUEST, a centralized data repository from included primary-care clinics. Encounters for wellness visits or those lacking a diagnosis code and patients with complex chronic conditions were excluded. Diagnoses were categorized using International Classification of Disease, Ninth Revision (ICD-9) and ICD-10 codes. Oral antibiotics prescribed within 3 days of an encounter were associated with that encounter. Demographic data included age, sex, race, and ethnicity. Antibiotic appropriateness was determined using a previously published 3-tiered classification system using diagnosis codes as always, sometimes, or never appropriate. Patient-level data (ZIP codes) were used to designate medically underserved areas (MUAs) and medically underserved populations (MUPs). Antibiotic prescribing was then analyzed within these groups. Results: In total, 37,314 patients across 206,845 encounters were included, of which 34,601 encounters (17%) resulted in antibiotic prescription (Table 1). Of those, appropriateness data were available for 34,286 (99%). Of the antibiotics prescribed, 14% were always appropriate, 57% were sometimes appropriate, and 27% were never appropriate (1% missing). In total, 64% and 35% of encounters occurred with patients from an MUA and MUP, respectively. Conclusions: Targets to improve oral antibiotic prescribing for children in a large PBRN include antibiotic prescribing for diagnoses that never require an antibiotic. Larger comparative studies may focus on the role (if any) that MUA/MUP has on antibiotic prescribing.

Disclosures: None

Objectives: We evaluated the effectiveness of using appropriate chemical(s) to treat the dental unit waterline (DUWL), and we recommended appropriate strategies to manage the DUWL system to maintain bacteria concentration below minimum recommended levels. Methods: Initial water samples were collected aseptically from the handpieces of the DUWL in dental clinics to assess the bacterial load prior to treatment of the dental unit. The dental staff were educated on the management and treatment of the DUWL. Appropriate chemicals were introduced to the DUWL system. Following the treatment, samples of water from the DUWLs were collected to assess the bacterial load. Results: The US CDC recommends a safe level of bacterial load of <500 CFU per mL of heterotrophic bacteria in the standard for drinking water by the US EPA. Initial results for the DUWL water showed unacceptably high levels of bacterial load between 1,930 and 35,000 CFU per mL prior to treatment. Subsequent sampling of DUWL water with treatment of appropriate chemicals showed vast reductions of the bacterial loads in all the dental units, with bacterial counts between <1 and 72 CFU per mL. Conclusions: It is important to ensure ongoing education and regular treatment with appropriate chemical and effective management and monitoring of all DUWLs from dental chairs to ensure that the water produced meets safe drinking standards.

Background: Critical-access hospitals (CAHs) are required to meet the CDC 7 Core Elements of antimicrobial stewardship programs (ASPs). CAHs have lower adherence to the core elements than larger acute-care hospitals, and literature defining which core-element deficiencies exist within CAHs as well as barriers to adherence is lacking. Methods: We evaluated 21 CAH ASPs (5 in Nebraska and 15 in Iowa) that self-identified as potentially deficient in the Core Elements, via self-assessment followed by in-depth interviews with local ASP team members to assess adherence to the CDC Core Elements for ASPs. Core-element compliance was rated as either full (1 point), partial (0.5), or deficient (0), with a maximum score of 7 per ASP. High-priority recommendations to ensure core-element compliance were provided to facilities as written feedback. Self-reported barriers to implementation were thematically categorized. Results: Among the 21 CAH ASPs, none fully met all 7 core elements (range, 2.5–6.5), with a median of 5 full core elements met (Fig. 1). Only 6 ASPs (28.6%) had at least partial adherence to each of the 7 core elements. Action (21 of 21, 100%) and leadership commitment (16 of 21, 76.2%) were the core elements with the highest adherence, and accountability (4 of 21, 19%) and education (9 of 21, 42.9%) were the lowest. The most frequent high-priority recommendations were to provide physician and pharmacist leader ASP training (19 of 21, 90.5%), to track antimicrobial stewardship interventions (12 of 21, 57.1%), and to provide or track educational activities (12 of 21, 57.1%) (Fig. 2). One-third of programs were recommended to establish a physician leader. The most commonly self-identified barriers to establishing and maintaining an ASP were a lack of dedicated resources such as time of personnel (15 of 20, 75%), lack of infectious diseases expertise and training (8 of 20, 40%), and electronic medical record limitations (5 of 20, 25%) (Fig. 3). Conclusions: CAH ASPs demonstrate several critical gaps in achieving adherence to the CDC Core Elements, primarily in training for physician and pharmacist leaders and providing stewardship-focused education. Further resources and training customized to the issues present in CAH ASPs should be developed.

Disclosures: None

Objectives: In Vietnam, although surveillance and control of multidrug-resistant organisms is a national priority, information on the burden of these pathogens remains scarce. At the University Medical Center in Ho Chi Minh City, we assessed the proportion of carbapanemase-producing carbapenem-resistant organisms (CP-CRO) and evaluated an intervention package to prevent transmission of carbapenemase-producing carbapenem-resistant Enterobacterieacea (CP-CRE) in the intensive care unit (ICU). Methods: All gram-negative isolates collected between November 2018 to April 2019 were tested for carbapenem resistance using the disc-diffusion method. Carbapenem-resistant bacteria, defined as meropenem resistant, were tested for phenotypic carbapenemase-production using the Becton Dickinson Phoenix CPO Detect assay. An intervention package, including placement of patients in cohorts, enhanced barrier precautions, enhanced discharge environmental cleaning, and CP-CRE rectal screening, was implemented from July 2019 through December 2020. During this period, all ICU patients were screened on admission, and negative patients were rescreened every 2 days or 7 days until discharge, death, or CRE-positive result. Admission prevalence and incidence of CP-CRE transmission was calculated among CP-CRE infected or colonized patients. Results: Among 599 gram-negative isolates collected, 108 were carbapenem-resistant isolates, of which 107 (99%) were CP-CRO by the phenotypic method. Most CP-CRO were Acinetobacter baumannii (42%) and Klebsiella pneumoniae (36%). Of 1,206 patients, 433 (35.9%) were already colonized or infected with CP-CRE before admission to the ICU. The incidence rate (cases per 100 risk days) of CP-CRE colonization or infection during ICU treatment decreased from 11.5 before the intervention to 2.9 after the implementation of the intervention package. The average number of days to change from a negative to positive screening result in the intervention phase was 7.4, compared with 4.9 days during preintervention phase. Conclusions: Nearly all CROs isolated from our ICU are carbapenemase-producing CROs, with high presence on admission as well as new acquisition during an ICU stay. An intervention package containing enhanced infection control measures was effective in reducing CP-CRE transmission.

Background: The FIRST Trial is a 5-year study funded by the Agency for Healthcare Research and Quality. Our investigation is situated within a more extensive study to restrict fluoroquinolone antibiotics by requiring providers to obtain authorization from an infectious disease physician before prescribing fluoroquinolones. Our research team is performing a systematic evaluation to identify organizational characteristics and influencers of the fluoroquinolone preprescription authorization implementation process to understand variables that may facilitate or hinder implementation success. Methods: To address this critical gap, we present a qualitative analysis from our ongoing, multisite research project aimed at systematically assessing the adoption of an antimicrobial stewardship intervention in the form of an EHR-integrated best-practice alert (BPA) at each site to identify work system factors that impact uptake and variability in the implementation of the BPA at each location. The evaluation provides a detailed explanation of activities through the implementation process (eg, before implementation, during implementation, and after implementation) to assess how an organization effectively negotiates the phases and transitions, ultimately influencing the impact of the intervention. We have used a contextual determinant framework (CFIR) that has enabled us to perform a systematic and comprehensive exploration and identification of potential explanatory themes or variables to shed light on the complex social phenomenon of implementation. Results: Participants who will be a part of our poster presentation will learn about implementing a BPA, the potential barriers to implementation, and strategies for overcoming these barriers. Stakeholders within our study include site coordinators, medical doctors, nurses, pharmacists, and clinical informaticists. Our analysis synthesizes their experiences implementing and sustaining this evidence-based antimicrobial stewardship intervention. It includes (1) a detailed description of the process of change, (2) work-system factors (eg, inner setting and outer setting) that they believe influenced the success of the intervention, (3) barriers and facilitators (eg, CFIR constructs) within the implementation process; and (4) description of how these could have influenced the outcomes of interest (eg, implementation and intervention effectiveness). Conclusions: Our research is expected to advance patient safety research and initiatives by providing a more robust approach to performing systematic intervention evaluations. By outlining stakeholders’ experiences within our study, implementation leaders within healthcare systems will utilize our findings to aid them in their design and implementation process when designing and implementing similar types of healthcare interventions.

Disclosures: None