A Multistage Mixed Methods Methodology to Develop a Toolkit to Reduce Infections Following Durable LVAD Implantation

BackgroundInfections following durable left ventricular assist device (dLVAD) implantation are common and associated with increased morbidity and mortality. Despite documented interhospital variability, few studies have identified strategies to mitigate their occurrence. This national study uses a multistage mixed methods design to develop a customizable and deployable toolkit of expert-guided recommendations to reduce infections post-dLVAD. MethodsRepresentatives from low, medium, and high-performance hospitals across the U.S. were interviewed to assess factors contributing to post-dLVAD infections. Draft toolkit recommendations were iteratively developed after integrating thematically analyzed qualitative and quantitative data. A national advisory team of ventricular assist device (VAD) subject matter experts provided mixed methods input to refine the toolkits content and structure. ResultsSeventy-three clinical and operational VAD team members were interviewed, and 14 subject matter experts provided stakeholder feedback to refine the toolkit. The resulting toolkit contains 39 infection prevention recommendations that address VAD program care processes (e.g., real-time provider communication), clinicians (e.g., multidisciplinary protocol development), patients & caregivers (e.g., engaging patient advisors in patient education), and VAD leadership (e.g., unit and service level data reporting). Accompanying resources (e.g., team-based exercises, data collection worksheets) support implementing and evaluating site-specific strategies. Input from clinical and research experts provided preliminary evidence of the toolkits acceptability and considerations for enhancing the toolkits adoption and implementation. ConclusionsUsing mixed methods approaches, an infection prevention toolkit was developed to enhance care coordination among VAD team members and mitigate post-dLVAD infections. Future work should evaluate the effectiveness of implementing this infection prevention toolkit within the dLVAD setting. What is KnownO_LISix out of every 10 patients develop an infection within 2 years of durable left ventricular assist device (dLVAD) implantation. C_LIO_LIInfections contribute to an increased risk of major morbidity and mortality. C_LIO_LIPost-dLVAD infection rates vary across hospitals, even after risk adjustment. C_LI What the Study AddsO_LIA customizable toolkit of infection prevention recommendations was developed and pilot tested using mixed methods approaches. C_LIO_LIRecommendations focus on modifiable aspects of organizational structure, patient care, patient education, quality reporting. C_LI