525. Evaluation of Implementation of Guidelines for Carbapenem-resistant Enterobacteriaceae (CRE) Prevention Using the Consolidated Framework for Implementation Research (CFIR)

BACKGROUND: Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing (CP) CRE are difficult to treat, resulting in a high mortality annually. In 2017, VA released guidelines for CRE/CP-CRE laboratory testing, prevention, and management. We used the Consolidated Framework for Implementation Research (CFIR) to understand factors influencing implementation of the CRE guideline at VA Medical Centers (VAMCs). METHODS: Between 9/17–8/18, 43 semi-structured interviews were conducted with Multi-Drug Resistant Organism Program Coordinators, laboratorians, physicians and infection preventionists from 29 geographically representative VAMCs of varying size and CP-CRE burden. Interviews addressed perceptions of guideline dissemination, laboratory testing, training, patient education, and IT support (e.g., CRE/CP-CRE flag, lab report and template). We analyzed transcripts using a consensus-based mixed deductive-inductive coding approach to identify CFIR constructs, best practices, recommendations/feedback and implementation challenges. RESULTS: 95% of interviewees reported using VA CRE/CP-CRE guidelines, most (79%) with high confidence. Respondent comments (n = 798) were coded using CFIR constructs [Inner Setting (e.g., resources), (48%); Process (e.g., planning), (23%); Intervention Characteristics (e.g., VA guidelines) (17%); Outer Setting (e.g., patient needs) (6%); Characteristics of Individuals (e.g., self-efficacy) (6%)]. Interviewees also described Best Practices (15%) and Feedback/Recommendations (12%) including the need for improved lab testing/reporting, communication, contact isolation, staff training, patient education and cost. CONCLUSION: Our results suggest sustained improvement in multiple areas to facilitate guideline implementation to identify, prevent, and manage CRE/CP-CRE are needed. This is critical because CRE/CP-CRE incidence and mortality rates are projected to increase. [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.