Implementing a national infection prevention trial with iPARIHS

Background and aims The Researching Effective Approaches to Cleaning in Hospitals (REACH) study, aims to evaluate the effectiveness of a novel cleaning bundle intervention in 11 major Australian hospitals. Outcome measures include healthcare associated infection rates, cleaning performance and cost effectiveness. Implementing a complex intervention in multiple, large healthcare environments requires a systematic and rigorous approach to ensure authenticity and trial integrity. The REACH study is using the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to inform the implementation of the environmental cleaning bundle in each hospital. Methods Using the iPARIHS framework constructs (innovation, recipients, context and facilitation), we will map the hospital characteristics, including infection prevention policies and practices, and environmental services staff knowledge and attitudes. We will use this information to develop a tailored implementation strategy for each site. During the trial we will assess and monitor the bundle implementation and local impact using tools based on the framework. Collecting this contextual and process information will allow the study team to respond to implementation issues. Further, it will assist in evaluating intervention and implementation delivery and fidelity. After the trial, information collected about the implementation process will be reviewed to develop an understanding of how and why the intervention did or did not work at each site. Conclusion A local implementation plan, informed by the iPARIHS framework, will support effective operationalisation of the REACH cleaning bundle intervention. Additional monitoring of the implementation process will assist with trial site comparisons, supporting future replication and scalability