Successful Implementation of the AHRQ Safety Program for Improving Skin Care and MDRO Prevention in Long-Term Care

To describe the implementation of the Agency for Healthcare Research and Quality safety program for improving skin care and multidrug-resistant organism prevention in long-term care (LTC), a national program that emphasized skin care and bathing to prevent multidrug-resistant organism transmission in LTC facilities, which had a 97% (309/318 enrolled LTC facilities) retention rate.

A quality improvement initiative that used a mixed-methods approach to assess process outcomes.

Nursing leadership and direct-care staff at LTC facilities in the United States.

The 18-month intervention (June 2023-November 2024) included educational webinars, office hours, and supporting materials. Implementation advisors (IAs) provided ongoing support to sites and assisted with data submission. Quantitative data on log-ins to webinars and office hours as well as resource downloads measured engagement. Qualitative analysis of reports and debriefing calls from the IAs provided perspective on implementation successes and challenges.

Educational content comprised 19 webinars delivered over 18 months, office hours offered twice monthly, and supporting material that included 60 one-page "Teachable Moments" designed to promote practice change among direct-care staff. Although webinar log-ins and office hours decreased over time, participants claimed 1031 continuing education credits throughout the program. Of the 6104 downloads of supporting material, 4713 (77%) were for Teachable Moment documents. Qualitative analysis of the IA's reports and debriefing calls yielded 4 themes: program engagement, data collection and reporting, enhanced barrier precautions, and the role of IAs.

The availability of continuing education credit, inclusion of flexible, high-interest educational content adaptable to each site's workflow, combined with robust implementation support, and low-burden data requirements likely contributed to sustaining high program retention. This approach can be adopted for future quality improvement programs, informing the strategy for public health agencies, quality improvement organizations, and LTC systems seeking to strengthen their infection prevention practices.