This article published in the Annals of Internal Medicine has demonstrated a reduction in healthcare-associated infections (HAIs) in hospitals as a result of the United States Centers for Disease Control and Prevention’s (CDC’s) States Targeting Reduction in Infections via Engagement (STRIVE) program.

In 2011, approximately 721,800 HAIs were identified in US hospitals; the most common etiologic pathogens were Clostridioides difficile and methicillin-resistant Staphylococcus aureus, Enterococcus spp, and Gram-negative bacilli. Therefore, the STRIVE initiative focused on improving infection prevention and control practices by bringing national healthcare professional societies, subject matter experts, and state-level healthcare organizations together with short-stay and long-term acute care hospitals. The program’s goal was to identify, partner with, and collaborate with hospitals struggling to reduce HAI by pairing national subject matter experts with regional, state, and local organizations in the hope of effecting sustainable change.

To achieve this goal, the initiative had 3 specific aims: strengthen infection control practices through dissemination and implementation of the CDC’s Targeted Assessment Prevention strategy; strengthen relationships among state hospital associations, state health departments, and other state HAI partners to create a structure to facilitate durable implementation of best infection control practices; and provide technical assistance to facilities to improve implementation of infection control practices in existing and newly constructed healthcare facilities.

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To determine the success of the initiative, reductions of C difficile infection, central line-associated bloodstream infection, catheter-associated urinary tract infection, and hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection were measured in participating hospitals. Hospitals with disproportionately high burdens of HAI were targeted; researchers identified high-burden institutions as hospitals with a cumulative attributable difference above the first tertile, as determined using data from the US Department of Health and Human Services. Recruitment with STRIVE occurred in waves to better consolidate efforts and understand the effect of interventions. In total, 443 short-stay and long-term acute care hospitals from 28 states and the District of Columbia were included in 4 overlapping, 10- to 12-month cohorts.

Hospitals completed a survey instrument to help identify and address gaps in HAI prevention both at enrollment (baseline) and at the end of the study. Subject matter experts created educational materials for 12 different topics that focused on 2 primary topic domains: foundational and HAI-specific. The foundational domains focused on core infection control practices that are known to have variable compliance but are critical for success of HAI prevention, which included hand hygiene, environmental cleaning, and personal protective equipment use. The HAI-specific domains focused on best practices for preventing C difficile infection, central line-associated bloodstream infection, catheter-associated urinary tract infection, and hospital-onset MRSA bloodstream infection.

Additional monthly learning action forums were hosted by the Health Research & Educational Trust for all cohorts, and were discussion-based and interactive and allowed hospitals to learn from each other. Training and education on best use of the CDC’s Targeted Assessment for Prevention was also provided via webinars and in-person, state-level meetings. State health departments and state hospital associations coached and collaborated with hospitals with one-on-one calls and open office hours.

The STRIVE implementation plan was divided into 3 phases: onboarding to the program, foundational infection prevention strategies, and education targeted to the program’s 4 targeted HAIs. Onboarding for cohort 1 started in May 2016. Web modules for STRIVE can be found on the CDC’s website.

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Overall, the study authors concluded that, “Through the STRIVE initiative, the architecture of preventing HAI shifted from hospital-based to instead utilizing national efforts to effect local improvement efforts in hospitals across the United States.”


Popovich KJ, Calfee DP, Patel PK, Lassiter S, Rolle AJ, Hung L, Saint S, Chopra V. The Centers for Disease Control and Prevention STRIVE initiative: construction of a national program to reduce health care-associated infections at the local level. Ann Intl Med. 2019;171(7):S2-S6.