What is Implementation Science?

In The Society for Healthcare Epidemiology of America (SHEA)'s 10-Year Research Plan, the organization highlights the critical role of implementation science in transforming infection prevention and control. While evidence-based research has the potential to reduce healthcare-associated infections (HAIs) and improve patient safety, it can take up to 17 years for proven practices to become standard in clinical settings. Implementation science aims to accelerate this process by identifying the specific barriers that prevent behavior change at every level—from C-suite executives to frontline staff and environmental services. By tailoring strategies to different facility types and prioritizing scalable solutions, implementation science ensures that effective interventions can be consistently applied across diverse healthcare settings.

Applying Research to Real-World Infection Prevention

Implementation science is the study of methods and strategies used to promote the adoption and integration of evidence-based practices, interventions, and policies into routine healthcare settings. While traditional research focuses on discovering what works, implementation science addresses how to make what works a regular part of patient care.

In the field of infection control and prevention (ICP), implementation science is critical for closing the gap between proven interventions and actual practice. Despite clear evidence supporting certain strategies—such as hand hygiene compliance, environmental cleaning protocols, and antimicrobial stewardship—these practices depend on human processes and are therefore not always applied consistently in healthcare settings. Implementation science helps identify the barriers to adoption and develop solutions that ensure effective, long-term uptake, including how to integrate innovations that do not depend on human processes, such as copper-infused biocidal surfaces.

Why Does Implementation Science Matter in Infection Control?

Healthcare-associated infections (HAIs) affect 1 in 31 hospital patients on any given day, according to the CDC. Many HAIs, including central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), and Clostridioides difficile (C. diff) infections, are preventable through the consistent application of evidence-based protocols. However, hospitals often struggle with variability in practice adherence, even when staff are aware of best practices.

Implementation science tackles this issue by examining:

• Barriers and facilitators to adopting evidence-based practices.
• Effective strategies for training, monitoring, and reinforcing behavior change.
• Sustainability measures to ensure long-term adherence.

Alongside implementation science, which focuses on human processes, Independent technologies that support human processes without depending on compliance are also considered. These would include biocidal surfaces, which continue to kill bacteria throughout the day.

Examples of Implementation Science in Infection Control

1. Improving Hand Hygiene Compliance

Hand hygiene is one of the most effective ways to prevent HAIs, yet compliance rates in hospitals often fall below 50%. An implementation science approach to improving hand hygiene might include:

• Identifying barriers: Observing staff behaviors to determine why compliance is low (e.g., lack of conveniently located hand sanitizers, skin irritation from repeated use).
• Testing strategies: Using interventions such as electronic monitoring systems, real-time feedback, and visual reminders to increase compliance.
• Measuring effectiveness: Tracking infection rates before and after implementation to assess impact.
• Ensuring sustainability: Involving staff in co-designing solutions to promote long-term behavior change.

2. Reducing HAIs with Antimicrobial Stewardship Programs (ASPs)

Inappropriate antibiotic use drives antimicrobial resistance and increases the risk of HAIs like C. diff infections. ASPs are evidence-based programs designed to promote the appropriate use of antibiotics.

• Implementation challenge: Despite the proven benefits of ASPs, many hospitals lack the resources or protocols for effective implementation.
• Implementation strategies: Hospitals may use bundled interventions, including clinician education, automatic stop orders for certain antibiotics, and regular prescribing audits with feedback.
• Outcome measurement: By tracking antibiotic usage patterns and HAI rates, hospitals can measure the program's effectiveness and refine their implementation approach.

3. Environmental Cleaning and Disinfection Protocols

Environmental surfaces are a key source of pathogen transmission in healthcare settings. However, even with established cleaning protocols, inconsistent practices lead to contamination.

• Identifying barriers: Implementation science reveals gaps such as lack of staff training, improper cleaning techniques, or reliance on ineffective disinfectants.
• Evidence-based interventions: Hospitals may implement technologies such as self-sanitizing surfaces (e.g., EOScu, which continuously kills bacteria) or UV disinfection systems as part of a comprehensive infection control plan.
• Evaluation and scaling: Implementation science helps determine how well these technologies are adopted, their impact on HAI rates, and the best ways to scale their use.

4. Biocidal Products that Work Independent from Human Processes

Key Takeaways: From Research to Real-World Impact

Implementation science ensures that research findings in infection control translate into consistent, effective practices at the bedside. By addressing the human, organizational, and systemic factors that influence healthcare delivery, this field helps hospitals reduce HAIs, improve patient outcomes, and create safer care environments.

For infection preventionists, hospital administrators, and policymakers, understanding and applying implementation science is essential for closing the gap between what should work and what does work in everyday healthcare settings.