An evaluation of the implementation of interventions to reduce postoperative infections and optimise antibiotic use across the surgical pathway in India: a mixed-methods exploratory study protocol.
An evaluation of the implementation of interventions to reduce postoperative infections and optimise antibiotic use across the surgical pathway in India: a mixed-methods exploratory study protocol.
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DOI：
10.1186/s40814-022-01192-z
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发表时间：
2022-11-05
影响因子：
1.7
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中科院分区：
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术后感染是一项重大的疾病负担，需要抗生素处方，并助长了抗菌素耐药性。感染作为手术并发症的负担在低收入和中等收入国家更大。我们报告了一项试点研究的方案，该方案旨在共同设计、实施和评估两种感染预防和控制（IPC）和抗菌药物管理（AMS）干预措施在印度的一家教学医院的外科途径。在深入的定性调查之后制定的两项干预措施是：(i)监测和反馈术后感染，以优化两个外科（胃肠外科、心血管外科和胸外科）抗生素的使用；（ii）提高患者、护理人员和公众对感染预防和辅助医疗的认识。我们将进行一项前瞻性研究，使用实施科学框架对提供两种共同设计的干预措施的实施过程进行形式化评估。这项研究将系统地评估提供干预措施的背景，以便在整个研究过程中，对干预措施的实施支持可以适应利益相关者的需求。在实施期结束后，对实施日志的分析和与利益相关者的访谈将提供对干预措施及其实施支持的可接受性、适当性、可行性和可持续性的见解。实施成本将被描述地捕获。临床数据收集的可行性调查干预措施的有效性也将评估为未来更大的研究。专题框架分析和描述性统计将分别用于报告定性和定量数据。•配对干预措施从一开始就与手术途径不同阶段的利益相关者参与共同设计。•同时对实施和临床结果进行评估，将为今后开展更大规模的研究提供信息，以实现/评估干预措施的可扩展性•该研究在中等收入国家医院的背景下，提供了一种基于实施理论、利益攸关方驱动和临床相关评估的新颖组合。•由于医疗系统和文化的差异，该项目可能不适用于每一个低资源环境和手术环境。然而，实施科学概念的应用可能促进对其他环境的可转移性和适应性。在线版本包含补充材料，可在10.1186/s40814-022-01192-z获得。
Postoperative infections represent a significant burden of disease, demanding antibiotic prescriptions, and are contributing to antimicrobial resistance. The burden of infection as a surgical complication is greater in low- and middle-income countries (LMICs). We report the protocol of a pilot study for the co-design, implementation and evaluation of two infection prevention and control (IPC) and antimicrobial stewardship (AMS) interventions across the surgical pathway in a teaching hospital in India. The two interventions developed following in-depth qualitative enquiry are (i) surveillance and feedback of postoperative infections to optimise the use of antibiotics in two surgical departments (gastrointestinal and cardiovascular and thoracic surgery) and (ii) raising awareness amongst patients, carers and members of public about IPC and AMS. We will conduct a prospective study, formatively evaluating the implementation process of delivering the two co-designed interventions using implementation science frameworks. The study will systematically assess the context of intervention delivery, so that implementation support for the interventions may be adapted to the needs of stakeholders throughout the study. Analysis of implementation logs and interviews with stakeholders upon completion of the implementation period, will offer insights into the perceived acceptability, appropriateness, feasibility and sustainability of the interventions and their implementation support. Implementation costs will be captured descriptively. Feasibility of clinical data collection to investigate effectiveness of interventions will also be assessed for a future larger study. Thematic framework analysis and descriptive statistics will be used to report the qualitative and quantitative data, respectively. • The paired interventions have been co-designed from their inception with involvement of stakeholders at different stages in the surgical pathway. • Simultaneous evaluation of implementation and clinical outcomes will inform the development of a future larger study to enable/assess the scalability of interventions • The study offers a novel combination of implementation theory-informed, stakeholder-driven and clinically relevant evaluation, carried out in the context of a middle-income country hospital. • The project may not be applicable to every low-resource setting and surgical context due to differences in healthcare systems and cultures. However, the application of implementation science concepts may facilitate transferability and adaptation to other settings. The online version contains supplementary material available at 10.1186/s40814-022-01192-z.