De-Implementation of Unnecessary Surgical Antibiotic Prophylaxis in Children

项目总结 背景：抗生素使医疗保健发生了革命性的变化，使临床医生能够治疗危及生命的疾病 感染和预防救命手术后的感染。不幸的是，过度使用抗生素会导致 抗生素耐药性细菌和不必要的不良事件，包括艰难梭状芽胞杆菌感染(CDI)。 目前的数据表明，抗药性细菌和CDI每年杀死多达150,000到29,000人 分别是美国人。外科抗生素预防是不必要使用抗生素的常见领域 在孩子们中间。美国疾病控制与预防中心手术部位感染(SSI)指南和AAP选择明智运动 对于被认为SSI风险较低的手术，建议不要进行术后抗生素预防。一个重要的 在抗菌药物管理计划(ASP)和外科医生的最佳干预措施上存在差距 对儿童实施(消除)不必要的术后抗生素预防。 目标：确定并测试两种基于证据的实现策略，以取消不必要的实现 评估包括SSI和CDI在内的重要临床结果的儿童术后抗生素使用情况。 方法：首先，我们将在I-PARIHS的指导下制定以证据为基础的非执行战略 框架(促进卫生服务研究实施行动的综合框架)。 基于外科医生焦点小组的初步数据和当前文献，标准顺序集审查和 将在9家儿童医院实施改装(控制干预)，这些医院都是 共享儿科管理(夏普)和国家外科质量的抗菌报告 改进计划-儿科(NSQIP-P)。利用iPARIHS框架了解关键因素 参与实施后，将实施加强的ASP便利化干预措施。我们会 利用阶梯式楔形设计研究这些干预措施的影响，该设计将按顺序提供 随着时间的推移，促进干预到所有医院。这些干预措施将得到落实和实施 结果(例如渗透率)将使用来自Sharps协作的已建立的ASP进行评估，a 致力于改善儿童抗生素的大型全国性合作。临床结果(例如术后 抗生素使用、SSI、CDI)将使用NSQIP-P在每家医院收集的数据进行评估。 创新和影响：这项研究具有创新性和影响力，因为它将：1)结合以下方面的专业知识 外科医生、抗菌素管家和实施科学家制定以理论为基础的策略以改进 抗生素使用；2)评估这些策略对儿童手术的影响，这是一个代表性不足的群体；3) 使用阶梯式楔形设计严格测试两种干预措施；4)收集临床结果(例如抗生素 Use，SSI，CDI)对ASP和外科医生很重要；5)收集实施成果，以告知 将战略传播到其他医院；以及6)两个大型合作伙伴之间的协同作用(夏普和 NSQIP)，这将提高儿科ASP，并改善对需要手术的儿童的护理。

PROJECT SUMMARY Background: Antibiotics have revolutionized healthcare allowing clinicians the ability to treat life-threatening infections and to prevent infections following life-saving surgery. Unfortunately, antibiotic overuse results in antibiotic resistant bacteria and unnecessary adverse events including Clostridioides difficile infections (CDI). Current data demonstrates that antibiotic resistant bacteria and CDI annually kill up to 150,000 and 29,000 Americans, respectively. Surgical antibiotic prophylaxis is a common area for unnecessary antibiotic use among children. Recent CDC surgical site infection (SSI) guidelines and the AAP Choosing Wisely Campaign recommend no postoperative antibiotic prophylaxis for procedures considered low risk for an SSI. A significant gap exists on the best interventions for antimicrobial stewardship programs (ASPs) and surgeons to de- implement (eliminate) unnecessary postoperative antibiotic prophylaxis in children. Goal: To determine and test two evidence-based implementation strategies to de-implement unnecessary postoperative antibiotic use in children while assessing important clinical outcomes including SSI and CDI. Methods: First, we will develop evidence-based de-implementation strategies guided by the i-PARIHS framework (Integrated Framework for Promoting Action on Research Implementation in Health Services). Based on preliminary data from surgeon focus groups and current literature, standard order set review and modification (control intervention) will be implemented in 9 Children's hospitals that are members of both the SHaring Antimicrobial Reports for Pediatric Stewardship (SHARPS) and the National Surgical Quality Improvement Program-Pediatric (NSQIP-P). Utilizing the iPARIHS framework to understand the key factors involved with implementation, an enhanced ASP facilitation intervention will then be implemented. We will study the impact of these interventions utilizing a stepped-wedge design that will sequentially deliver the facilitation intervention over time to all hospitals. These interventions will be implemented and implementation outcomes (e.g. penetration) will be assessed utilizing established ASPs from the SHARPS collaborative, a large national collaborative dedicated to improving antibiotics in children. Clinical outcomes (e.g. postoperative antibiotic use, SSI, CDI) will be assessed using data collected at each hospital by NSQIP-P. Innovation and Impact: This study is innovative and impactful because it will: 1) combine expertise from surgeons, antimicrobial stewards and implementation scientist to develop theory based strategies to improve antibiotic use; 2) assess the impact of these strategies on surgeries in children, an underrepresented group; 3) rigorously test two interventions utilizing a stepped-wedge design; 4) collect clinical outcomes (e.g. antibiotic use, SSI, CDI) important to ASPs and surgeons; 5) collect implementation outcomes that will inform the dissemination of the strategies to other hospitals; and 6) synergy between 2 large collaboratives (SHARPS & NSQIP) that will enhance pediatric ASPs and improve the care of children requiring surgical procedures.