Implementation and Effectiveness of a S. aureus Surgical Site Infection Preventio

金黄色葡萄球菌手术部位感染预防的实施和有效性

• 批准号: 8608222
• 负责人: Loreen A Herwaldt
• 金额: $ 148.13万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2018-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8608222
• 关键词: Implementation; Effectiveness; S.; aureus; Surgical

Staphylococcus aureus causes ~30-50% of surgical site infections (SSIs). We previously reviewed published studies and current practices to identify ways to decrease S. aureus SSI rates. On the basis of our review, we developed an evidence-based bundle: 1) screening for S. aureus, 2) decolonization of carriers, and 3) prophylaxis with cefazolin and vancomycin for methicillin-resistant S. aureus carriers. The bundle efficacy is being tested in the AHRQ-funded STOP SSI Study among patients undergoing cardiac operations (CO), total hip (THA), or total knee (TKA) arthroplasties at 20 Hospital Corporation of America (HCA) hospitals. However, no one has compared the effectiveness of the whole bundle or of bundle elements with no bundle. Moreover, the STOP SSI Study did not evaluate facilitators and barriers to implementation of the bundle. These gaps in our knowledge may discourage surgeons or hospitals from implementing the bundle. Our goal is to decrease S. aureus SSIs. Thus, we propose to extend the current STOP SSI Study at the 20 HCA hospitals and to expand the study to additional hospitals and surgical populations so that we can accomplish 4 aims: 1) Assess the comparative effectiveness (CE) of implementing the full bundle, implementing parts of the bundle, and not implementing the bundle for preventing S. aureus SSIs among patients undergoing CO, THA, TKA, spine operations (SO), or craniotomy/craniectomy (CRANI); 2) Identify facilitators and barriers to bundle implementation at the hospital, surgical service, and patient level; 3) Create a toolkit that hospitals can use to facilitate bundle implementation; 4) Determine whether the bundle increases the number of mupirocin-resistant or CHG-resistant S. aureus isolates. Aim 1 involves 3 tasks: 1) Continue the quasi-experimental (QE) STOP SSI Study at 20 HCA hospitals; 2) Add hospitals and surgical populations: the Iowa City Veterans Affairs Medical Center (ICVAMC; THA, TKA), the University of Iowa Hospitals and Clinics (UIHC; CO, THA, TKA, SO, CRANI), and Covenant Hospital (CH; SO, CRANI); 3) Repeat the time series analysis from the QE study on the expanded dataset and conduct a CE study assessing the effectiveness of the "full bundle," "elements of the bundle," "decolonization only," and "no bundle elements." HCA, UIHC, ICVAMC, 9 additional VAMCs, and CH will be the CE intervention group; 8 Duke-affiliated hospitals, which do not use the bundle, will be the "no bundle" group. Aim 2 includes 2 tasks (UI, ICVAMC, CH, Johns Hopkins Hospital, Johns Hopkins-affiliated hospitals) to help us identify factors that facilitate or inhibit bundle implementation by healthcare workers and by patients: 1) Interview healthcare workers; 2) Survey patients. The toolkit created for Aim 3 will provide practical tools to help staff at other hospitals implement the bundle as easily as possible. Because mupirocin or CHG resistance could limit future use of these agents, Aim 4 will help us ensure that the bundle does not increase the number of S. aureus resistant to these agents.

金黄色葡萄球菌引起约30-50%的手术部位感染（SSI）。我们以前审查过出版的 研究和目前的做法，以确定如何减少S。金黄色葡萄球菌SSI率。根据我们的审查，我们 开发了一个基于证据的捆绑包：1）筛查S。金黄色葡萄球菌，2）载体的去殖民化，和3） 头孢唑啉和万古霉素预防耐甲氧西林链球菌。金黄色葡萄球菌携带者。束效率是 AHRQ资助的STOP SSI研究正在接受心脏手术（CO）的患者中进行测试，总数 髋关节（THA）或全膝关节（TKA）关节置换术，在20家美国医院公司（HCA）医院。然而，在这方面， 没有人比较过整个集束或集束要素与无集束的有效性。此外，委员会认为， STOPSSI研究没有评估捆绑包实施的促进者和障碍。这些差距在 我们的知识可能会阻止外科医生或医院实施捆绑。我们的目标是减少 S.金黄色SSIs。因此，我们建议在20间医疗机构附属医院扩展现时的STOP SSI研究， 将研究扩展到更多的医院和手术人群，以便我们能够实现4个目标：1）评估 实施完整捆绑包、实施捆绑包的部分以及不实施捆绑包的比较有效性（CE） 实施捆绑以防止S.在接受CO、THA、TKA、脊柱 手术（SO）或开颅术/颅骨切除术（CRANI）; 2）确定促进因素和障碍，以捆绑 在医院、外科服务和患者层面实施; 3）创建医院可以使用的工具包， 4）确定捆绑是否增加了莫匹罗星耐药的数量; 或CHG抗性S.金黄色葡萄球菌分离株。目标1涉及3个任务：1）继续准实验（QE）停止 20家HCA医院的SSI研究; 2）增加医院和手术人群：爱荷华州市退伍军人事务部 医学中心（ICVAMC; THA，TKA），爱荷华州大学医院和诊所（UIHC; CO，THA，TKA，SO， CRANI）和Covenant Hospital（CH; SO，CRANI）; 3）重复QE研究的时间序列分析， 扩展的数据集，并进行CE研究，评估“完整包”，“元素的有效性， 束”、“仅非殖民化”和“无束元素”。“HCA、UIHC、ICVAMC、9个额外的VAMC和CH 将是CE干预组; 8杜克大学附属医院，不使用捆绑，将是“没有 bundle”组。目标2包括2项任务（UI、ICVAMC、CH、约翰霍普金斯医院、约翰霍普金斯附属医院 医院），以帮助我们确定促进或抑制医护人员实施捆绑包的因素， 患者：1）采访医护人员; 2）调查患者。为Aim 3创建的工具包将提供 实用工具，帮助其他医院的工作人员尽可能轻松地实施捆绑包。因为莫匹罗星或 CHG耐药性可能会限制这些药物的未来使用，Aim 4将帮助我们确保该捆绑包不会 增加S的数量。金黄色葡萄球菌对这些药剂具有抗性。

项目成果

Patients' experiences and compliance with preoperative screening and decolonization.

患者对术前筛查和去殖民化的经历和依从性。

• DOI: 10.1016/j.ajic.2022.03.013
• 发表时间: 2023
• 期刊: American journal of infection control
• 影响因子: 4.9
• 作者: Wilson,Ethan;Marra,AlexandreR;Ward,Melissa;Chapin,Laura;Boulden,Stephanie;Ryken,TimothyC;Jones,LynneC;Herwaldt,LoreenA
• 通讯作者: Herwaldt,LoreenA