Optimizing Prevention of Healthcare-Acquired Infections After Cardiac Surgery

描述(申请人提供)：在美国，每年进行的冠状动脉旁路移植(CABG)手术超过40万例。接受冠脉搭桥手术的患者面临着一些不良后遗症的风险，其中许多会影响生存并增加整体医疗成本。医疗保健获得性感染(HAI)，包括肺炎以及胸骨浅层和深层伤口感染，发生在16%的CABG患者中，增加了患者的死亡风险，并增加了医疗保健系统的额外前期和长期支出。在冠状动脉搭桥术的背景下，许多障碍阻碍了HAI率的广泛提高。虽然已经制定了一些预防HAI的措施，但这些措施并没有完全涵盖可能影响患者HAI风险的一套做法。确定心脏手术特定的危险因素将作为有针对性的质量改进策略的基础。在缺乏关于最佳实践的明确数据的情况下，HAI预防措施在外科医生和机构之间是不同的，导致不必要的发病率和成本。先前的工作已经表明了在普通重症监护病房环境中实施循证方案的价值。心脏手术特定标准化做法的实施在多大程度上导致较低的HAI率尚不确定。了解这种方法的有效性肯定会帮助外科医生和机构为他们的患者群体提供更安全的护理。在密歇根州进行冠状动脉搭桥手术的33家机构中，HAI的发生率从0到26%不等。这项申请旨在通过确定并随后实施标准化做法，并评估其对HAI比率的影响来降低这一比率。这项研究将基于密歇根胸科和心血管外科医生质量合作协会(MSTCVS-QC)的前瞻性数据和区域质量改进活动和基础设施。我们将评估这些标准化做法在区域范围内减少HAI方面的有效性，并将在同一时期内相对于国家比率评估这些标准化做法的有效性。

DESCRIPTION (provided by applicant): More than 400,000 coronary artery bypass grafting (CABG) procedures are performed every year in the United States (U.S.). Patients undergoing CABG surgery are at risk for a number of adverse sequelae, many of which impact survival and contribute to overall health-care costs. Healthcare-acquired infections (HAIs), including pneumonia and superficial and deep sternal wound infections, occur among 16% of CABG patients and elevate a patient's risk of mortality and add excess upfront and long-term expenditures to the health care system. A number of barriers prevent wide-scale improvements in HAI rates within the setting of CABG surgery. While a number of HAI prophylaxis measures have been developed, these measures do not fully encompass the set of practices that may impact a patient's risk of HAI. Identifying cardiac surgery specific risk factors would serve as th foundation for targeted quality improvement strategies. In the absence of definitive data concerning best practices, HAI prophylaxis is variable across surgeons and institutions, resulting in unnecessary morbidity and cost. Prior work has shown the value of implementing evidence-based protocols in the general intensive care unit setting. To what extent the implementation of cardiac surgery specific standardized practices results in lower HAI rates is uncertain. An understanding of the effectiveness of this approach would certainly assist surgeons and institutions in providing safer care to their patient populations. Rates of HAIs vary from 0-26% across the 33 institutions performing CABG surgery in Michigan. This application seeks to reduce this rate by identifying and subsequently implementing standardized practices, and evaluating their impact on HAI rates. This study will be based on the prospective data and regional quality improvement activities and infrastructure of the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC). We will evaluate the effectiveness of these standardized practices in reducing HAIs regionally and relative to national rates during the same time period.