Checklist to Prevent MRSA Surgical Site Infections

预防 MRSA 手术部位感染的清单

• 批准号: 9894746
• 负责人: Eli N Perencevich
• 金额: --
• 依托单位: IOWA CITY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2019-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9894746
• 关键词: Adoption; Antibiotic Prophylaxis; Antibiotics; Bathing; Businesses; Cardiac; Cardiac Surgery procedures; Cefazolin; Centers for Disease Control and Prevention (U.S.); Cessation of life; Chlorhexidine; Clinical; Communicable Diseases; Control Groups; Cost Savings; Data; Databases; Decision Support Systems; Effectiveness; Ensure; Epidemiology; Evaluation; Foundations; Gluconates; Goals; Health Services Research; Hip region structure; Hospitals; Infection; Infection Control; Infection prevention; Informatics; Infrastructure; Inpatients; Intervention; Interview; Knee; Length of Stay; Life; Mediastinitis; Medical center; Meta-Analysis; Methods; Modeling; Morbidity - disease rate; Multi-Drug Resistance; Mupirocin; Nose; Occupational Health; Ointments; Operative Surgical Procedures; Oral; Orthopedic Surgery procedures; Outcome; Patients; Prevention; Process; Quality-Adjusted Life Years; Replacement Arthroplasty; Reporting; Research Methodology; Research Personnel; Schedule; Screening Result; Site; Skin; Staphylococcus aureus infection; Statistical Data Interpretation; Structure; Surgical Error; Surgical incisions; Surgical wound; System; Testing; Time; Time Series Analysis; Treatment Cost; Vancomycin; Veterans; base; contextual factors; cost; cost effectiveness; design; economic impact; evidence base; experience; experimental study; group intervention; healthcare-associated infections; implementation research; implementation science; meetings; methicillin resistant Staphylococcus aureus; mortality; operation; pathogen; prevent; programs; prophylactic; transmission process

DESCRIPTION (provided by applicant): Aims and Design: Methicillin-resistant Staphylococcus aureus (MRSA), accounts for an estimated 94,000 invasive infections and 19,000 deaths annually in the U.S. In order to prevent MRSA infections among veterans, the VA successfully implemented the VA MRSA Prevention Initiative that has reduced patient-to- patient transmission of MRSA. However, this Initiative does not prevent most MRSA surgical site infections (SSIs) because MRSA SSIs are usually caused by MRSA transferring from a patient's nose to their own surgical incision site. Cardiac surgery and total joint arthroplasty (TJA; e.g. hip or knee surgery) are among the most common operations performed by the VA and are associated with particularly high clinical and economic impact. In order to eliminate MRSA SSIs in the VA, the study group developed a checklist based on a meta- analysis of studies that assessed methods to prevent gram-positive SSIs among TJA and cardiac surgery patients. This SSI Checklist includes preoperatively testing a surgical patient's nose for asymptomatic MRSA colonization. If the patient is MRSA colonized, s/he will be treated with prophylactic nasal mupirocin ointment, chlorhexidine gluconate baths, and antibiotic prophylaxis with both cefazolin and vancomycin. The SSI Checklist will be implemented in 10 VA Medical Centers (VAMCs). A high-quality quasi-experimental study, with a qualitative process evaluation will be performed to assess the SSI Checklist. The goals of this project are 1) to assess the effectiveness and cost-effectiveness of the checklist to prevent MRSA SSIs among veterans undergoing TJA or cardiac surgery, and 2) to assess barriers and facilitators to checklist implementation. Methods: This study includes both quantitative and qualitative components. In the quantitative component, the SSI Checklist will be implemented in 10 VAMCs for 3 years and outcomes will be compared between the intervention group and two control groups: 1) 5 years of historic data from the same 10 VAMCs, 2) 8 years (5 historic year and 3 intervention years) of concurrent data from other VAMCs that did not implement the SSI Checklist. Study endpoints will include: 1) MRSA SSIs as defined by the CDC; 2) SSIs caused by other pathogens; 3) cost per SSI prevented, cost per life-saved, cost per MRSA SSI prevented and cost per quality- adjusted life-year (QALY) saved. VA databases including VA National Surgical Quality Improvement Program (VASQIP), VA Decision Support System, VA Inpatient Evaluation Center (IPEC) and Veterans' Informatics & Computing Infrastructure (VINCI) will be used to collect data. Time series analysis and linear mixed effects models will be used for the statistical analysis. In the qualitative component, a process evaluation will be conducted at 6 different VAMCs, which includes collecting data before, during and after implementation, to examine the contextual factors and stakeholder perspectives that influence adoption of the SSI Checklist. Observations and semi-structured interviews will be conducted in Years 1 and 3, along with thematic content analysis, to examine facilitators and barriers to the implementation at the different study sites. The Consolidated Framework for Implementation Research will be used to guide the process evaluation and provide the foundation for a systematic evaluation of local contextual factors that influence implementation of the SSI Checklist. The products of this study include a validated SSI Checklist, a business-case analysis, an implementation toolkit, and a team experienced in checklist implementation for prevention of infections. At the end of this study period, the study team will meet with operational partners including National Infectious Disease Program Office (NIDS) and the MRSA / Multidrug-resistant Program Office (MDRO), and the National Center for Occupational Health and Infection Control (COHIC) to discuss implementing this checklist nationwide as part of the VA MRSA Prevention Initiative. This study has high potential to significantly decrease SSI, and in turn morbidity and mortality due to SSIs, in our Nation's Veterans.

描述(由申请人提供)： 目的和设计：耐甲氧西林金黄色葡萄球菌(MRSA)，在美国每年约有94,000例侵袭性感染和19,000例死亡。为了预防退伍军人中的MRSA感染，退伍军人管理局成功地实施了VA MRSA预防计划，减少了MRSA在患者之间的传播。然而，这一举措并不能预防大多数MRSA手术部位感染(SSI)，因为MRSA手术部位感染通常是由MRSA从患者的鼻子转移到他们自己的手术切口部位引起的。心脏手术和全关节置换术(TJA；例如髋关节或膝关节手术)是退伍军人管理局最常见的手术之一，与特别高的临床和经济影响有关。为了消除VA中的MRSA SSI，研究小组基于对评估TJA和心脏手术患者中预防革兰氏阳性SSI的方法的研究的荟萃分析，制定了一份核对表。这份SSI检查表包括术前检查手术患者的鼻子是否有无症状的MRSA定植。如果患者是耐甲氧西林金黄色葡萄球菌，S将接受预防性鼻腔莫匹罗星软膏、葡萄糖酸氯己定沐浴，以及头孢唑林和万古霉素的抗生素预防治疗。SSI检查表将在10个退伍军人医疗中心(VAMC)实施。将进行高质量的准实验研究，并进行定性的过程评估，以评估SSI检查表。该项目的目标是1)评估清单的有效性和成本效益，以预防接受TJA或心脏手术的退伍军人中的MRSA SSI，以及2)评估清单实施的障碍和促进者。方法：本研究包括定量和定性两个部分。在数量部分，将在10个可变资产管理公司中实施SSI检查表，为期3年，并将在干预组和两个对照组之间比较结果：1)来自相同10个VAMC的5年历史数据，2)来自没有实施SSI检查表的其他VAMC的8年(5个历史年和3个干预年)的并发数据。研究终点将包括：1)疾控中心定义的MRSA SSI；2)其他病原体引起的SSI；3)预防SSI的成本、挽救生命的成本、预防MRSA SSI的成本和节省的质量调整生命年(QALY)成本。包括退伍军人管理局国家外科质量改进计划(VASQIP)、退伍军人管理局决策支持系统、退伍军人住院评估中心(IPEC)和退伍军人信息学与计算基础设施(VINCI)在内的退伍军人数据库将用于收集数据。统计分析将采用时间序列分析和线性混合效应模型。在定性部分，将在6个不同的VAMC进行过程评估，包括在实施之前、期间和之后收集数据，以审查影响采用SSI核对表的背景因素和利益相关者的观点。将在第一年和第三年进行观察和半结构化访谈，并进行专题内容分析，以审查在不同研究地点实施的促进者和障碍。将使用《执行研究综合框架》来指导进程评估，并为系统评估影响执行安全部门倡议清单的当地背景因素奠定基础。这项研究的产品包括经过验证的SSI检查表、业务案例分析、实施工具包，以及在实施检查表以预防感染方面经验丰富的团队。在本研究结束时，研究小组将与包括国家传染病规划办公室(NIDS)和MRSA/多药耐药规划办公室(MDRO)以及国家职业健康和感染控制中心(COHIC)在内的业务伙伴会面，讨论在全国范围内实施这份清单，作为退伍军人管理局MRSA预防计划的一部分。这项研究有很高的潜力显著降低SSI，进而降低我国退伍军人SSI的发病率和死亡率。