Targeting Surgical Site Infections through a Perioperative Antibiotic Clinical Decision Support Tool

通过围手术期抗生素临床决策支持工具针对手术部位感染

• 批准号: 10564738
• 负责人: AMIT BARDIA
• 金额: $ 48.54万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10564738
• 关键词: Targeting; Surgical; Site; Infections; through

PROJECT SUMMARY / ABSTRACT More than 500,000 patients acquire Surgical Site Infections (SSIs) each year, making them the leading cause of hospital-acquired infections. SSIs account for billions of dollars in added health care costs and are associated with up to 11 times higher risk of post-surgical mortality. Despite near universal adherence to Surgical Care Improvement Project (SCIP) guidelines for prophylactic antibiotic administration, SSI rates remain stagnant. As compared to SCIP, the Infectious Disease Society of America (IDSA) provides far more comprehensive guidelines for surgical antibiotic prophylaxis. Beyond the SCIP measures, which focus mostly on antibiotic timing with respect to surgical incision, IDSA guidelines additionally include: 1) more specific antibiotic selection for several surgical procedures, 2) weight-adjusted antibiotic dosing, and 3) timely antibiotic re-dosing during prolonged surgeries. Each of these is a crucial aspect of antibiotic administration and is not addressed by SCIP guidelines that inform the majority of perioperative antibiotic practice. In preliminary work using a national dataset, we found that non-adherence to at least one of the components of IDSA guidelines occurred in over one-third of surgical cases. We also found that IDSA non-adherence is markedly higher during unplanned scenarios such as surgeries involving multiple blood product transfusions and emergency surgeries indicating there may be a situational component to the non-adherence. We believe promoting adherence to IDSA guidelines can markedly reduce SSIs and can be achieved by targeting healthcare provider workflow barriers and knowledge deficits using a provider centered clinical decision support (CDS) tool. We propose to - Aim 1: Measure the association of nonadherence to IDSA guidelines and its components (antibiotic choice, timing, dosing, and intraoperative redosing) with SSI occurrence by analyzing merged data from two robust national registries: the National Surgical Quality Improvement Program (NSQIP), which captures detailed postoperative outcomes, with the Multicenter Perioperative Outcomes Group (MPOG) that captures detailed perioperative data. Additionally, we will examine differences in nonadherence (disparities in care) across several AHRQ priority groups to identify opportunities for SSI reduction within these subgroups. Aim 2: Identify factors associated with deviation from IDSA guidelines in practice through semi structured interviews of perioperative healthcare providers and incorporate these to develop a CDS tool that promotes IDSA adherent antibiotic practices. Aim 3: Assess the real-world performance of the CDS tool and provider feedback using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework of implementation evaluation. Public Health Significance: SSIs are common, costly, and largely avoidable. The proposed study will a) help determine relationships between IDSA guideline nonadherence and SSIs including among AHRQ priority groups; b) identify barriers to guideline adherence; and c) test a readily usable intervention for implementation in a future large pragmatic trial powered to detect reduction in SSI outcomes.

项目总结/摘要 每年有超过500，000名患者获得手术部位感染（SSI），使其成为主要原因 医院获得性感染SSI会增加数十亿美元的医疗保健成本， 与术后死亡率高出11倍的风险相关。尽管几乎普遍遵守， 外科护理改善项目（SCIP）预防性抗生素给药指南，SSI率 仍然停滞不前。与SCIP相比，美国传染病学会（IDSA）提供的内容要多得多 外科抗生素预防的综合指南。除了SCIP措施之外， 关于手术切口的抗生素使用时间，IDSA指南还包括：1）更具体 几种外科手术的抗生素选择，2）体重调整的抗生素剂量，3）及时的抗生素 在长时间手术中重新给药。这些都是抗生素给药的关键方面， 由SCIP指南解决，该指南告知大多数围手术期抗生素实践。在初步工作中 使用国家数据集，我们发现，不遵守IDSA指南的至少一个组成部分， 发生在超过三分之一的手术病例中。我们还发现，IDSA不依从性在 计划外情况，如涉及多次血液制品输注的手术和紧急手术 指示可能存在不遵守的情境成分。我们相信促进遵守 IDSA指南可以显著减少SSI，并可以通过针对医疗保健提供者的工作流程来实现 障碍和知识赤字使用提供者为中心的临床决策支持（CDS）工具。我们建议- 目的1：测量不遵守IDSA指南及其组成部分（抗生素选择， 时间、给药和术中再给药）与SSI发生率的关系，通过分析来自两个稳健的 国家登记系统：国家手术质量改进计划（NSQIP）， 术后结局，多中心围手术期结局组（MPOG）收集了详细的 围手术期数据。此外，我们还将研究不同地区的不依从性差异（护理差异）。 几个AHRQ优先组，以确定这些子组内SSI减少的机会。目标2：确定 通过半结构化访谈， 围手术期医疗保健提供者，并结合这些开发CDS工具，促进IDSA遵守 抗生素实践目标3：评估CDS工具的真实性能和提供者反馈， RE-AIM（Reach，Effectiveness，Adoption，Implementation，Maintenance）框架 评价公共卫生意义：SSI是常见的，昂贵的，而且在很大程度上是可以避免的。拟定研究 a）帮助确定IDSA指南不依从性与SSI（包括AHRQ）之间的关系 优先群体; B）识别指南遵守的障碍;以及c）测试一种易于使用的干预措施， 在未来的大型实用试验中实施，以检测SSI结局的减少。