权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

De-Implementation of Unnecessary Surgical Antibiotic Prophylaxis in Children

取消儿童不必要的手术抗生素预防

基本信息

批准号：
10671500
负责人：
Jason Newland
金额：
$ 46.82万
依托单位：
WASHINGTON UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-30 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10671500
关键词：
De Implementation Unnecessary Surgical Antibiotic

项目摘要

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.

项目概要背景：抗生素彻底改变了医疗保健，使临床医生能够治疗危及生命的疾病感染并预防救生手术后的感染。不幸的是，抗生素的过度使用会导致抗生素耐药细菌和不必要的不良事件，包括艰难梭菌感染 (CDI)。目前的数据表明，抗生素耐药性细菌和 CDI 每年分别杀死多达 150,000 和 29,000 只细菌分别是美国人。外科抗生素预防是不必要使用抗生素的常见领域儿童之间。最近的 CDC 手术部位感染 (SSI) 指南和 AAP 明智选择运动对于 SSI 风险较低的手术，建议不要进行术后抗生素预防。一个重要的抗菌药物管理计划（ASP）和外科医生的最佳干预措施之间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施策略，以消除不必要的儿童术后抗生素的使用，同时评估重要的临床结果，包括 SSI 和 CDI。方法：首先，我们将制定以 i-PARIHS 为指导的基于证据的取消实施策略框架（促进卫生服务研究实施行动综合框架）。根据外科医生焦点小组和当前文献的初步数据，标准医嘱集审查和修改（控制干预）将在 9 家儿童医院实施，这些医院都是共享儿科管理抗菌报告 (SHARPS) 和国家手术质量儿科改进计划 (NSQIP-P)。利用 iPARIHS 框架了解关键因素在实施过程中，将实施增强的 ASP 便利干预措施。我们将利用阶梯式楔形设计研究这些干预措施的影响，该设计将依次提供随着时间的推移，对所有医院进行便利干预。这些干预措施将得到实施并实施结果（例如渗透率）将利用 SHARPS 协作组织建立的 ASP 进行评估，致力于改善儿童抗生素的大型全国性合作组织。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）结合来自外科医生、抗菌管理员和实施科学家制定基于理论的策略来改善抗生素的使用； 2) 评估这些策略对儿童（代表性不足的群体）手术的影响； 3）利用阶梯楔形设计严格测试两种干预措施； 4) 收集临床结果（例如抗生素使用、SSI、CDI）对于 ASP 和外科医生很重要； 5）收集实施结果，以告知将这些策略传播给其他医院； 6) 两个大型合作机构之间的协同作用（SHARPS 和 NSQIP）将增强儿科 ASP 并改善需要外科手术的儿童的护理。