The BASIC trial: Improving implementation of evidence-based approaches and surveillance to prevent bacterial transmission and infection

我们建议建立一个最佳做法，以执行一个多方面的办法， 围手术期ESKAPE（Enterococcus，S.金黄色葡萄球菌属、克雷伯氏菌属、不动杆菌属、假单胞菌属、肠杆菌属） 传播和相关的手术部位感染（SSI）的发展。围手术期ESKAPE传输 （接种物）导致发生手术部位感染（SSI），影响3 - 5%的患者 正在接受手术SSI增加患者发病率，延长住院时间，增加重症监护风险 单位入院，并增加死亡的风险2倍。ESKAPE病原体尤其成问题。 流行病学相关的围手术期S。金黄色葡萄球菌传播事件实现了通过 多方面的方法，包括监督反馈优化，大大减少了SSI (88%下降）。一个基于证据的方法，减少围手术期细菌接种2必须 提供者手部卫生、血管内导管设计/处理、环境 清洁/组织和患者去殖民化。在本申请中，我们提出了一种1型混合动力车， 有效性-使用由RE-AIM指导的2x2析因群集随机化设计实施。我们的目标是 确定解决围手术期ESKAPE接种的最佳实践。我们会检查 提高现场意识和承诺的有效性，以通过技术改进 援助（TA），团队指导实施一套基于证据的干预措施（EBIP），以及TA或 EBIP与ESKAPE传输监控反馈。我们从一项随机试验中获得的有力的初步数据 实施一项多方面的监测计划， 显著降低了S.金黄色葡萄球菌和90天SSI，最近再现了我们的随机 在另一个外部研究中心的试验结果。因此，我们先前的研究强烈建议， 应当进行研究，并证明有理由扩大传播和执行。我们卓越 多学科团队有能力成功完成拟议的试验和目标。拟议 在RE-AIM的指导下，我们将推进科学知识，并为未来的传播提供信息， 通过调查如何以最佳方式扩大已经成功的多方面国家 通过TA或EBIP传播，有或没有监测。我们会严格控制成本- 效益分析，包括评价净成本节约。拟议的试验由RE-AIM（目标1）指导， 增加一年可持续性后续行动（目标2）和成本效益分析（目标3）将提供 必要的科学知识，采用者和组织者能够复制最有效的 除了告知我们的调查小组， 扩大规模以达到全国传播的方法。

We propose to establish a best practice for implementation of a multifaceted approach designed to attenuate perioperative ESKAPE (Enterococcus, S. aureus, Klebsiella, Acinetobacter, Pseudomonas, Enterobacter spp.) transmission and associated surgical site infection (SSI) development. Perioperative ESKAPE transmission (inoculum) contributes to the development of surgical site infections (SSIs) which affect 3-5% of patients undergoing surgery. SSIs increase patient morbidity, prolong hospitalization, increase the risk of intensive care unit admission, and increase the risk of death 2-fold. ESKAPE pathogens are particularly problematic. Sustained reductions in epidemiologically-related, perioperative S. aureus transmission events achieved via a multi-faceted approach including surveillance feedback optimization resulted in substantial SSI reductions (88% decrease). An evidence-based approach for attenuation of the perioperative bacterial inoculum2 must integrate improvements in provider hand hygiene, intravascular catheter design/handling, environmental cleaning/organization, and patient decolonization. In this application, we propose a type 1 hybrid effectiveness-implementation using a 2x2 factorial cluster-randomized design guided by RE-AIM. We aim to identify a best practice for addressing the perioperative ESKAPE inoculum. We will examine the relative effectiveness of increased site awareness and commitment to generating improvements via technical assistance (TA), team coaching implementation of an evidence-based set of interventions (EBIP), and TA or EBIP with ESKAPE transmission surveillance feedback. Our strong preliminary data from a randomized trial implementing a multifaceted program with surveillance has demonstrated substantial and statistically significant reductions in transmission of S. aureus and 90-day SSIs and recently reproduced our randomized trial findings in an additional external site. Therefore, our prior research strongly suggests that the proposed research should be done and justifies scaling up to dissemination and implementation. Our exceptional multidisciplinary team is well equipped to successfully complete the proposed trial and aims. In the proposed trial guided by RE-AIM, we will advance scientific knowledge and inform future dissemination and implementation by investigating how best to scale-up an already successful multifaceted approach to national dissemination through either TA or EBIP with or without surveillance. We will conduct a rigorous cost- effectiveness analysis including evaluation of net cost savings. The proposed trial guided by RE-AIM (Aim 1), the addition of 1-year follow-up for sustainability (Aim 2), and cost-effectiveness analysis (Aim 3) will provide the essential scientific knowledge to adopters and organizers to be able to reproduce the most effective delivery method of our interventions to their local setting in addition to informing our investigative team which approach to scale-up to reach national dissemination.