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

我们建议建立一种最佳做法，用于实施旨在减少 围手术期感染(肠球菌、金黄色葡萄球菌、克雷伯菌、不动杆菌、假单胞菌、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传播 (接种物)导致手术部位感染(SSI)，影响3%-5%的患者 正在接受手术。SSIS增加了患者的发病率，延长了住院时间，增加了重症监护的风险 单位入院，死亡风险增加2倍。ESKAPE病原体尤其有问题。 持续减少流行病学相关的围手术期金黄色葡萄球菌传播事件 包括监控反馈优化在内的多方面方法大幅降低了SSI (减少88%)。减少围手术期接种细菌的循证方法2必须 综合改善供应商手部卫生、血管内导管设计/处理、环境 清洁/组织和耐心非殖民化。在本申请中，我们提出了一种类型1混合 有效性-在RE-AIM指导下使用2x2因素群随机设计实施。我们的目标是 确定解决围手术期接种ESKAPE的最佳实践。我们将检查亲属 提高现场意识并致力于通过技术支持进行改进的有效性 协助(TA)、团队教练实施循证干预措施(EBIP)，以及TA或 EBIP与ESKAPE变速箱监控反馈。我们来自一项随机试验的强有力的初步数据 实施多方面的监测计划已经证明了实质性的和统计上的 金黄色葡萄球菌和90天SSI的传播显著减少，最近复制了我们的随机 在另一个外部站点的试验结果。因此，我们先前的研究强烈表明，拟议的 应该进行研究，并证明扩大传播和实施是合理的。我们的非凡之处 多学科团队有能力成功完成拟议的试验和目标。在建议的 在RE-AIM的指导下，我们将推进科学知识，并为未来的传播和 通过调查如何最好地扩大已经成功的多方面方法来实施 通过TA或EBIP传播，有或没有监测。我们将进行严格的成本控制- 效益分析，包括对净成本节约的评估。由RE-AIM指导的拟议试验(目标1)， 增加为期一年的可持续性后续行动(目标2)和成本效益分析(目标3)将提供 向采用者和组织者提供基本的科学知识，以便能够复制最有效的 我们向当地环境提供干预措施的方法，除了通知我们的调查团队 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.