Electronic Surveillance for Wound Infections after Ambulatory Pediatric Surgery

描述（由申请人提供）：我们对手术部位感染（SSI）的理解存在重大差距，SSI是成人和儿童中第二大最常报告的医疗保健相关感染，这使我们无法准确识别高危患者并集中采取预防措施。儿童和门诊手术患者代表了两个重叠的群体，他们缺乏SSI发病率和风险因素的基本知识。在最常进行的儿科手术后，对SSI的流行病学知之甚少。同样，很少有数据支持门诊手术与SSI低风险相关的流行假设。由于门诊手术占美国所有外科手术的75%以上，即使SSI发生率相对较低，这些感染的负担也可能相当大。 鉴于有限的感染预防和控制资源， SSI监测是非常必要的。电子健康记录（EHR）有望作为一种工具，提高我们在不同环境下准确有效地跟踪患者健康状况的能力，特别是当观察的患者数量很大时。的 EHR促进SSI监测的潜在优势对于门诊患者尤其明显， 手术患者，其中有大量暴露的患者，每个患者都可能有 发生不良结局的风险相对较低。 我们的建议审查了SEN中要求的关键问题，1）描述流行病学特征， SSI方面，2）关注门诊手术，3）使用EHR指导跨 各种护理设置。目标1将定义门诊后SSI的发生率和风险因素 使用大型儿科医疗保健中患者的前瞻性队列研究进行的儿科手术 网络和严格，全面的SSI监测技术，以建立黄金标准。目的2 将确定与SSI相关的EHR数据元素，并评估 与金标准监测相比，用于识别SSI的基于HER的监测算法。最后，目标3将产生一个供应商不可知的，EHR嵌入式SSI监控工作站，将在最后一年的资金验证。在项目完成后，当局会提供详细的技术附录，说明SSI监察工作站的实施程序，并会以开放源码方式免费提供对框架的任何修改 公共卫生相关性：鉴于手术部位感染（SSI）是第二常见的医疗获得性感染，75%的手术是在门诊环境中进行的，儿科门诊手术后的SSI是一个重要但被忽视的研究主题。门诊儿科手术后的监测对于提供SSI预防措施有效性的数据至关重要。该提案旨在确定门诊儿科手术后SSI的频率和特征，并建立有效的监测机制。

DESCRIPTION (provided by applicant): Critical gaps in our understanding of surgical site infections (SSI), the second most commonly reported healthcare-associated infection in adults and children, prevent us from accurately identifying at-risk patients and focusing preventive actions. Children and ambulatory surgical patients represent two overlapping groups for whom basic knowledge of SSI incidence and risk factors is lacking. Little is known about the epidemiology of SSI after the most commonly performed pediatric surgeries. Similarly, few data support the prevailing assumption that ambulatory surgeries are associated with a low risk of SSI. Because outpatient surgery accounts for more than 75% of all surgical procedures conducted in the United States, the burden of these infections could be quite large even if the SSI rate is relatively low. Given finite infection prevention and control resources, new strategies to conduct efficient and targeted SSI surveillance are badly needed. The electronic health record (EHR) holds promise as a tool to increase our capacity to accurately and efficiently track patient outcomes after health encounters across varied settings, particularly when the number of patients under observation is large. The potential advantages of EHR-facilitated surveillance of SSIs are particularly evident for ambulatory Surgical patients, for which there are large numbers of exposed patients, each of whom may have a Relatively low risk of experiencing an adverse outcome. Our proposal examines key issues requested in the SEN, by 1) characterizing the epidemiological aspects SSI, 2) focusing on ambulatory surgery, and 3) using an EHR to guide surveillance across various settings of care. Aim 1 will define the incidence of and risk factors for SSI after ambulatory pediatric surgery using a prospective cohort study of patients across a large pediatric healthcare network and rigorous, comprehensive SSI surveillance techniques to establish a gold standard. Aim 2 will determine the EHR data elements associated with SSI and evaluate the performance of an HER based surveillance algorithm for identifying SSI as compared to the gold standard surveillance. Finally, Aim 3 will yield a vendor-agnostic, EHR-embedded SSI surveillance workstation that will be validated during the final year of funding. Upon completion of the project, a detailed technical appendix specifying the implementation process for the SSI surveillance workstation will be provided and any modifications to the framework will be provided open source and free of charge PUBLIC HEALTH RELEVANCE: Given that surgical site infections (SSI) are the second most common healthcare acquired infection and 75% of surgeries are performed in an ambulatory setting, SSI after pediatric ambulatory surgery are an important but neglected topic of study. Surveillance after ambulatory pediatric surgery is essential to provide data on the effectiveness of SSI preventive measures. This proposal is designed to determine the frequency and characteristics of and create an efficient surveillance mechanism for SSI after ambulatory pediatric surgery.