Optimizing Prevention of Healthcare-Acquired Infections After Cardiac Surgery

描述（由申请人提供）：在美国（U.S.），每年进行超过400，000例冠状动脉旁路移植术（CABG）手术。接受CABG手术的患者有许多不良后遗症的风险，其中许多影响生存率并导致整体医疗保健费用。医疗获得性感染（HAI），包括肺炎和浅表和深部胸骨伤口感染，发生在16%的CABG患者中，增加了患者的死亡风险，并增加了医疗保健系统的前期和长期支出。许多障碍阻止了CABG手术中HAI率的大范围改善。虽然已经制定了许多HAI预防措施，但这些措施并不完全涵盖可能影响患者HAI风险的一系列实践。识别心脏手术的特定风险因素将作为有针对性的质量改进策略的基础。在缺乏关于最佳实践的确切数据的情况下，HAI预防在外科医生和机构之间存在差异，导致不必要的发病率和成本。先前的工作已经显示了在一般重症监护病房环境中实施循证方案的价值。心脏手术特定标准化实践的实施在多大程度上降低了HAI率尚不确定。了解这种方法的有效性肯定会帮助外科医生和机构为他们的患者群体提供更安全的护理。在密歇根州进行CABG手术的33家机构中，HAI的发生率从0-26%不等。该应用程序旨在通过确定并随后实施标准化做法，并评估其对HAI率的影响来降低这一比率。本研究将基于密歇根州胸心血管外科医师质量协作协会（MSTCVS-QC）的前瞻性数据和区域质量改进活动和基础设施。我们将评估这些标准化做法在减少区域HAI方面的有效性，以及在同一时期相对于国家比率的有效性。

DESCRIPTION (provided by applicant): More than 400,000 coronary artery bypass grafting (CABG) procedures are performed every year in the United States (U.S.). Patients undergoing CABG surgery are at risk for a number of adverse sequelae, many of which impact survival and contribute to overall health-care costs. Healthcare-acquired infections (HAIs), including pneumonia and superficial and deep sternal wound infections, occur among 16% of CABG patients and elevate a patient's risk of mortality and add excess upfront and long-term expenditures to the health care system. A number of barriers prevent wide-scale improvements in HAI rates within the setting of CABG surgery. While a number of HAI prophylaxis measures have been developed, these measures do not fully encompass the set of practices that may impact a patient's risk of HAI. Identifying cardiac surgery specific risk factors would serve as th foundation for targeted quality improvement strategies. In the absence of definitive data concerning best practices, HAI prophylaxis is variable across surgeons and institutions, resulting in unnecessary morbidity and cost. Prior work has shown the value of implementing evidence-based protocols in the general intensive care unit setting. To what extent the implementation of cardiac surgery specific standardized practices results in lower HAI rates is uncertain. An understanding of the effectiveness of this approach would certainly assist surgeons and institutions in providing safer care to their patient populations. Rates of HAIs vary from 0-26% across the 33 institutions performing CABG surgery in Michigan. This application seeks to reduce this rate by identifying and subsequently implementing standardized practices, and evaluating their impact on HAI rates. This study will be based on the prospective data and regional quality improvement activities and infrastructure of the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC). We will evaluate the effectiveness of these standardized practices in reducing HAIs regionally and relative to national rates during the same time period.