Electronic Surveillance for Wound Infections after Ambulatory Pediatric Surgery

项目总结/摘要 我们对手术部位感染（SSI）的理解存在重大差距，这是成人和儿童中第二大最常见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。同样地， 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，迫切需要新的战略来进行有效和有针对性的SSI监测。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。EHR辅助SSI监测的潜在优势对于门诊患者尤其明显。 手术患者，其中有大量暴露患者，每个患者经历不良结局的风险相对较低。 我们的提案审查了SEN中要求的关键问题，通过1）描述SSI的流行病学方面，2）关注门诊手术，3）使用EHR指导各种护理环境的监测。目标1将使用大型儿科医疗保健网络中患者的前瞻性队列研究和严格、全面的SSI监测技术来定义门诊儿科手术后SSI的发生率和风险因素，以建立金标准。目标2将确定与SSI相关的EHR数据元素，并评估基于EHR的 与金标准监测相比，用于识别SSI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。项目完成后，将提供详细的技术附录，说明SSI监测工作站的实施过程，并将以开放源代码和免费的方式提供对框架的任何修改。

Project Summary/Abstract 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 EHRbased 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.