Optimizing Prevention of Healthcare-Acquired Infections After Cardiac Surgery

描述（由申请人提供）：在美国，每年有超过40万例冠状动脉旁路移植术（CABG）。接受冠状动脉搭桥手术的患者面临许多不良后遗症的风险，其中许多影响生存并增加总体医疗保健费用。医疗保健获得性感染（HAIs），包括肺炎和胸骨浅层和深部伤口感染，发生在16%的冠脉搭桥患者中，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。在冠脉搭桥手术的情况下，许多障碍阻碍了HAI率的大规模改善。虽然已经制定了一些HAI预防措施，但这些措施并未完全包括可能影响患者HAI风险的一整套做法。确定心脏手术特定的危险因素将作为有针对性的质量改进策略的基础。由于缺乏关于最佳做法的明确数据，不同外科医生和机构的HAI预防存在差异，导致不必要的发病率和成本。先前的工作已经显示了在普通重症监护病房环境中实施循证协议的价值。在多大程度上实施心脏外科特定的标准化做法导致较低的HAI率是不确定的。了解这种方法的有效性肯定会帮助外科医生和医疗机构为他们的患者群体提供更安全的护理。在密歇根州33家进行冠脉搭桥手术的机构中，HAIs的发生率从0-26%不等。本应用程序旨在通过识别和随后实施标准化实践，并评估其对HAI率的影响来降低这一比率。本研究将基于前瞻性数据和密歇根胸心血管外科医师协会质量协作（MSTCVS-QC）的区域质量改进活动和基础设施。我们将在同一时期内评估这些标准化做法在减少区域和相对于全国卫生保健死亡率方面的有效性。

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.