Electronic Surveillance for Wound Infections after Ambulatory Pediatric Surgery

项目摘要/摘要 外科手术部位感染(SSI)是成人和儿童中第二种最常见的与医疗保健相关的感染，我们对手术部位感染(SSI)的理解存在严重差距，这阻碍了我们准确识别高危患者并集中采取预防行动。儿童和门诊外科患者是两个重叠的群体，他们缺乏SSI发病率和危险因素的基本知识。对最常见的儿科手术后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风险低相关的流行假设。由于门诊手术占美国所有外科手术的75%以上，即使SSI率相对较低，这些感染的负担也可能相当大。 鉴于感染预防和控制资源有限，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)有望成为一种工具，提高我们在各种环境下遇到健康状况后准确和有效地跟踪患者结果的能力，特别是在观察的患者数量很大的情况下。EHR促进的性传播感染监测的潜在优势在门诊尤为明显 外科患者，有大量暴露的患者，他们每个人经历不良后果的风险可能相对较低。 我们的建议通过1)描述流行病学方面的SSI，2)侧重于门诊手术，以及3)使用EHR来指导各种护理环境中的监测，审查了SEN中要求的关键问题。目的1将通过对大型儿科保健网络的患者进行前瞻性队列研究和严格、全面的SSI监测技术来确定儿科手术后SSI的发生率和危险因素，以建立一个黄金标准。AIM 2将确定与SSI相关的EHR数据元素，并评估基于EHR的 用于识别SSI的监视算法与黄金标准监视相比较。最后，AIM 3将生产一个与供应商无关的、嵌入EHR的SSI监视工作站，该工作站将在最后一年的资助期间进行验证。项目完成后，将提供一份详细的技术附录，具体说明SSI监测工作站的实施过程，对框架的任何修改都将开放源码并免费提供。

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.