The BASIC trial: Improving implementation of evidence-based approaches and surveillance to prevent bacterial transmission and infection

BASIC 试验：改进循证方法和监测的实施，以防止细菌传播和感染

• 批准号: 10316780
• 负责人: Jeremiah R Brown
• 金额: $ 84.31万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-17 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10316780
• 关键词: Acinetobacter; Address; Admission activity; Affect; Area; Attenuated; Awareness; Catheters; Characteristics; Colony-forming units; Complex; Cost Effectiveness Analysis; Cost Savings; Data; Data Collection; Development; Dissemination and Implementation; ESKAPE pathogens; Effectiveness; Enterobacter; Enterococcus; Epidemiology; Evaluation; Event; Evidence based intervention; Evidence based program; Feedback; Future; Hand; Health Care Costs; Hospitalization; Hospitals; Hygiene; Incidence; Infection; Infection prevention; Intensive Care Units; Intervention; Investments; Klebsiella; Knowledge; Link; Maintenance; Measures; Methods; Morbidity - disease rate; Operative Surgical Procedures; Outcome; Pathogenicity; Patients; Perioperative; Phase; Prevention strategy; Preventive measure; Provider; Pseudomonas; Quality of Care; Randomized; Research; Resistance; Risk; Sampling; Savings; Scientific Advances and Accomplishments; Site; Staphylococcus aureus; Surface; Surgical Specialties; Surgical Wound Infection; Translating; Validation; Virulence; Work; attenuation; comparative efficacy; comparison intervention; cost; cost effectiveness; design; effectiveness implementation study; evidence base; follow-up; genome analysis; high risk; implementation strategy; improved; mortality; mortality risk; multidisciplinary; operation; pathogen; patient safety; prevent; programs; prospective; randomized trial; relative effectiveness; scale up; trait; transmission process; treatment as usual

We propose to establish a best practice for implementation of a multifaceted approach designed to attenuate perioperative ESKAPE (Enterococcus, S. aureus, Klebsiella, Acinetobacter, Pseudomonas, Enterobacter spp.) transmission and associated surgical site infection (SSI) development. Perioperative ESKAPE transmission (inoculum) contributes to the development of surgical site infections (SSIs) which affect 3-5% of patients undergoing surgery. SSIs increase patient morbidity, prolong hospitalization, increase the risk of intensive care unit admission, and increase the risk of death 2-fold. ESKAPE pathogens are particularly problematic. Sustained reductions in epidemiologically-related, perioperative S. aureus transmission events achieved via a multi-faceted approach including surveillance feedback optimization resulted in substantial SSI reductions (88% decrease). An evidence-based approach for attenuation of the perioperative bacterial inoculum2 must integrate improvements in provider hand hygiene, intravascular catheter design/handling, environmental cleaning/organization, and patient decolonization. In this application, we propose a type 1 hybrid effectiveness-implementation using a 2x2 factorial cluster-randomized design guided by RE-AIM. We aim to identify a best practice for addressing the perioperative ESKAPE inoculum. We will examine the relative effectiveness of increased site awareness and commitment to generating improvements via technical assistance (TA), team coaching implementation of an evidence-based set of interventions (EBIP), and TA or EBIP with ESKAPE transmission surveillance feedback. Our strong preliminary data from a randomized trial implementing a multifaceted program with surveillance has demonstrated substantial and statistically significant reductions in transmission of S. aureus and 90-day SSIs and recently reproduced our randomized trial findings in an additional external site. Therefore, our prior research strongly suggests that the proposed research should be done and justifies scaling up to dissemination and implementation. Our exceptional multidisciplinary team is well equipped to successfully complete the proposed trial and aims. In the proposed trial guided by RE-AIM, we will advance scientific knowledge and inform future dissemination and implementation by investigating how best to scale-up an already successful multifaceted approach to national dissemination through either TA or EBIP with or without surveillance. We will conduct a rigorous cost- effectiveness analysis including evaluation of net cost savings. The proposed trial guided by RE-AIM (Aim 1), the addition of 1-year follow-up for sustainability (Aim 2), and cost-effectiveness analysis (Aim 3) will provide the essential scientific knowledge to adopters and organizers to be able to reproduce the most effective delivery method of our interventions to their local setting in addition to informing our investigative team which approach to scale-up to reach national dissemination.

我们建议建立一个最佳实践来实施多方面的方法，旨在减少 围手术期 ESKAPE（肠球菌、金黄色葡萄球菌、克雷伯氏菌、不动杆菌、假单胞菌、肠杆菌属） 传播和相关手术部位感染（SSI）的发展。围手术期 ESKAPE 传播 （接种物）会导致手术部位感染 (SSI)，影响 3-5% 的患者 正在接受手术。 SSI 会增加患者发病率、延长住院时间、增加重症监护的风险 入院，死亡风险增加 2 倍。 ESKAPE 病原体尤其成问题。 通过以下措施持续减少流行病学相关的围手术期金黄色葡萄球菌传播事件 包括监视反馈优化在内的多方面方法导致 SSI 大幅减少 （减少 88%）。必须采用基于证据的方法来减少围手术期细菌接种2 整合提供者手部卫生、血管内导管设计/处理、环境方面的改进 清洁/组织和患者非殖民化。在此应用中，我们提出了 1 型混合动力 使用 RE-AIM 指导下的 2x2 阶乘聚类随机设计实现有效性。我们的目标是 确定解决围手术期 ESKAPE 接种问题的最佳实践。我们将检查亲属 提高现场意识和致力于通过技术进行改进的有效性 协助 (TA)、团队指导实施一套循证干预措施 (EBIP) 以及 TA 或 EBIP 与 ESKAPE 传输监视反馈。我们来自随机试验的强有力的初步数据 实施多方面的监测计划已证明具有实质性和统计意义 金黄色葡萄球菌和 90 天 SSI 的传播显着减少，并且最近重现了我们的随机 另一个外部网站的试验结果。因此，我们之前的研究强烈表明，所提出的 应当进行研究并证明扩大传播和实施的合理性。我们卓越的 多学科团队装备精良，能够成功完成拟议的试验和目标。在提议的 在 RE-AIM 指导下的试验中，我们将推进科学知识并为未来的传播和提供信息 通过调查如何最好地将已经成功的多方面方法推广到国家 通过 TA 或 EBIP 进行传播，有或没有监督。我们将进行严格的成本- 有效性分析，包括评估净成本节省。由 RE-AIM（目标 1）指导的拟议试验， 增加为期 1 年的可持续发展后续行动（目标 2）和成本效益分析（目标 3）将提供 采用者和组织者能够复制最有效的基本科学知识 除了通知我们的调查团队外，我们还向当地环境提供干预措施的方法 扩大规模以达到全国传播的方法。