Implementation and Effectiveness of a S. aureus Surgical Site Infection Preventio

金黄色葡萄球菌手术部位感染预防的实施和有效性

• 批准号: 8608222
• 负责人: Loreen A Herwaldt
• 金额: $ 148.13万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2018-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8608222
• 关键词: Implementation; Effectiveness; S.; aureus; Surgical

Staphylococcus aureus causes ~30-50% of surgical site infections (SSIs). We previously reviewed published studies and current practices to identify ways to decrease S. aureus SSI rates. On the basis of our review, we developed an evidence-based bundle: 1) screening for S. aureus, 2) decolonization of carriers, and 3) prophylaxis with cefazolin and vancomycin for methicillin-resistant S. aureus carriers. The bundle efficacy is being tested in the AHRQ-funded STOP SSI Study among patients undergoing cardiac operations (CO), total hip (THA), or total knee (TKA) arthroplasties at 20 Hospital Corporation of America (HCA) hospitals. However, no one has compared the effectiveness of the whole bundle or of bundle elements with no bundle. Moreover, the STOP SSI Study did not evaluate facilitators and barriers to implementation of the bundle. These gaps in our knowledge may discourage surgeons or hospitals from implementing the bundle. Our goal is to decrease S. aureus SSIs. Thus, we propose to extend the current STOP SSI Study at the 20 HCA hospitals and to expand the study to additional hospitals and surgical populations so that we can accomplish 4 aims: 1) Assess the comparative effectiveness (CE) of implementing the full bundle, implementing parts of the bundle, and not implementing the bundle for preventing S. aureus SSIs among patients undergoing CO, THA, TKA, spine operations (SO), or craniotomy/craniectomy (CRANI); 2) Identify facilitators and barriers to bundle implementation at the hospital, surgical service, and patient level; 3) Create a toolkit that hospitals can use to facilitate bundle implementation; 4) Determine whether the bundle increases the number of mupirocin-resistant or CHG-resistant S. aureus isolates. Aim 1 involves 3 tasks: 1) Continue the quasi-experimental (QE) STOP SSI Study at 20 HCA hospitals; 2) Add hospitals and surgical populations: the Iowa City Veterans Affairs Medical Center (ICVAMC; THA, TKA), the University of Iowa Hospitals and Clinics (UIHC; CO, THA, TKA, SO, CRANI), and Covenant Hospital (CH; SO, CRANI); 3) Repeat the time series analysis from the QE study on the expanded dataset and conduct a CE study assessing the effectiveness of the "full bundle," "elements of the bundle," "decolonization only," and "no bundle elements." HCA, UIHC, ICVAMC, 9 additional VAMCs, and CH will be the CE intervention group; 8 Duke-affiliated hospitals, which do not use the bundle, will be the "no bundle" group. Aim 2 includes 2 tasks (UI, ICVAMC, CH, Johns Hopkins Hospital, Johns Hopkins-affiliated hospitals) to help us identify factors that facilitate or inhibit bundle implementation by healthcare workers and by patients: 1) Interview healthcare workers; 2) Survey patients. The toolkit created for Aim 3 will provide practical tools to help staff at other hospitals implement the bundle as easily as possible. Because mupirocin or CHG resistance could limit future use of these agents, Aim 4 will help us ensure that the bundle does not increase the number of S. aureus resistant to these agents.

金黄色葡萄球菌引起约 30-50% 的手术部位感染 (SSI)。我们之前回顾过已发布的 研究和当前实践以确定降低金黄色葡萄球菌 SSI 率的方法。根据我们的审查，我们 开发了基于证据的捆绑包：1）金黄色葡萄球菌筛查，2）携带者去定植，3） 对耐甲氧西林金黄色葡萄球菌携带者使用头孢唑啉和万古霉素进行预防。束功效为 正在 AHRQ 资助的 STOP SSI 研究中对接受心脏手术 (CO) 的患者进行测试，总计 美国医院集团 (HCA) 的 20 家医院提供髋关节 (THA) 或全膝关节置换术 (TKA)。然而， 没有人比较过整个捆绑包或捆绑包元素与没有捆绑包的有效性。而且， STOP SSI 研究没有评估捆绑实施的促进因素和障碍。这些差距 我们的知识可能会阻止外科医生或医院实施捆绑销售。我们的目标是减少 金黄色葡萄球菌 SSI。因此，我们建议在 20 家 HCA 医院扩展当前的 STOP SSI 研究，并 将研究扩展到更多医院和手术人群，以便我们能够实现 4 个目标：1) 评估 实施整个捆绑包、实施部分捆绑包的相对有效性 (CE)，而不是 在接受 CO、THA、TKA、脊柱治疗的患者中实施预防金黄色葡萄球菌 SSI 的捆绑包 手术 (SO) 或开颅手术/颅骨切除术 (CRANI)； 2）确定捆绑的促进因素和障碍 在医院、外科服务和患者层面实施； 3) 创建医院可以使用的工具包 促进捆绑实施； 4) 确定捆绑是否增加了莫匹罗星耐药的数量 或 CHG 抗性金黄色葡萄球菌分离株。目标 1 涉及 3 个任务：1）继续准实验（QE）停止 HCA 20 家医院的 SSI 研究； 2) 增加医院和手术人群：爱荷华市退伍军人事务部 医疗中心（ICVAMC；THA、TKA）、爱荷华大学医院和诊所（UIHC；CO、THA、TKA、SO、 CRANI) 和圣约医院 (CH; SO, CRANI)； 3) 重复 QE 研究的时间序列分析 扩展的数据集并进行 CE 研究，评估“完整捆绑”、“元素的有效性” 捆绑”、“仅去殖民化”和“无捆绑元素”。HCA、UIHC、ICVAMC、9 个附加 VAMC 和 CH 将是CE干预组；不使用该捆绑包的 8 家杜克大学附属医院将成为“非 目标 2 包括 2 项任务（UI、ICVAMC、CH、约翰霍普金斯医院、约翰霍普金斯附属医院） 医院）帮助我们确定促进或抑制医护人员实施捆绑包的因素，以及 患者： 1) 采访医护人员； 2) 调查患者。为 Aim 3 创建的工具包将提供 帮助其他医院的工作人员尽可能轻松地实施捆绑包的实用工具。因为莫匹罗星或 CHG 耐药性可能会限制这些药剂的未来使用，目标 4 将帮助我们确保捆绑包不会 增加对这些药物具有抗药性的金黄色葡萄球菌数量。

项目成果

Patients' experiences and compliance with preoperative screening and decolonization.

患者对术前筛查和去殖民化的经历和依从性。

• DOI: 10.1016/j.ajic.2022.03.013
• 发表时间: 2023
• 期刊: American journal of infection control
• 影响因子: 4.9
• 作者: Wilson,Ethan;Marra,AlexandreR;Ward,Melissa;Chapin,Laura;Boulden,Stephanie;Ryken,TimothyC;Jones,LynneC;Herwaldt,LoreenA
• 通讯作者: Herwaldt,LoreenA