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Effectiveness and feasibility of an evidence-based intraoperative infection control program targeting improved basic measures: a post-implementation prospective case-cohort study.
Wall, Russell T; Datta, Subhradeep; Dexter, Franklin; Ghyasi, Niloofar; Robinson, Alysha D M; Persons, Deanna; Boling, Kate A; McCloud, Christopher A; Krisanda, Emily K; Gordon, Brandon M; Koff, Matthew D; Yeager, Mark P; Brown, Jeremiah; Wong, Cynthia A; Loftus, Randy W.
Afiliação
  • Wall RT; Department of Anesthesia, MedStar Georgetown University Hospital, Washington, DC, United States.
  • Datta S; Medical Student Class of 2022, Georgetown University, Washington, DC, United States.
  • Dexter F; Department of Anesthesia, University of Iowa, Iowa City, IA, United States.
  • Ghyasi N; Medical Student Class of 2022, Georgetown University, Washington, DC, United States.
  • Robinson ADM; Medical Laboratory Scientist, RDB Bioinformatics, Iowa City, IA, United States.
  • Persons D; Laboratory Assistant, RDB Bioinformatics, Iowa City, IA, United States.
  • Boling KA; Research Assistant, Georgetown University, Washington, DC, United States.
  • McCloud CA; Medical Student Class of 2022, Georgetown University, Washington, DC, United States.
  • Krisanda EK; Medical Student Class of 2022, Georgetown University, Washington, DC, United States.
  • Gordon BM; Information Technologist, RDB Bioinformatics, Iowa City, IA, United States.
  • Koff MD; Department of Anesthesia, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.
  • Yeager MP; Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.
  • Brown J; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
  • Wong CA; Department of Anesthesia, University of Iowa, Iowa City, IA, United States.
  • Loftus RW; Department of Anesthesia, University of Iowa, Iowa City, IA, United States. Electronic address: randy-loftus@uiowa.edu.
J Clin Anesth ; 77: 110632, 2022 05.
Article em En | MEDLINE | ID: mdl-34929497
ABSTRACT
STUDY

OBJECTIVE:

A randomized controlled study demonstrated that an optimized intraoperative infection control program targeting basic preventive measures can reduce Staphylococcus aureus transmission and surgical site infections. In this study we address potential limitations of operating room heterogeneity of infections and compliance with behavioral interventions following adoption into clinical practice.

DESIGN:

A post-implementation prospective case-cohort study.

SETTING:

Twenty-three operating rooms at a large teaching hospital. PATIENTS A total of 801 surgical patients [425 (53%) women; 350 (44%) ASA > 2, age 54.6 ± 15.9 years] were analyzed for the primary and 804 for the secondary outcomes.

INTERVENTIONS:

A multifaceted, evidence-based intraoperative infection control program involving hand hygiene, vascular care, and environmental cleaning improvements was implemented for 23 operating room environments. Bacterial transmission monitoring was used to provide monthly feedback for intervention optimization. MEASUREMENTS S. aureus transmission (primary) and surgical site infection (secondary). MATERIALS AND

METHODS:

The incidence of S. aureus transmission and surgical site infection before (3.5 months) and after (4.5 months) infection control optimization was assessed. Optimization was defined by a sustained reduction in anesthesia work area bacterial reservoir isolate counts. Poisson regression with robust error variances was used to estimate the incidence risk ratio (IRR) of intraoperative S. aureus transmission and surgical site infection for the independent variable of optimization. MAIN

RESULTS:

Optimization was associated with decreased S. aureus transmission [24% before (85/357) to 9% after (42/444), IRR 0.39, 95% CI 0.28 to 0.56, P < .001] and surgical site infections [8% before (29/360) and 3% after (15/444) (IRR 0.42, 95% CI 0.23 to 0.77, P = .005; adjusted for American Society of Anesthesiologists' physical status, aIRR 0.45, 95% CI 0.25 to 0.82, P = .009].

CONCLUSION:

An optimized intraoperative infection control program targeting improvements in basic preventive measures is an effective and feasible approach for reducing S. aureus transmission and surgical site infection development.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções Estafilocócicas / Infecção Hospitalar Tipo de estudo: Clinical_trials / Etiology_studies / Evaluation_studies / Incidence_studies / Observational_studies / Risk_factors_studies / Sysrev_observational_studies Aspecto: Implementation_research Limite: Adult / Aged / Female / Humans / Middle aged Idioma: En Revista: J Clin Anesth Assunto da revista: ANESTESIOLOGIA Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções Estafilocócicas / Infecção Hospitalar Tipo de estudo: Clinical_trials / Etiology_studies / Evaluation_studies / Incidence_studies / Observational_studies / Risk_factors_studies / Sysrev_observational_studies Aspecto: Implementation_research Limite: Adult / Aged / Female / Humans / Middle aged Idioma: En Revista: J Clin Anesth Assunto da revista: ANESTESIOLOGIA Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Estados Unidos