Effectiveness and feasibility of an evidence-based intraoperative infection control program targeting improved basic measures; a post-implementation prospective case-cohort study

Russell T Wall; Subhradeep Datta; Franklin Dexter; Niloofar Ghyasi; Alysha D.M Robinson; Deanna Persons; Kate A Boling; Christopher A McCloud; Emily K Krisanda; Brandon M Gordon; Matthew D Koff; Mark P Yeager; Jeremiah Brown; Cynthia A Wong; Randy W Loftus

doi:10.1016/j.jclinane.2021.110632

Back

Effectiveness and feasibility of an evidence-based intraoperative infection control program targeting improved basic measures; a post-implementation prospective case-cohort study

Journal article

Open access

Peer reviewed

Effectiveness and feasibility of an evidence-based intraoperative infection control program targeting improved basic measures; a post-implementation prospective case-cohort study

Russell T Wall, Subhradeep Datta, Franklin Dexter, Niloofar Ghyasi, Alysha D.M Robinson, Deanna Persons, Kate A Boling, Christopher A McCloud, Emily K Krisanda, Brandon M Gordon, …

Journal of clinical anesthesia, Vol.77, p.110632

05/2022

DOI: 10.1016/j.jclinane.2021.110632

Files and links (1)

url

https://doi.org/10.1016/j.jclinane.2021.110632View

Published (Version of record) Open Access

Abstract

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. A post-implementation prospective case-cohort study. Twenty-three operating rooms at a large teaching hospital. 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. 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. S. aureus transmission (primary) and surgical site infection (secondary). 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. 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]. 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. •An evidence-based intraoperative infection control program can reduce surgical site infections.•This study demonstrates implementation effectiveness and feasibility.•With proven efficacy, effectiveness, and feasibility, this important safety measure is poised for dissemination.

Bacterial transmission

Basic preventive measures

Environmental cleaning

Hand hygiene

Intraoperative infection control

Monitoring

Patient decolonization

surgical site infection

Details

Title: Subtitle: Effectiveness and feasibility of an evidence-based intraoperative infection control program targeting improved basic measures; a post-implementation prospective case-cohort study
Creators: Russell T Wall - MedStar Georgetown University Hospital
Subhradeep Datta - Medical Student Class of 2022, Georgetown University, Washington, DC, United States
Franklin Dexter - University of Iowa
Niloofar Ghyasi - Medical Student Class of 2022, Georgetown University, Washington, DC, United States
Alysha D.M Robinson - Medical Laboratory Scientist, RDB Bioinformatics, Iowa City, IA, United States
Deanna Persons - Laboratory Assistant, RDB Bioinformatics, Iowa City, IA, United States
Kate A Boling - Research Assistant, Georgetown University, Washington, DC, United States
Christopher A McCloud - Medical Student Class of 2022, Georgetown University, Washington, DC, United States
Emily K Krisanda - Medical Student Class of 2022, Georgetown University, Washington, DC, United States
Brandon M Gordon - Information Technologist, RDB Bioinformatics, Iowa City, IA, United States
Matthew D Koff - Dartmouth–Hitchcock Medical Center
Mark P Yeager - Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
Jeremiah Brown - Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
Cynthia A Wong - University of Iowa
Randy W Loftus - University of Iowa
Resource Type: Journal article
Publication Details: Journal of clinical anesthesia, Vol.77, p.110632
DOI: 10.1016/j.jclinane.2021.110632
ISSN: 0952-8180
eISSN: 1873-4529
Publisher: Elsevier Inc
Language: English
Date published: 05/2022
Academic Unit: Health Management and Policy; Anesthesia
Record Identifier: 9984202248302771

Metrics

37 Record Views

28 Times Cited - Web of Science