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93. Early Recognition and Response to Increases in Surgical Site Infections (SSI) using Optimized Statistical Process Control (SPC) Charts – the Early 2RIS Trial: A Multicenter Stepped Wedge Cluster Randomized Controlled Trial (RCT)

BACKGROUND: Traditional approaches for SSI surveillance have deficiencies that can delay detection of SSI outbreaks and other clinically important increases in SSI rates. Optimized SPC methods for SSI surveillance have not been prospectively evaluated. METHODS: We conducted a prospective multicenter...

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Autores principales: Baker, Arthur W, Ilieş, Iulian, Benneyan, James C, Lokhnygina, Yuliya, Foy, Katherine R, Lewis, Sarah S, Wood, Brittain A, Baker, Esther, Crane, Linda, Crawford, Kathryn L, Cromer, Andrea, Padgette, Polly W, Roach, Linda, Adcock, Linda, Nehls, Nicole, Salem, Joseph, Bratzler, Dale W, Dellinger, Patch, Greene, Linda R, Huang, Susan S, Mantyh, Christopher, Anderson, Deverick J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8644572/
http://dx.doi.org/10.1093/ofid/ofab466.093
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author Baker, Arthur W
Ilieş, Iulian
Benneyan, James C
Lokhnygina, Yuliya
Foy, Katherine R
Lewis, Sarah S
Wood, Brittain A
Baker, Esther
Crane, Linda
Crawford, Kathryn L
Cromer, Andrea
Padgette, Polly W
Roach, Linda
Adcock, Linda
Nehls, Nicole
Salem, Joseph
Bratzler, Dale W
Dellinger, Patch
Greene, Linda R
Huang, Susan S
Mantyh, Christopher
Anderson, Deverick J
author_facet Baker, Arthur W
Ilieş, Iulian
Benneyan, James C
Lokhnygina, Yuliya
Foy, Katherine R
Lewis, Sarah S
Wood, Brittain A
Baker, Esther
Crane, Linda
Crawford, Kathryn L
Cromer, Andrea
Padgette, Polly W
Roach, Linda
Adcock, Linda
Nehls, Nicole
Salem, Joseph
Bratzler, Dale W
Dellinger, Patch
Greene, Linda R
Huang, Susan S
Mantyh, Christopher
Anderson, Deverick J
author_sort Baker, Arthur W
collection PubMed
description BACKGROUND: Traditional approaches for SSI surveillance have deficiencies that can delay detection of SSI outbreaks and other clinically important increases in SSI rates. Optimized SPC methods for SSI surveillance have not been prospectively evaluated. METHODS: We conducted a prospective multicenter stepped wedge cluster RCT to evaluate the performance of SSI surveillance and feedback performed with optimized SPC plus traditional surveillance methods compared to traditional surveillance alone. We divided 13 common surgical procedures into 6 clusters (Table 1). A cluster of procedures at a single hospital was the unit of randomization and analysis, and 105 total clusters across 29 community hospitals were randomized to 12 groups of 8-10 clusters (Figure 1). After a 12-month baseline observation period (3/2016-2/2017), the SPC surveillance intervention was serially implemented according to stepped wedge assignment over a 36-month intervention period (3/2017-2/2020) until all 12 groups of clusters had received the intervention. The primary outcome was the overall SSI prevalence rate (PR=SSIs/100 procedures), evaluated with a GEE model with Poisson distribution. Table 1 [Image: see text] Figure 1 [Image: see text] Schematic for stepped wedge design. The 12-month baseline observation period was followed by the 36-month intervention period, comprised of 12 3-month steps. RESULTS: Our trial involved prospective surveillance of 237,704 procedures that resulted in 1,952 SSIs (PR=0.82). The overall SSI PR did not differ significantly between clusters of procedures assigned to SPC surveillance (781 SSIs/89,339 procedures; PR=0.87) and those assigned to traditional surveillance (1,171 SSIs/148,365 procedures; PR=0.79; PR ratio=1.10 [95% CI, 0.94–1.30]; P=.25) (Table 2). SPC surveillance identified 104 SSI rate increases that required formal investigations, compared to only 25 investigations generated by traditional surveillance. Among 10 best practices for SSI prevention, 453 of 502 (90%) SSIs analyzed due to SPC detection of SSI rate increases had at least 2 deficiencies (Table 3). Table 2 [Image: see text] Poisson regression models comparing surgical site infection (SSI) prevalence rates for procedure clusters receiving statistical process control surveillance to SSI rates for clusters receiving traditional control surveillance. Table 3 [Image: see text] Compliance with 10 best practices for surgical site infection (SSI) prevention among 502 SSIs analyzed during SSI investigations generated by statistical process control surveillance. CONCLUSION: SPC methods more frequently detected important SSI rate increases associated with deficiencies in SSI prevention best practices than traditional surveillance; however, feedback of this information did not lead to SSI rate reductions. Further study is indicated to determine the best application of SPC methods to improve adherence to SSI quality measures and prevent SSIs. DISCLOSURES: Arthur W. Baker, MD, MPH, Medincell (Advisor or Review Panel member) Susan S. Huang, MD, MPH, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)
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spelling pubmed-86445722021-12-06 93. Early Recognition and Response to Increases in Surgical Site Infections (SSI) using Optimized Statistical Process Control (SPC) Charts – the Early 2RIS Trial: A Multicenter Stepped Wedge Cluster Randomized Controlled Trial (RCT) Baker, Arthur W Ilieş, Iulian Benneyan, James C Lokhnygina, Yuliya Foy, Katherine R Lewis, Sarah S Wood, Brittain A Baker, Esther Crane, Linda Crawford, Kathryn L Cromer, Andrea Padgette, Polly W Roach, Linda Adcock, Linda Nehls, Nicole Salem, Joseph Bratzler, Dale W Dellinger, Patch Greene, Linda R Huang, Susan S Mantyh, Christopher Anderson, Deverick J Open Forum Infect Dis Oral Abstracts BACKGROUND: Traditional approaches for SSI surveillance have deficiencies that can delay detection of SSI outbreaks and other clinically important increases in SSI rates. Optimized SPC methods for SSI surveillance have not been prospectively evaluated. METHODS: We conducted a prospective multicenter stepped wedge cluster RCT to evaluate the performance of SSI surveillance and feedback performed with optimized SPC plus traditional surveillance methods compared to traditional surveillance alone. We divided 13 common surgical procedures into 6 clusters (Table 1). A cluster of procedures at a single hospital was the unit of randomization and analysis, and 105 total clusters across 29 community hospitals were randomized to 12 groups of 8-10 clusters (Figure 1). After a 12-month baseline observation period (3/2016-2/2017), the SPC surveillance intervention was serially implemented according to stepped wedge assignment over a 36-month intervention period (3/2017-2/2020) until all 12 groups of clusters had received the intervention. The primary outcome was the overall SSI prevalence rate (PR=SSIs/100 procedures), evaluated with a GEE model with Poisson distribution. Table 1 [Image: see text] Figure 1 [Image: see text] Schematic for stepped wedge design. The 12-month baseline observation period was followed by the 36-month intervention period, comprised of 12 3-month steps. RESULTS: Our trial involved prospective surveillance of 237,704 procedures that resulted in 1,952 SSIs (PR=0.82). The overall SSI PR did not differ significantly between clusters of procedures assigned to SPC surveillance (781 SSIs/89,339 procedures; PR=0.87) and those assigned to traditional surveillance (1,171 SSIs/148,365 procedures; PR=0.79; PR ratio=1.10 [95% CI, 0.94–1.30]; P=.25) (Table 2). SPC surveillance identified 104 SSI rate increases that required formal investigations, compared to only 25 investigations generated by traditional surveillance. Among 10 best practices for SSI prevention, 453 of 502 (90%) SSIs analyzed due to SPC detection of SSI rate increases had at least 2 deficiencies (Table 3). Table 2 [Image: see text] Poisson regression models comparing surgical site infection (SSI) prevalence rates for procedure clusters receiving statistical process control surveillance to SSI rates for clusters receiving traditional control surveillance. Table 3 [Image: see text] Compliance with 10 best practices for surgical site infection (SSI) prevention among 502 SSIs analyzed during SSI investigations generated by statistical process control surveillance. CONCLUSION: SPC methods more frequently detected important SSI rate increases associated with deficiencies in SSI prevention best practices than traditional surveillance; however, feedback of this information did not lead to SSI rate reductions. Further study is indicated to determine the best application of SPC methods to improve adherence to SSI quality measures and prevent SSIs. DISCLOSURES: Arthur W. Baker, MD, MPH, Medincell (Advisor or Review Panel member) Susan S. Huang, MD, MPH, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Oxford University Press 2021-12-04 /pmc/articles/PMC8644572/ http://dx.doi.org/10.1093/ofid/ofab466.093 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Oral Abstracts
Baker, Arthur W
Ilieş, Iulian
Benneyan, James C
Lokhnygina, Yuliya
Foy, Katherine R
Lewis, Sarah S
Wood, Brittain A
Baker, Esther
Crane, Linda
Crawford, Kathryn L
Cromer, Andrea
Padgette, Polly W
Roach, Linda
Adcock, Linda
Nehls, Nicole
Salem, Joseph
Bratzler, Dale W
Dellinger, Patch
Greene, Linda R
Huang, Susan S
Mantyh, Christopher
Anderson, Deverick J
93. Early Recognition and Response to Increases in Surgical Site Infections (SSI) using Optimized Statistical Process Control (SPC) Charts – the Early 2RIS Trial: A Multicenter Stepped Wedge Cluster Randomized Controlled Trial (RCT)
title 93. Early Recognition and Response to Increases in Surgical Site Infections (SSI) using Optimized Statistical Process Control (SPC) Charts – the Early 2RIS Trial: A Multicenter Stepped Wedge Cluster Randomized Controlled Trial (RCT)
title_full 93. Early Recognition and Response to Increases in Surgical Site Infections (SSI) using Optimized Statistical Process Control (SPC) Charts – the Early 2RIS Trial: A Multicenter Stepped Wedge Cluster Randomized Controlled Trial (RCT)
title_fullStr 93. Early Recognition and Response to Increases in Surgical Site Infections (SSI) using Optimized Statistical Process Control (SPC) Charts – the Early 2RIS Trial: A Multicenter Stepped Wedge Cluster Randomized Controlled Trial (RCT)
title_full_unstemmed 93. Early Recognition and Response to Increases in Surgical Site Infections (SSI) using Optimized Statistical Process Control (SPC) Charts – the Early 2RIS Trial: A Multicenter Stepped Wedge Cluster Randomized Controlled Trial (RCT)
title_short 93. Early Recognition and Response to Increases in Surgical Site Infections (SSI) using Optimized Statistical Process Control (SPC) Charts – the Early 2RIS Trial: A Multicenter Stepped Wedge Cluster Randomized Controlled Trial (RCT)
title_sort 93. early recognition and response to increases in surgical site infections (ssi) using optimized statistical process control (spc) charts – the early 2ris trial: a multicenter stepped wedge cluster randomized controlled trial (rct)
topic Oral Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8644572/
http://dx.doi.org/10.1093/ofid/ofab466.093
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