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Wall RT, Datta S, Dexter F, et al. Effectiveness and feasibility of an evidence-based intraoperative infection control program targeting improved basic measures: a post-implementation prospective case-cohort study. J Clin Anesth. 2021;77:110632doi: 10.1016/j.jclinane.2021.110632.
Wall, R. T., Datta, S., Dexter, F., Ghyasi, N., Robinson, A. D. M., Persons, D., Boling, K. A., McCloud, C. A., Krisanda, E. K., Gordon, B. M., Koff, M. D., Yeager, M. P., Brown, J., Wong, C. A., & Loftus, R. W. (2021). Effectiveness and feasibility of an evidence-based intraoperative infection control program targeting improved basic measures: a post-implementation prospective case-cohort study. Journal of clinical anesthesia, 77110632. https://doi.org/10.1016/j.jclinane.2021.110632
Wall, Russell T, et al. "Effectiveness and feasibility of an evidence-based intraoperative infection control program targeting improved basic measures: a post-implementation prospective case-cohort study." Journal of clinical anesthesia vol. 77 (2021): 110632. doi: https://doi.org/10.1016/j.jclinane.2021.110632
Wall RT, Datta S, Dexter F, Ghyasi N, Robinson ADM, Persons D, Boling KA, McCloud CA, Krisanda EK, Gordon BM, Koff MD, Yeager MP, Brown J, Wong CA, Loftus RW. Effectiveness and feasibility of an evidence-based intraoperative infection control program targeting improved basic measures: a post-implementation prospective case-cohort study. J Clin Anesth. 2021 Dec 17;77:110632. doi: 10.1016/j.jclinane.2021.110632. Epub 2021 Dec 17. PMID: 34929497.
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J Clin Anesth. 2021 Dec 17;77:110632. doi: 10.1016/j.jclinane.2021.110632. Epub 2021 Dec 17.

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

Journal of clinical anesthesia

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

Affiliations

  1. Department of Anesthesia, MedStar Georgetown University Hospital, Washington, DC, United States.
  2. Medical Student Class of 2022, Georgetown University, Washington, DC, United States.
  3. Department of Anesthesia, University of Iowa, Iowa City, IA, United States.
  4. Medical Laboratory Scientist, RDB Bioinformatics, Iowa City, IA, United States.
  5. Laboratory Assistant, RDB Bioinformatics, Iowa City, IA, United States.
  6. Research Assistant, Georgetown University, Washington, DC, United States.
  7. Information Technologist, RDB Bioinformatics, Iowa City, IA, United States.
  8. Department of Anesthesia, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.
  9. Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.
  10. Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
  11. Department of Anesthesia, University of Iowa, Iowa City, IA, United States. Electronic address: [email protected].

PMID: 34929497 DOI: 10.1016/j.jclinane.2021.110632

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.

Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

Keywords: Bacterial transmission; Basic preventive measures; Environmental cleaning; Hand hygiene; Intraoperative infection control; Monitoring; Patient decolonization; surgical site infection

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