Clinical trial NCT02073760: Optimizing Prevention of Healthcare-Acquired Infections After Cardiac Surgery (HAI)_2
Official title: Optimizing Prevention of Healthcare-Acquired Infections After Cardiac Surgery (HAI)_2
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Cardiovascular Disease
Healthcare Associated Infectious Disease
Sternal Superficial Wound Infection
Deep Sternal Infection
Mediastinitis
Thoracotomy
Conduit Harvest or Cannulation Site
Sepsis
Pneumonia
Keywords: Healthcare acquired infections
Cardiac Surgery
Sternal Superficial Wound Infection
Deep Sternal Infection
Mediastinitis
Thoracotomy
Conduit harvest or cannulation site
Sepsis
Pneumonia
Lead sponsor: University of Michigan
Sponsor class: OTHER
Collaborators: name: Agency for Healthcare Research and Quality (AHRQ)
First posted: 2014-02-27
Enrollment: 79
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: OTHER
Time perspective: CROSS_SECTIONAL
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Clinical providers and administrators working at any of 33 institutions performing cardiac surgery in the state of Michigan

Brief summary: The investigators will conduct qualitative interviews of hospital personnel regarding HAI prevention practices, and use coded data from these interviews to assist in developing standardized practices.

Detailed description: More than 400,000 coronary artery bypass grafting (CABG) procedures are performed every year in the United States (U.S.). Patients undergoing CABG surgery are at risk for a number of adverse sequelae, many of which impact survival and contribute to overall health-care costs. Healthcare-acquired infections (HAIs), including pneumonia and superficial and deep sternal wound infections, occur among 16% of CABG patients and elevate a patient's risk of mortality and add excess upfront and long-term expenditures to the health care system.

A number of barriers prevent wide-scale improvements in HAl rates within the setting of CABG surgery. While a number of HAl prophylaxis measures have been developed, these measures do not fully encompass the set of practices that may impact a patient's risk of HAl. Identifying cardiac surgery specific risk factors would serve as the foundation for targeted quality improvement strategies. In the absence of definitive data concerning best practices, HAl prophylaxis is variable across surgeons and institutions, resulting in unnecessary morbidity and cost. Prior work has shown the value of implementing evidence-based protocols in the general intensive care unit setting. To what extent the implementation of cardiac surgery specific standardized practices results in lower HAl rates is uncertain. An understanding of the effectiveness of this approach would certainly assist surgeons and institutions in providing safer care to their patient populations.

Rates of HAIs vary from 0-26% across the 33 institutions performing CABG surgery in Michigan. This application seeks to reduce this rate by identifying and subsequently implementing standardized practices, and evaluating their impact on HAl rates. This study will be based on the prospective data and regional quality improvement activities and infrastructure of the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC). The investigators will evaluate the effectiveness of these standardized practices in reducing HAIs regionally and relative to national rates during the same time period.

The investigators will conduct qualitative interviews of hospital personnel regarding HAI prevention practices, and use coded data from these interviews to assist in developing standardized practices.

Eligibility criteria: Inclusion Criteria:

* Clinical providers or
* Administrators
* Must work at any of 33 institutions performing cardiac surgery in the state of Michigan

Exclusion Criteria: Under 18 years of age

Primary outcomes:
measure: Preventive Strategies
timeFrame: During the time of the interview
Secondary outcomes:
Other outcomes:
Locations:
city: Ann Arbor
country: United States
facility: Mstcvs-Qc
state: Michigan
Study officials:
affiliation: University of Michigan
name: Donald S Likosky, Ph.D.
role: PRINCIPAL_INVESTIGATOR
References:
citation: Likosky DS, Paone G, Zhang M, Rogers MA, Harrington SD, Theurer PF, DeLucia A 3rd, Fishstrom A, Camaj A, Prager RL; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative. Red Blood Cell Transfusions Impact Pneumonia Rates After Coronary Artery Bypass Grafting. Ann Thorac Surg. 2015 Sep;100(3):794-800; discussion 801. doi: 10.1016/j.athoracsur.2015.03.089. Epub 2015 Jul 21.