The BASIC trial: Improving implementation of evidence-based approaches and surveillance to prevent bacterial transmission and infection
Project Number5R01AI155752-04
Former Number1R01AI155752-01
Contact PI/Project LeaderBROWN, JEREMIAH R Other PIs
Awardee OrganizationDARTMOUTH COLLEGE
Description
Abstract Text
We propose to establish a best practice for implementation of a multifaceted approach designed to attenuate
perioperative ESKAPE (Enterococcus, S. aureus, Klebsiella, Acinetobacter, Pseudomonas, Enterobacter spp.)
transmission and associated surgical site infection (SSI) development. Perioperative ESKAPE transmission
(inoculum) contributes to the development of surgical site infections (SSIs) which affect 3-5% of patients
undergoing surgery. SSIs increase patient morbidity, prolong hospitalization, increase the risk of intensive care
unit admission, and increase the risk of death 2-fold. ESKAPE pathogens are particularly problematic.
Sustained reductions in epidemiologically-related, perioperative S. aureus transmission events achieved via a
multi-faceted approach including surveillance feedback optimization resulted in substantial SSI reductions
(88% decrease). An evidence-based approach for attenuation of the perioperative bacterial inoculum2 must
integrate improvements in provider hand hygiene, intravascular catheter design/handling, environmental
cleaning/organization, and patient decolonization. In this application, we propose a type 1 hybrid
effectiveness-implementation using a 2x2 factorial cluster-randomized design guided by RE-AIM. We aim to
identify a best practice for addressing the perioperative ESKAPE inoculum. We will examine the relative
effectiveness of increased site awareness and commitment to generating improvements via technical
assistance (TA), team coaching implementation of an evidence-based set of interventions (EBIP), and TA or
EBIP with ESKAPE transmission surveillance feedback. Our strong preliminary data from a randomized trial
implementing a multifaceted program with surveillance has demonstrated substantial and statistically
significant reductions in transmission of S. aureus and 90-day SSIs and recently reproduced our randomized
trial findings in an additional external site. Therefore, our prior research strongly suggests that the proposed
research should be done and justifies scaling up to dissemination and implementation. Our exceptional
multidisciplinary team is well equipped to successfully complete the proposed trial and aims. In the proposed
trial guided by RE-AIM, we will advance scientific knowledge and inform future dissemination and
implementation by investigating how best to scale-up an already successful multifaceted approach to national
dissemination through either TA or EBIP with or without surveillance. We will conduct a rigorous cost-
effectiveness analysis including evaluation of net cost savings. The proposed trial guided by RE-AIM (Aim 1),
the addition of 1-year follow-up for sustainability (Aim 2), and cost-effectiveness analysis (Aim 3) will provide
the essential scientific knowledge to adopters and organizers to be able to reproduce the most effective
delivery method of our interventions to their local setting in addition to informing our investigative team which
approach to scale-up to reach national dissemination.
Public Health Relevance Statement
PROJECT NARRATIVE
Surgical site infections (SSIs) are associated with increased patient morbidity, mortality, and healthcare
costs. ESKAPE (Enterococcus, S. aureus, Klebsiella, Acinetobacter, Pseudomonas, and Enterobacter spp.)
pathogens are particularly pathogenic because they have increased capacity to acquire resistance and
virulence traits. We have proven that a multifaceted program involving improved basic perioperative preventive
measures can generate substantial reductions in S. aureus transmission and significant reductions in SSIs
(88% reduction as compared to usual care). In this study, we aim to examine the relative effectiveness of each
component of this program in controlling ESKAPE transmission and reducing SSIs and to identify an optimal
implementation strategy for national dissemination. This work will improve perioperative patient safety for the
51 million patients who undergo surgery each year.
NIH Spending Category
No NIH Spending Category available.
Project Terms
AcinetobacterAddressAdmission activityAffectAreaAttenuatedAwarenessCathetersCharacteristicsColony-forming unitsComplexCost AnalysisCost Effectiveness AnalysisCost SavingsDataData CollectionDay SurgeryDevelopmentDissemination and ImplementationEffectivenessEligibility DeterminationEnterobacterEnterococcusEpidemiologyEvaluationEventEvidence based interventionEvidence based programFeedbackFutureHandHealth Care CostsHospitalizationHospitalsHygieneIncidenceInfectionInfection preventionInstitutionIntensive Care UnitsInterventionInvestmentsKlebsiellaKnowledgeLinkMaintenanceMeasuresMethodsMorbidity - disease rateOperative Surgical ProceduresOutcomePathogenicityPatient CarePatientsPerioperativePhasePrevention strategyPreventive measureProviderPseudomonasQuality of CareRandomizedReach, Effectiveness, Adoption, Implementation, and MaintenanceResearchResistanceRiskSamplingScientific Advances and AccomplishmentsSiteStaphylococcus aureusSurfaceSurgical SpecialtiesSurgical Wound InfectionTranslatingValidationVirulenceWorkattenuationcluster randomized designcomparative efficacycomparison interventioncostcost effectivenessdesigneffectiveness/implementation hybridevidence basefollow-upgenome analysishigh riskimplementation strategyimprovedincremental costmortalitymortality riskmultidisciplinaryoperationpathogenpatient safetypost implementationpreventprogramsprospectiverandomized trialrelative effectivenessscale uptraittransmission processtreatment as usual
National Institute of Allergy and Infectious Diseases
CFDA Code
855
DUNS Number
041027822
UEI
EB8ASJBCFER9
Project Start Date
17-June-2021
Project End Date
31-May-2026
Budget Start Date
01-June-2024
Budget End Date
31-May-2025
Project Funding Information for 2024
Total Funding
$796,388
Direct Costs
$543,629
Indirect Costs
$252,759
Year
Funding IC
FY Total Cost by IC
2024
National Institute of Allergy and Infectious Diseases
$796,388
Year
Funding IC
FY Total Cost by IC
Sub Projects
No Sub Projects information available for 5R01AI155752-04
Publications
Publications are associated with projects, but cannot be identified with any particular year of the project or fiscal year of funding. This is due to the continuous and cumulative nature of knowledge generation across the life of a project and the sometimes long and variable publishing timeline. Similarly, for multi-component projects, publications are associated with the parent core project and not with individual sub-projects.
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Patents
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Outcomes
The Project Outcomes shown here are displayed verbatim as submitted by the Principal Investigator (PI) for this award. Any opinions, findings, and conclusions or recommendations expressed are those of the PI and do not necessarily reflect the views of the National Institutes of Health. NIH has not endorsed the content below.
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Clinical Studies
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History
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