Ahuja Shalini, Singh Sanjeev, Charani Esmita, Surendran Surya, Nampoothiri Vrinda, Edathadathil Fabia, George Anu, Leather Andrew, Tarrant Carolyn, Holmes Alison, Sevdalis Nick, Birgand Gabriel
Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.
Pilot Feasibility Stud. 2022 Nov 5;8(1):237. doi: 10.1186/s40814-022-01192-z.
Postoperative infections represent a significant burden of disease, demanding antibiotic prescriptions, and are contributing to antimicrobial resistance. The burden of infection as a surgical complication is greater in low- and middle-income countries (LMICs). We report the protocol of a pilot study for the co-design, implementation and evaluation of two infection prevention and control (IPC) and antimicrobial stewardship (AMS) interventions across the surgical pathway in a teaching hospital in India.
The two interventions developed following in-depth qualitative enquiry are (i) surveillance and feedback of postoperative infections to optimise the use of antibiotics in two surgical departments (gastrointestinal and cardiovascular and thoracic surgery) and (ii) raising awareness amongst patients, carers and members of public about IPC and AMS. We will conduct a prospective study, formatively evaluating the implementation process of delivering the two co-designed interventions using implementation science frameworks. The study will systematically assess the context of intervention delivery, so that implementation support for the interventions may be adapted to the needs of stakeholders throughout the study. Analysis of implementation logs and interviews with stakeholders upon completion of the implementation period, will offer insights into the perceived acceptability, appropriateness, feasibility and sustainability of the interventions and their implementation support. Implementation costs will be captured descriptively. Feasibility of clinical data collection to investigate effectiveness of interventions will also be assessed for a future larger study. Thematic framework analysis and descriptive statistics will be used to report the qualitative and quantitative data, respectively.
• The paired interventions have been co-designed from their inception with involvement of stakeholders at different stages in the surgical pathway. • Simultaneous evaluation of implementation and clinical outcomes will inform the development of a future larger study to enable/assess the scalability of interventions • The study offers a novel combination of implementation theory-informed, stakeholder-driven and clinically relevant evaluation, carried out in the context of a middle-income country hospital. • The project may not be applicable to every low-resource setting and surgical context due to differences in healthcare systems and cultures. However, the application of implementation science concepts may facilitate transferability and adaptation to other settings.
术后感染是一项重大的疾病负担，需要开具抗生素处方，且会导致抗菌药物耐药性。作为一种手术并发症，感染负担在低收入和中等收入国家（LMICs）更为严重。我们报告了一项试点研究的方案，该研究旨在对印度一家教学医院手术路径中的两项感染预防与控制（IPC）及抗菌药物管理（AMS）干预措施进行联合设计、实施和评估。
经过深入的定性调查后制定的两项干预措施为：（i）对术后感染进行监测和反馈，以优化两个外科科室（胃肠外科以及心血管和胸外科）抗生素的使用；（ii）提高患者、护理人员和公众对IPC和AMS的认识。我们将开展一项前瞻性研究，使用实施科学框架对两项联合设计的干预措施的实施过程进行形成性评估。该研究将系统地评估干预措施实施的背景，以便在整个研究过程中根据利益相关者的需求调整对干预措施的实施支持。在实施期结束后，对实施日志进行分析并与利益相关者进行访谈，将深入了解干预措施及其实施支持在可接受性、适宜性、可行性和可持续性方面的情况。将对实施成本进行描述性记录。还将评估收集临床数据以调查干预措施有效性的可行性，以便未来开展更大规模的研究。主题框架分析和描述性统计将分别用于报告定性和定量数据。
• 这两项配对干预措施从一开始就与手术路径中不同阶段的利益相关者共同设计。• 对实施情况和临床结果进行同步评估将为未来更大规模研究的开展提供信息，以实现/评估干预措施的可扩展性。• 本研究在中等收入国家医院的背景下，提供了一种新颖的、结合了实施理论指导下的利益相关者驱动且与临床相关的评估方式。• 由于医疗系统和文化的差异，该项目可能不适用于每个资源匮乏的环境和手术场景。然而，实施科学概念的应用可能有助于其可转移性和对其他场景的适应性。
