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2020 ; 20
(ä): 100115
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Sample sizes for surveillance of S aureus transmission to monitor effectiveness
and provide feedback on intraoperative infection control including for COVID-19
#MMPMID32501426
Dexter F
; Ledolter J
; Wall RT
; Datta S
; Loftus RW
Perioper Care Oper Room Manag
2020[Sep]; 20
(ä): 100115
PMID32501426
show ga
Reductions in perioperative surgical site infections are obtained by a
multifaceted approach including patient decolonization, hand hygiene, and hub
disinfection, and environmental cleaning. Associated surveillance of S. aureus
transmission quantifies the effectiveness of the basic measures to prevent the
transmission to patients and clinicians of pathogenic bacteria and viruses,
including Coronavirus Disease 2019 (COVID-19). To measure transmission, the
observational units are pairs of successive surgical cases in the same operating
room on the same day. We evaluated appropriate sample sizes and strategies for
measuring transmission. There was absence of serial correlation among observed
counts of transmitted isolates within each of several periods (all P ?.18).
Similarly, observing transmission within or between cases of a pair did not
increase the probability that the next sampled pair of cases also had observed
transmission (all P ?.23). Most pairs of cases had no detected transmitted
isolates. Also, although transmission (yes/no) was associated with surgical site
infection (P =.004), among cases with transmission, there was no detected dose
response between counts of transmitted isolates and probability of infection (P
=.25). The first of a fixed series of tests is to use the binomial test to
compare the proportion of pairs of cases with S. aureus transmission to an
acceptable threshold. An appropriate sample size for this screening is N =25
pairs. If significant, more samples are obtained while additional measures are
implemented to reduce transmission and infections. Subsequent sampling is done to
evaluate effectiveness. The two independent binomial proportions are compared
using Boschloo's exact test. The total sample size for the 1(st) and 2(nd) stage
is N =100 pairs. Because S. aureus transmission is invisible without testing,
when choosing what population(s) to screen for surveillance, another endpoint
needs to be used (e.g., infections). Only 10/298 combinations of specialty and
operating room were relatively common (?1.0% of cases) and had expected incidence
?0.20 infections per 8 hours of sampled cases. The 10 combinations encompassed
?17% of cases, showing the value of targeting surveillance of transmission to a
few combinations of specialties and rooms. In conclusion, we created a sampling
protocol and appropriate sample sizes for using S. aureus transmission within and
between pairs of successive cases in the same operating room, the purpose being
to monitor the quality of prevention of intraoperative spread of pathogenic
bacteria and viruses.