Brown, Jeremiah R.

Scientific evidence regarding AKI and acute kidney care has advanced in recent years. However, a knowledge gap remains on the implementation of these evidence-based practices (EBPs) into clinical care. Implementation science (IS) is focused on ensuring that this knowledge is translated in an effective, efficient and sustainable fashion. Objectives: 1) Define the current status of IS; 2) Define a roadmap for accelerating IS with a focus on patient/care partner advocacy, digital tool application, social determinants of health, and resource-limited settings; and 3) Develop a robust and broad research agenda incorporating IS methodology into the programs. Evidence Review: ADQI XXXV was conducted through a modified Delphi process with virtual meetings preceding an in-person meeting. Five workgroups were determined a priori to focus on 1) IS definitions and methods applicable to AKI and acute kidney care; 2) IS literature in AKI and acute kidney care; 3) Innovations in IS to accelerate the adoption, adherence to, and sustainment of EBPs in AKI and acute kidney care; 4) IS methods in resource-limited settings; and 5) Recommendations to identify and evaluate EBPs that are ready for implementation or de-implementation. Prior to the in-person meeting, each workgroup met virtually to review the literature and develop framework questions to address their objectives. During the two-day in person meeting, through iterative discussions, questions and supporting statements were finalized. These questions and statements were agreed upon through voting to achieve consensus, defined as agreement of ≥80%. Conclusions and Relevance: We report a structured multidisciplinary consensus for defining the role of IS in AKI and acute kidney care. Future programs should address these consensus questions and apply these statements along with IS methodology in the translation of science into clinical practice and the implementation/de-implementation of EBPs in clinical care.

BACKGROUND: Improved cleaning in the anesthesia workspace is important for surgical site infection prevention. We sought to identify high-priority cleaning targets to guide post-induction surface disinfection and use of a triangular ultraviolet-C (UV-C) configuration involving placement of one emitter at the head and one on each side of the surgical bed. METHODS: The 20 sites most frequently touched by anesthesia practitioners, previously identified via video-based workflow analysis, were filtered to remove disposable (eg, stopcocks) and transient (eg, the patient bed) sites, leaving durable cleaning targets amenable to repeated surface disinfection and UV-C irradiation within and/or between cases. Inequality in the distribution of cleaning target touches was quantified using the Gini coefficient, and uncertainty was estimated using bootstrap resampling (10,000 iterations). We then assessed residual contamination after standard terminal cleaning across three operating rooms and 171 sites to evaluate the difficulty of cleaning high-touch surfaces and the efficacy of UV-C disinfection. Simulations using medical devices composed of materials representative of cleaning targets contaminated with high-level Clostridium difficile were conducted to evaluate generalizability to more resistant pathogens. RESULTS: There were 13 of 20 frequently touched sites that were considered durable cleaning targets. Touches were relatively equal among the 13 cleaning targets (Gini coefficient 0.16, 95% confidence interval [CI], 0.12–0.20). Cleaning targets included components of the anesthesia cart (first and second drawer handles); anesthesia machine (reservoir bag, circuit ventilator control, oxygen dial, vaporizer dial, adjustable pressure-limiting valve), monitoring equipment (screen buttons/knob, electrocardiogram leads); and room infrastructure (intravenous pole, operating room table and chair). Residual contamination after cleaning was identified at 4% (7/171) of sites, mostly (6/7) within the anesthesia workspace, involving the anesthesia cart (N = 2), machine (N = 3), and monitor (N = 1). Only one site outside of the anesthesia workspace, the circulating nurse’s mouse, had residual contamination. Triangular UV-C reduced mean (standard deviation [SD]) colony-forming units (CFU) from 60.47 (542.22) to 0.12 (1.08), achieving a 2.7-log reduction. Simulation with high-level C. difficile contamination demonstrated ≥3-log reductions on surfaces representative of high-touch sites, confirming applicability to resistant pathogens. CONCLUSIONS: Thirteen durable cleaning targets in the anesthesia workspace are largely equivalent in terms of risk of touch. They are amenable to UV-C augmentation of surface disinfection in the real-world clinical environment. These findings can guide targeted post-induction cleaning and use of triangular UV-C, particularly for surfaces with substantial contamination or resistant pathogens.