# Assessing the Sustainability of Compliance with Surgical Site Infection Prophylaxis After Discontinuation of Mandatory Active Reporting

> **NIH VA I01** · VA BOSTON HEALTH CARE SYSTEM · 2021 · —

## Abstract

Background: SSIs are common and preventable adverse surgical outcomes that account for substantial
morbidity and mortality. Pre-operative antimicrobial administration reduces SSI; post-operative antimicrobials do
not reduce SSI but do increase other post-operative adverse events. In 2005, the VA implemented the Surgical
Care Improvement Project (SCIP) to increase compliance with peri-operative quality metrics, including
appropriate antimicrobial use. SCIP included a set of publicly reported evidenced-based antimicrobial guideline
compliance metrics targeting high-risk surgeries. The metrics required resource-intense manual review as part
of the VA’s External Peer Review Program (EPRP). In 2015, SCIP achieved sustained compliance with
antimicrobial use metrics exceeding 95% and the program was retired due to the high costs of manual review
with minimal expected additional benefit. This IIR proposal is guided by the Dynamic Sustainability Framework
and examines whether the antimicrobial practice changes achieved by SCIP were sustained and how they
spread to surgeries and practice areas beyond the original scope of the program. This multiple PI submission by
Dr. Hillary Mull, PhD and Dr. Westyn Branch-Elliman, MD, MMSc builds and expands upon their prior VA-funded
collaborative work applying electronic algorithms to measure antimicrobial use and identify adverse outcomes.
 Significance/Impact: Improving antimicrobial prescribing and surgical quality are major VA goals. In FY
2018, within the VA, there were 190,000 surgeries among SCIP-targeted specialties (cardiac, orthopedic,
general/colorectal, gynecology and vascular). Of these, 64% were outpatient, where the PIs found high rates
guideline discordant post-operative antimicrobial use, which contribute to substantial patient harms. Thus, the
potential impact of the research on direct clinical care is high. In addition, there are limited studies examining
what happens to practice change after discontinuation of active programs designed to support compliance with
evidence-based guidelines. The proposed study will close this gap in implementation science research.
 Innovation: In line with the VA’s Learning Health System directive, this project will use the VA’s electronic
health record data to develop algorithms to identify pre-and post-operative antimicrobial use based on the PI’s
prior work. These electronic data mining algorithms capture structured and text note data and represent a
significant technological advancement over costly manual review. This study also answers important questions
about the sustainability of practice change after discontinuation of an active policy with input from frontline staff.
 Specific Aims: 1) Measure sustainability of antimicrobial prophylaxis guideline compliance after SCIP
retirement and assess whether practice changes spread to SCIP-excluded procedures; 2) Assess facilitators
and barriers to implementation sustainability through staff interviews, and map results...

## Key facts

- **NIH application ID:** 10174418
- **Project number:** 1I01HX003231-01A1
- **Recipient organization:** VA BOSTON HEALTH CARE SYSTEM
- **Principal Investigator:** Westyn Branch-Elliman
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2021-10-01 → 2025-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10174418

## Citation

> US National Institutes of Health, RePORTER application 10174418, Assessing the Sustainability of Compliance with Surgical Site Infection Prophylaxis After Discontinuation of Mandatory Active Reporting (1I01HX003231-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10174418. Licensed CC0.

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