Cade Karthchner

Background: ESKAPE pathogens are a significant culprit of healthcare-associated infections (HAIs), including surgical site infections (SSIs), which prolong recovery, increase readmissions, and are extremely costly. Perioperative transmission from reservoirs (e.g., patient’s skin, provider hands, environmental contamination) to susceptible hosts is a key mechanism. Despite strong evidence supporting practices like patient decolonization, hand hygiene, anesthesia workspace cleaning, and sterile intravascular access, widespread adoption is lacking. This study hypothesizes that implementation methods of monthly coaching and surveillance feedback will reduce cross-transmission and SSIs through improved compliance.

Methods: The BASIC trial is a multi-center, 2×2 factorial, clustered, randomized, controlled trial with two phases: active coaching/surveillance (first 250 patients/site) and sustained improvement. Twelve hospitals were randomized into four groups: (1) technical assistance without surveillance feedback, (2) technical assistance with surveillance feedback, (3) coaching without surveillance feedback, or (4) coaching with surveillance feedback. The primary outcome is to evaluate transmission events defined as the same bacteria (genetically identified) in multiple reservoirs with a secondary outcome of tracking SSI rates. Phase 1 began in 2022, with each site enrolling 125 case pairs: Case 1 (elective primary spine/joint surgery) and Case 2 (surgery immediately after Case 1). Pre-, intra-, and post-op swabs are analyzed for pathogen transmission.

Results: The study is in phase 1. We were randomized to the technical assistance only group and have enrolled 180 patients.

Conclusions: Despite strong evidence, compliance with practices to reduce transmission and SSIs is inadequate. The BASIC trial will evaluate the effectiveness of coaching and surveillance feedback.