Targeted Contact Precaution Use to Prevent MRSA Transmission

背景：关于接触预防措施的利弊仍存在巨大争议 用于耐甲氧西林金黄色葡萄球菌(MRSA)。这个应用程序的基本原理是 需要知识来确定哪些患者需要采取基于传播的接触预防措施 (医护人员使用的手套和睡衣)；以及何时和哪些患者不需要接触 预防耐甲氧西林金黄色葡萄球菌扩散的预防措施。 意义和影响：抗生素耐药性是我们这个时代最大的公共卫生挑战之一。这个 应用意义重大，因为它认识到并解决了制度化接触预防措施的障碍 对于所有患有MRSA的患者，当忙碌的医护人员(HCP)感到他们可能没有时间 在从一个房间过渡到另一个房间时，不断地穿上和脱下礼服和手套。如果研究结果是 提供关于何时最有必要(以及何时不是)接触预防措施的指导， 建议减少不必要地使用睡袍和手套的次数，同时还 就何时接触预防措施仍然至关重要提供新的证据。 创新：这项工作是创新的，我们的目标是将精准的公共卫生带入该领域 抗生素耐药性和该国所有退伍军人医疗中心(VAM)：正确的预防类型， 在正确的时间遇到正确的类型。 具体目标：目标1：在退伍军人管理局进行多地点、不同地理位置的队列研究并登记 MRSA患者确定MRSA传播率医护人员手套和长袍 ICU和非ICU设置。目标2：确定哪些患者风险因素，包括合并症和 疾病严重程度标记、哪些患者护理互动以及哪些医护人员类型 与更大的耐甲氧西林金黄色葡萄球菌传播有关。目标3：开发一个动态传播模型来比较 不同接触预防策略的成本效益。 方法：在6个VAMC中，我们将在重症监护病房(ICU)招募800名患有MRSA的患者。 和非ICU设置。研究协调员将随机观察五名医护人员--患者 每名患者的互动。研究协调员将收集有关患者水平因素和医疗保健的数据 人与人、人与人的互动因素。当医护人员离开房间时，研究协调员 将医护人员的手套和长袍印在房间出口上。因此，五名医护人员戴上手套 将获得每个患者的礼服文化，从而产生4,000个手套文化成果和4,000个礼服 文化成果。成本效益目标将使用目标1和目标2的结果来构建动态的 传播模型评估不同接触预防策略的有效性。对于每种策略， 成本将包括直接医疗成本和间接(即生产力损失)成本。 实施/下一步：我们将在适当的同行评议的科学期刊上发表我们的研究结果，并 在退伍军人事务部HSR&D会议、Shea Spring会议等国家科学论坛上展示研究成果 以及IDSA的IDWeek年会。确保学习的成功实施和适当的知识 为了传播调查结果并将其转化为政策，我们成立了一个跨学科的咨询委员会 以及在VAMC领域拥有多年专业经验的研究现场合作调查员。顾问委员会的成员是 VHA中的传染病，制定并指导了退伍军人管理局MRSA预防倡议 多年，并能将调查结果落实到退伍军人事务部政策中。此外，哈里斯博士也是美国医学会的前主席 美国卫生保健流行病学和疾控中心HICPAC顾问组的现任成员。他将使用 这些连接有助于指导SHEA和CDC有关接触预防措施的政策。退伍军人管理局是一种理想的 由于它在制定国家政策方面的灵活性，它是进行这项研究并使其得到广泛实施的地方。

Background: There remains tremendous controversy surrounding the pros and cons of contact precautions for methicillin-resistant Staphylococcus aureus (MRSA). The rationale for this application is that more knowledge is needed to identify which patients need to be placed on transmission-based contact precautions (gloves and gowns used by healthcare workers); and when and which patients may not require contact precautions to prevent the spread of MRSA. Significance and Impact: Antibiotic resistance is one of the biggest public health challenges of our time. The application is significant in that it recognizes and addresses the barrier to institutionalizing contact precautions for all patients with MRSA when busy healthcare personnel (HCP) feel that they may not have time to continuously don and doff gowns and gloves as they transition from one room to another. If the study results provide guidance on when contact precautions are most necessary (and when they are not), it may be safe to recommend reducing the number of times when gowns and gloves are used unnecessarily, while also providing new evidence on when contact precautions remain essential. Innovation: The work is innovative in that we are aiming for precision public health to be brought into the field of antibiotic resistance and all VA medical centers (VAMCs) in the country: the right type of precautions, for the right type of encounter at the right time. Specific Aims: Aim 1: Perform a multi-site, geographically diverse cohort study at VA facilities and enroll patients with MRSA to determine the rate of MRSA transmission to healthcare personnel gloves and gowns in the ICU and non-ICU setting. Aim 2: Determine which patient risk factors, including comorbid conditions and severity of illness markers, which patient care interactions and which healthcare personnel types are associated with greater transmission of MRSA. Aim 3: Develop a dynamic transmission model to compare the cost-effectiveness of different contact precaution strategies. Methodology: Across six VAMCs, we will enroll 800 patients who have MRSA in the intensive care unit (ICU) and non-ICU setting. Research coordinators will randomly observe five healthcare personnel-patient interactions per patient. Research coordinators will gather data on the patient level factors and on healthcare personnel patient interaction factors. When the healthcare personnel leave the room, research coordinators will culture the healthcare personnel's gloves and gown upon room exit. Thus, five healthcare personnel glove and gown cultures per patient will be obtained, leading to 4,000 glove culture outcomes and 4,000 gown culture outcomes. The cost-effectiveness aim will use the results from aims 1 and 2 to build a dynamic transmission model to assess the effectiveness of different contact precaution strategies. For each strategy, costs will include both direct medical and indirect (i.e., productivity losses) costs. Implementation/next steps: We will publish our findings in appropriate peer-reviewed scientific journals and present the results at national scientific forums such as the VA HSR&D Conference, the SHEA Spring Meeting and IDSA’s IDWeek annual meeting. To ensure successful study implementation and appropriate knowledge dissemination and translation of findings into policy, we have established an interdisciplinary advisory board and study site co-investigators with years of expertise in VAMCs. The advisory board members are leaders in infectious disease in the VHA who have developed and guided the VA MRSA Prevention Initiative over the years and can implement findings into VA policy. As well, Dr. Harris is a former president of the Society of Healthcare Epidemiology of America and current member of the CDC HICPAC Advisory group. He will use these connections to help guide SHEA and CDC policies relative to contact precautions. The VA is an ideal place to perform this study and have it widely implemented due to its agility in making national policies.