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 耐甲氧西林金黄色葡萄球菌（MRSA）。这种应用的理由是， 需要了解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长袍）;以及何时以及哪些患者可能不需要接触 预防MRSA传播的措施。 抗生素耐药性是我们这个时代最大的公共卫生挑战之一。的 应用的重要性在于它认识到并解决了接触预防制度化的障碍 对于所有MRSA患者，当忙碌的医护人员（HCP）认为他们可能没有时间 当他们从一个房间到另一个房间时，不断地穿上和脱下长袍和手套。如果研究结果 提供关于何时最需要（何时不需要）接触预防措施的指导， 建议减少不必要地使用长袍和手套的次数，同时 提供了关于何时接触预防措施仍然至关重要的新证据。 创新：这项工作是创新的，因为我们的目标是将精准的公共卫生带入该领域 抗生素耐药性和全国所有VA医疗中心（VAMC）：正确的预防措施， 在正确的时间遇到正确的人 具体目的：目的1：在VA机构进行多中心、地理位置多样化的队列研究，并招募 MRSA患者，以确定MRSA传播到医护人员手套和长袍的比率， ICU和非ICU环境。目的2：确定哪些患者风险因素，包括合并症， 疾病严重程度标记，哪些患者护理交互以及哪些医疗保健人员类型 与MRSA的更大传播有关。目标3：建立一个动态传输模型， 不同接触预防策略的成本效益。 方法学：在6个VAMC中，我们将入组800例重症监护室（ICU）的MRSA患者 非ICU环境。研究协调员将随机观察5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 人员与患者的相互作用因素。当医护人员离开房间时，研究协调员 将在离开房间时对医护人员的手套和长袍进行培养。因此，五名医护人员戴上手套 每名患者将获得4，000个手套培养结果和4，000个长袍培养结果 文化成果。成本效益目标将利用目标1和目标2的结果， 传播模型，以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和间接（即，生产力损失）成本。 实施/后续步骤：我们将在适当的同行评审科学期刊上发表我们的研究结果， 在国家科学论坛上展示研究结果，如VA HSR&D会议、SHEA春季会议 IDSA的IDWeek年会。确保研究成功实施和适当的知识 为了传播研究结果并将其转化为政策，我们设立了一个跨学科咨询委员会， 和具有多年VAMC专业知识的研究中心合作研究者。顾问委员会成员是领导者， VHA中的感染性疾病，他们制定并指导了VA MRSA预防计划， 年，并可以将调查结果纳入VA政策。此外，哈里斯博士是社会的前总统， 美国卫生保健流行病学和疾病控制和预防中心咨询小组的现任成员。他将利用 这些联系有助于指导SHEA和CDC有关接触预防措施的政策。VA是一个理想的 由于其在制定国家政策方面的灵活性，该研究已被广泛实施。

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.