Coaching, Collaboration, Cleaning, & Communication: 4C Intervention to Reduce SARS-CoV-2 Transmission

摘要 自从新型冠状病毒SARS-CoV-2被发现以来的六个月里，新冠肺炎在全球迅速传播 在武汉一群社区获得性肺炎患者中首次发现中国。截至6月10日， 2020年，美国疾病控制和预防中心报告了190多万例新冠肺炎病例和 美国有112,133人死亡；世界卫生组织(WHO)报告了超过710万例和408,025例 全球(216个国家)的死亡人数。高龄和基础条件是ICU的危险因素 入院时感染了新冠肺炎，这意味着养老院居民患严重疾病的风险更大。 与此同时，NHS在实施有效的感染预防方面长期以来一直面临着特殊的挑战 计划，包括有限的资源和虚弱的功能残疾长期居留的诊断挑战 人口。到目前为止，在美国，大约三分之一的人死于这种病毒，与NHS或 其他长期护理设施。预计病毒将在2020年秋季卷土重来，推进我们的 应了解SARS-CoV-2在这些设施内针对弱势人群的传播情况 紧急和进一步的调查。SARS-CoV-2对环境的污染有限 研究强调了患者、他们的环境和医疗保健之间传播的潜在重要性 通过直接和间接接触提供服务。根据这项建议，我们计划描述SARS的流行病学特征： 随着时间的推移，在NH病房环境中的CoV-2以及传播到近环境和远环境的风险， 明确意图制定完整、简单的新冠肺炎感染预防策略。我们会 通过以下目标实现这些目标。具体目标1：确定SARS-CoV的传播特征- 2急性后护理环境中的病毒，包括病房和护士等常用区域 车站、就餐区和娱乐区。我们将对老年人进行前瞻性的纵向研究 在4个国民保健系统中有活跃的新冠肺炎感染，并指定新冠肺炎单位来描述病毒的危险因素 变速箱。我们假设风险因素包括功能障碍、合并症和新冠肺炎 症状的严重程度将与SARS-CoV-2传播到环境的几率增加相关 在新冠肺炎感染活跃的居民中。具体目标2：采用整群随机研究设计， 我们将测试一种多模式的老化友好型干预，包括四个组成部分(4C)：1)指导：感染 预防培训，以观察、教授和审计所有第一线的循证感染预防做法 临床医生；2)清洁：标准化的推荐环境清洁方案，并提供反馈 环境污染；3)沟通：患者和家人的沟通策略和 实施患者手部卫生和建议使用个人防护用品；以及4)协作：快速检测、重新 与转诊医院合作，进行检测和接触者追踪。我们假设， 这种干预将与降低SARS-CoV-2向环境传播的几率有关。

ABSTRACT COVID-19 has spread rapidly across the globe in the six months since the novel coronavirus SARS-CoV-2 was first detected in a cluster of patients with community-acquired pneumonia in Wuhan, China. As of June 10, 2020, the Centers for Disease Control and Prevention (CDC) reports over 1.9 million COVID-19 cases and 112,133 deaths in the US; the World Health Organization (WHO) reports over 7.1 million cases and 408,025 deaths worldwide (in 216 countries). Advanced age and underlying conditions are risk factors for ICU admission with COVID-19 infection, meaning nursing home (NH) residents are at greater risk for severe illness. At the same time, NHs have long faced special challenges in implementing effective infection prevention programs, including limited resources and diagnostic challenges in a frail functionally disabled long-stay population. To date, approximately one in three deaths from the virus in the US have been linked to NHs or other long-term care facilities. Anticipating that the virus will return in the fall of 2020, advancing our understanding of the transmission of SARS-CoV-2 within these facilities for vulnerable populations deserves urgent and further investigation. Environmental contamination with SARS-CoV-2 that is reported in limited studies highlights the potential importance of transmission between patients, their environment, and healthcare providers via direct and indirect contact. With this proposal, we plan to characterize the epidemiology of SARS- CoV-2 in the NH patient room environment over time and the risk of transmission to near and far environments, with the explicit intent of developing integrated, simple COVID-19 infection prevention strategies. We will achieve these goals through the following aims. Specific Aim 1: Characterize transmission of the SARS-CoV- 2 virus within post-acute care settings including patient rooms and common use areas such as nurses' stations, dining areas and recreation areas. We will conduct a prospective longitudinal study of older adults with active COVID-19 infection at 4 NHs with designated COVID-19 units to describe risk factors for virus transmission. We hypothesize that risk factors including functional disability, comorbidities, and COVID-19 symptom severity will be associated with increased odds of SARS-CoV-2 transmission to the environment among residents with active COVID-19 infections. Specific Aim 2: Using a cluster-randomized study design, we will test a multimodal aging-friendly intervention including four components (4Cs): 1) Coaching: infection prevention coaching to observe, teach, and audit evidence-based infection prevention practices by all frontline clinicians; 2) Cleaning: standardized recommended environmental cleaning protocols with feedback on environmental contamination; 3) Communication: patient and family communication strategy and implementation of patient hand hygiene and recommended PPE use; and 4) Collaboration: rapid testing, re- testing and contact tracing, in collaboration with referral hospitals. We hypothesize that the implementation of this intervention will be associated with lower odds of SARS-CoV-2 transmission to the environment.