Povidone-iodine to Stop Access-related Infections and Transmission of Staphylococcus aureus (PAINTS)

摘要 背景：“聚维酮碘用于阻止与Access相关的感染和 金黄色葡萄球菌的传播（PAINTS）”的建议是降低医疗保健的比率- 在医院外发生的相关感染（即，社区感染）。最近的数据 疾病控制和预防中心（CDC）的研究表明，83%的甲氧西林- 耐药金黄色葡萄球菌（MRSA）血流感染是社区发病的。血液透析 患者是社区发病的血流感染的高危人群，尤其是沙门氏菌。aureus access- 相关血流感染（ARBSI）。这些感染导致发病率和死亡率增加。 鼻用聚维酮碘去殖民化是一种新的干预措施，可以潜在地预防S。金黄色 ARBSI在该患者人群中。具体目的：目的1：评估鼻用聚维酮碘 使用多中心阶梯楔形块减少血液透析患者的非殖民化感染 整群随机试验主要结局：S。金黄色ARBSI。次要结局：其他S。金黄色 CDC国家医疗安全网络（ARBSI）定义的透析相关感染 由除沙门氏菌以外的病原体引起。金黄色葡萄球菌，所有病原体引起的所有透析相关感染， 和S.金黄色葡萄球菌定植和传播。目的2：评价鼻用聚维酮的患者满意度- 碘去殖民化，评估其在患者激活中的作用，并评估 使用患者调查实施。目标3：检查医护人员对 实施鼻用聚维酮碘去殖民化，并评估 通过定性访谈和实地考察进行。研究设计：我们的目标是进行一项随机 在隶属于5个地理位置不同的医疗保健机构的16个血液透析单位中进行的阶梯楔形研究 中心评估鼻用聚维酮碘是否会降低S.金黄色葡萄球菌ARBSI 血液透析患者这些血液透析单位代表了农村和市中心的患者， 接受长期护理（AHRQ优先人群）。我们将对所有患者进行调查， 卫生保健工作者评估这种干预的可接受性和可行性，以及障碍， 促进执行。我们会检查病人的鼻子是否有S。金黄色葡萄球菌定植，以确定 鼻用聚维酮碘是否降低S.金黄色葡萄球菌定殖和S.金黄色葡萄球菌传播。网站 将参与这项研究的人（爱荷华州大学、伊利诺伊大学、宾夕法尼亚大学， 华盛顿大学、埃默里医疗保健）有着良好的合作历史。相关性：本研究 将帮助AHRQ实现其目标，即“建立在门诊中对抗抗生素耐药性的证据， 环境”，并帮助实现预防医疗相关感染的国家行动计划 建议血液透析中心旨在提高ARBSI率。

Abstract Background: The long-term objective of the “Povidone-iodine to stop Access related INfections and Transmission of Staphylococcus aureus (PAINTS)” proposal is to decrease rates of healthcare- associated infections that occur outside of the hospital (i.e., community-onset infections). Recent data from the Centers for Disease Control and Prevention (CDC) demonstrated that 83% of methicillin- resistant Staphylococcus aureus (MRSA) bloodstream infections are community-onset. Hemodialysis patients are at high-risk for community-onset bloodstream infections, particularly S. aureus access- related bloodstream infections (ARBSI). These infections cause increased morbidity and mortality. Nasal povidone-iodine decolonization is a novel intervention that can potentially prevent S. aureus ARBSI in this patient population. Specific Aims: Aim 1: Assess whether nasal povidone-iodine decolonization reduces infections among hemodialysis patients using a multicenter, stepped-wedge cluster randomized trial. Primary outcome: S. aureus ARBSI. Secondary outcomes: Other S. aureus dialysis-associated infections as defined by the CDC National Healthcare Safety Network, ARBSI caused by pathogens other than S. aureus, all dialysis-associated infections caused by all pathogens, and S. aureus colonization and transmission. Aim 2: Evaluate patient satisfaction with nasal povidone- iodine decolonization, assess its role in patient activation, and assess barriers and facilitators to implementation using patient surveys. Aim 3: Examine healthcare worker satisfaction with implementation of nasal povidone-iodine decolonization and assess barriers and facilitators to the process via qualitative interviews and site visits. Research Design: We aim to perform a randomized stepped wedge study among 16 hemodialysis units affiliated with 5 geographically diverse healthcare centers to evaluate whether nasal povidone-iodine will reduce rates of S. aureus ARBSI among hemodialysis patients. These hemodialysis units represent both rural and inner-city patients who receive chronic care (AHRQ priority populations). We will survey all patients and qualitatively interview healthcare workers to assess the acceptability and feasibility of this intervention, as well as barriers and facilitators to implementation. We will test patients' noses for S. aureus colonization to determine whether nasal povidone-iodine decreases S. aureus colonization and S. aureus transmission. The sites that will participate in this study (University of Iowa, University of Illinois, University of Pennsylvania, Washington University, Emory Healthcare) have a good history of collaboration. Relevance: This study will help AHRQ address its goal to “build the evidence for fighting antibiotic resistance in the ambulatory setting,” and help meet the National Action Plan to Prevent Healthcare-Associated Infections recommendation that hemodialysis centers aim to improve ARBSI rates.