Patient Movement and Impact on Multidrug-Resistant Organism (MDRO) Transmission

患者移动及其对多重耐药菌 (MDRO) 传播的影响

• 批准号: 10394783
• 负责人: Lona Mody
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10394783
• 关键词: Aging; Antibiotic Resistance; Area; Bacillus; Biopsy; CLC Gene; Caregivers; Caring; Clinic; Clinical; Clinical Data; Clinical Microbiology; Communicable Diseases; Day Surgery; Development; Dialysis procedure; Discipline of Nuclear Medicine; Discipline of Nursing; Distant; Ecology; Education; Elderly; Environment; Environmental Pollution; Epidemiology; Evaluation; Family; Fingerprint; Focus Groups; Future; Genomics; Goals; Hand; Health; Health Professional; Health Service Area; Health behavior; Healthcare Systems; Hospital Nursing; Hospitals; Hygiene; Individual; Infection; Infection prevention; Infusion procedures; Institution; Intensive Care Units; Intervention; Knowledge; Leadership; Medical; Methods; Microbiology; Molecular; Molecular Epidemiology; Movement; Nursing Homes; Occupational Therapy; Operative Surgical Procedures; Organism; Outcome; Participant; Patients; Patients' Rooms; Pattern; Physical therapy; Population; Positioning Attribute; Pre-Post Tests; Prevalence; Prevention; Prevention education; Prevention strategy; Procedures; Prospective cohort study; Provider; Qualitative Research; Quality of life; Radiology Specialty; Recreation; Rehabilitation therapy; Research Design; Role; Safety; Saints; Science; Services; Spinal Cord; Staphylococcus aureus infection; Surface; Time; United States Department of Veterans Affairs; Vancomycin resistant enterococcus; Veterans; Visit; acute care; clinical diagnostics; community living; comorbidity; design; disability; genomic data; genomic epidemiology; high risk; improved; indexing; innovation; intervention mapping; medical appointment; methicillin resistant Staphylococcus aureus; multi-component intervention; multi-drug resistant pathogen; multidisciplinary; nursing home length of stay; patient oriented research; prevent; statistics; success; therapy design; therapy development; translational study; transmission process; ward

Multidrug-resistant organisms (MDROs) are endemic in both acute care and nursing homes (NHs). However, predictors for new MDRO acquisition in older adults and transmission to healthcare professionals (HCPs) and the environment, particularly outside of patient rooms, remain unclear. This is relevant in today’s contemporary healthcare systems with patient movement outside the rooms for medical diagnostics and treatment- such as rehabilitation including physical and occupational therapy, procedures such as biopsies, services such as dialysis, infusion clinics and recreational activities- presenting a tremendous potential for transmission of organisms With this project and a focus on high-risk NH Veterans, our aims are to first characterize the changing epidemiology of MDROs at 3 VA NHs with the explicit goal of developing a ‘Patient Movement Index’ depicting the role of out-of-room visits for medical appointments and recreation in MDRO transmission across the institution. Using molecular and genomic methods, we will develop an understanding of the impact of MDRO transmission, predominant strains circulating in the NHs and other patient use areas. Using an ‘Intervention Mapping Framework’ we will next develop and pilot an integrated multi-modal intervention involving Veterans, their families, HCP as well as leadership to reduce transmission and infections. We anticipate this intervention to include: 1) Veterans’ and caregivers’ hand hygiene and infection prevention education; 2) provider education on MDRO prevention strategies and environmental cleaning; and 3) leadership involvement including infection prevention team, VA NH leadership, and managers of common use areas frequented by our participants. Patterns of patient movements outside their rooms as well as the molecular and genomic data obtained in Specific Aim 1 will be critical in informing our intervention. Our proposed translational study is innovative and timely as we plan to develop a new index that will characterize the amount of time Veterans spend outside their immediate environment in a colonized state and define a “fingerprint” of Veteran-caregiver-environment contamination. These studies will open a new line of inquiry allowing us to design future projects in order to characterize patient movement and transmission in other service areas such as hospitals and specialized units. We expect our results to have widespread application within and outside the VA, enhance Veterans’ quality of life by improving their hygiene practices and preventing infections, and help understand MDRO transmission within an evolving healthcare system. Our multidisciplinary team with expertise in aging, epidemiology including molecular epidemiology, microbiology, infectious diseases, health outcomes, nursing and patient oriented research is uniquely positioned to achieve our goals and advance the field.

在急性护理和护士住宅（NHS）中，多种耐药的生物（MDROS）都是内在的。然而， 老年人新的MDRO获取的预测因素，并向医疗保健专业人员（HCP）和 环境，尤其是在病房外，尚不清楚。这与当今的 当代医疗保健系统，患者在房间外运动进行医学诊断和 治疗 - 例如康复，包括物理和占领治疗，诸如活检等程序， 透析，输液诊所和娱乐活动等服务具有巨大潜力 生物的传播 有了这个项目，专注于高风险的NH退伍军人，我们的目的是首先描述变化 MDRO的流行病学在3 VA NHS处，其明确的目标是开发描绘的“患者运动指数” 室外访问在MDRO传播中进行医疗预约和娱乐的作用 机构。使用分子和基因组方法，我们将对MDRO的影响有所了解 传播，主要菌株在NHS和其他患者使用区域中循环。使用“干预” 映射框架’我们接下来将开发并试行一项集成的多模式干预措施，涉及 退伍军人，他们的家人，HCP以及领导层以减少传播和感染。我们期待这一点 干预措施包括：1）退伍军人和看护人的手卫生和预防教育； 2） 提供者关于MDRO预防策略和环境清洁的教育； 3）领导 参与包括预防感染团队，VA NH领导和常用领域的经理 经常由我们的参与者。病人运动的模式以及分子和分子和 在特定目标1中获得的基因组数据对于告知我们的干预至关重要。 当我们计划开发一个新指数时，我们提出的翻译研究具有创新性和及时 表征退伍军人在殖民状态以外的环境之外的时间和 定义退伍军人 - 照顾者 - 环境污染的“指纹”。这些研究将开放一条新的线 询问允许我们设计未来的项目，以表征患者的运动和传播 其他服务领域，例如医院和专业部门。我们希望我们的结果具有宽度 VA内外的应用，通过改善其卫生实践来增强退伍军人的生活质量 并防止感染，并帮助了解不断发展的医疗保健系统中的MDRO传播。 我们具有衰老，流行病学专业知识的多学科团队，包括分子流行病学， 微生物学，传染病，健康结果，护士和患者的研究是独特的 定位以实现我们的目标并促进该领域。