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

聚维酮碘可阻止与接触相关的金黄色葡萄球菌感染和传播 (PAINTS)

• 批准号: 10553613
• 负责人: Marin Leigh Schweizer
• 金额: $ 35万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10553613
• 关键词: Povidone; iodine; Stop; Access; related

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.

抽象的 背景：“普韦酮 - 碘的长期目标，以停止访问相关感染和 金黄色葡萄球菌（油漆）的传播”提案是降低医疗保健率 医院外发生的相关感染（即社区发作感染）。最新数据 从疾病控制与预防中心（CDC）表明，甲氧西林83％ 抗性金黄色葡萄球菌（MRSA）血液感染是社区发作的。血液透析 患者患有社区发作的血液感染，尤其是金黄色葡萄球菌 - 相关的血液感染（ARBSI）。这些感染导致发病率和死亡率增加。 鼻povidone-iodine非殖民化是一种新颖的干预措施，可以潜在地预防金黄色葡萄球菌 该患者人群中的Arbsi。具体目的：目标1：评估鼻povidone-iodine是否 非殖民化可减少使用多中心阶梯式北方的血液透析患者的感染 聚类随机试验。主要结果：Aureus arbsi。次要结果：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 由金黄色葡萄球菌以外的病原体引起，所有病原体引起的所有透析相关感染， 和金黄色葡萄球菌定植和传播。目标2：评估患者对鼻povidone-的满意 碘非殖民化，评估其在患者激活中的作用以及评估障碍和促进因子 使用患者调查实施。目标3：检查医疗人员对 实施鼻povidone-碘非殖民化和评估障碍以及促进者 通过定性访谈和现场访问进行处理。研究设计：我们旨在执行随机的 16个血液透析单元的阶梯楔研究与5个地理上不同的医疗保健 评估鼻povidone-碘是否会降低金黄色葡萄球菌Arbsi的中心 血液透析患者。这些血液透析单元代表农村和内城患者 接受慢性护理（AHRQ优先人群）。我们将调查所有患者并进行定性面试 医疗保健工人评估这种干预措施的可接受性和可行性，以及障碍和 促进者实施。我们将测试患者的金黄色葡萄球菌定植的鼻子，以确定 鼻丙酮碘是否会降低金黄色葡萄球菌定植和金黄色葡萄球菌的传播。站点 这将参加这项研究（爱荷华大学，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）拥有良好的合作历史。相关性：这项研究 将帮助AHRQ解决其目标的目标 设置，”并帮助符合国家行动计划，以防止医疗保健相关感染 建议血液透析中心旨在提高ARBSI率。