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.

摘要 背景：聚维酮碘的长期目标是阻止与接触有关的感染和 金黄色葡萄球菌的传播(油漆)“的建议是降低医疗保健率- 发生在医院外的相关感染(即社区首发感染)。最新数据 来自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)血液感染是社区感染。血液透析 患者患社区血流感染的风险很高，特别是金黄色葡萄球菌- 相关血流感染(ARBSI)。这些感染导致发病率和死亡率增加。 聚维酮碘鼻腔非殖民化是一种潜在预防金黄色葡萄球菌的新型干预方法 ARBSI在这一患者群体中。具体目标：目标1：评估鼻腔用聚维酮碘 非殖民化使用多中心阶梯楔形减少血液透析患者的感染 整群随机试验。主要结果：金黄色葡萄球菌。次要结果：其他金黄色葡萄球菌 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，所有与透析相关的感染由所有病原体引起， 和金黄色葡萄球菌的定植和传播。目的2：评估患者对鼻腔聚维酮的满意度 碘非殖民化，评估其在患者激活中的作用，并评估障碍和促进者 使用患者调查实施。目标3：检查医护人员对以下方面的满意度 实施鼻腔聚维酮碘非殖民化并评估障碍和促进者 通过定性访谈和现场访问的过程。研究设计：我们的目标是进行一项随机的 5个不同地域医疗保健所属16个血液透析单位的阶梯楔形研究 评估鼻用聚维酮碘是否会降低以下人群中金黄色葡萄球菌的发病率 血液透析患者。这些血液透析单元既代表农村患者，也代表市中心患者 接受长期护理(AHRQ优先人群)。我们将对所有患者进行调查，并进行定性访谈 医护人员评估这种干预措施的可接受性和可行性，以及障碍和 执行的促进者。我们将测试患者的鼻部金黄色葡萄球菌的定植情况以确定 鼻用聚维酮碘是否能减少金黄色葡萄球菌的定植和传播。这些网站 将参与这项研究(爱荷华大学、伊利诺伊大学、宾夕法尼亚大学、 华盛顿大学、Emory Healthcare)有着良好的合作历史。相关性：这项研究 将帮助AHRQ实现其目标：“建立在门诊中对抗抗生素耐药性的证据” 并帮助满足预防医疗保健相关感染的国家行动计划 建议血液透析中心致力于提高ARBSI发生率。