Strategies to Reduce Transmission of Antimicrobial Resis

这项研究将确定在成人重症监护病房(ICU)中，与仅使用标准护理的ICU相比，使用重症感染控制策略和标准护理的ICU患者中，2种耐药革兰氏阳性菌--甲氧西林耐药金黄色葡萄球菌(MRSA)和万古霉素耐药肠球菌(VRE)--的定殖率和感染率是否较低。强化控制策略包括：1)通过报告前鼻孔、大便或肛周的监测培养结果来确定感染MRSA或VRE的患者；2)普遍戴手套(在与患者或患者互动时使用手套-S环境)，直到患者出院或他们的监测培养结果表明他们没有感染MRSA或VRE(以最先发生者为准)；3)在护理感染MRSA或VRE的患者期间采取接触预防措施(与患者或患者互动时使用手套和大衣？S环境)。标准护理包括适当的手卫生(洗手或使用无水手消毒剂)和使用标准预防措施(接触粘膜、伤口和体液时使用手套和其他所需屏障)和收集监测培养物，但不向这些地点报告结果。监测培养将在患者进入ICU时，此后每周一次，出院时从患者的鼻子和粪便或肛周区域采集拭子进行。监测培养的结果将被用来比较使用强化控制策略的ICU中MRSA和VRE的定殖率与仅使用标准护理的ICU中的定殖率。 进展报告：这项研究是由国家过敏和传染病研究所(NIAID)支持的一项多中心试验，并通过由NIAID资助的临床试验网络细菌学和真菌学研究小组进行。年龄在18岁及以上的男性和女性患者，只要在20个参与地点中的一个被送入MICU、SICU或MICU/SICU，就有资格参加研究。美国国立卫生研究院为这一方案提供微生物学，与患者没有直接接触。美国国立卫生研究院的实验室医学部对在参与地点收集的样本进行微生物学检测。NIH实验室将培养结果记录在Bambu系统中。 这项研究在4个月的基线密度数据收集期间招募了2982名患者。那些被随机分配到强化控制组的ICU的6个月干预期从2006年1月1日开始。目前还没有进行任何数据分析。

This study will determine if rates of colonization and infection with 2 resistant Gram positive bacteria?methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococci (VRE)?among patients in adult intensive care units (ICUs) are lower in ICUs that use an intensive infection control strategy plus standard care compared to ICUs that use standard care alone. The intensive control strategy involves: 1) identifying patients who are colonized with MRSA or VRE by reporting the results of surveillance cultures of the anterior nares and stool or perianal area; 2) Universal Gloving (use of gloves during interactions with the patient or the patient?s environment) until the patients are discharged or their surveillance culture results show they are not colonized with MRSA or VRE (whichever happens first); and 3) Contact Precautions (use of gloves and gowns during interactions with the patient or the patient?s environment) during care of patients who are colonized with MRSA or VRE. Standard care involves proper hand hygiene (handwashing or use of a waterless hand antiseptic) and use of Standard Precautions (use of gloves and other barriers as needed for interactions involving contact with mucous membranes, wounds, and body fluids) and collection of surveillance cultures, but not reporting of results to these sites. The surveillance cultures will be performed by obtaining swabs of the nose and stool or perianal area from patients upon admission to the ICU, at weekly intervals thereafter, and upon discharge from the ICU. The results of the surveillance cultures will be used to compare the rate of colonization with MRSA and VRE in ICUs using the intensive control strategy with those that use standard care alone. Progress Report: This study is a multi-center trial supported by the National Institute of Allergy and Infectious Diseases (NIAID) and is conducted through the Bacteriology and Mycology Study Group, a clinical trials network funded by NIAID. Male and female patients, ages 18 and above, who are admitted to the MICU, SICU or MICU/SICU at one of the 20 participating sites are eligible for the study. The NIH provides the microbiology for this protocol and has no direct patient contact. The Department of Laboratory Medicine at the NIH performs the microbiology on the samples collected at the participating sites. The NIH lab records the culture results in the BAMBU system. This study has enrolled 2982 patients over a 4 month baseline density data collection period. The 6 month intervention period for those ICUs randomized to the intensive control arm begins January 1, 2006. No data analysis has yet occurred.