Statewide Implementation of Guidelines to Control MRSA

全州范围内实施 MRSA 控制指南

• 批准号: 7405902
• 负责人: Loreen A Herwaldt
• 金额: $ 45万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-30 至 2010-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7405902
• 关键词: Statewide; Implementation; Guidelines; Control; MRSA

DESCRIPTION (provided by applicant): Methicillin (oxacillin)-resistant Staphylococcus aureus (MRSA) is by far the most common resistant bacterial pathogen. Despite concerted efforts to decrease transmission, the prevalence of this organism continues to increase in healthcare facilities and in the community. Moreover, this organism now causes serious infections in persons who do not have the traditional risk factors for MRSA infections and it can spread silently in the healthcare setting and in the community. Few hospitals have implemented all components of the evidence-based guidelines for preventing spread of MRSA. The purpose of the proposed study is to 1) encourage all Iowa hospitals to implement the Institute for Healthcare Improvement's (IHI) MRSA bundle and to report data on nosocomial MRSA infections to Iowa's unique voluntary reporting system for healthcare-associated infections; 2) identify impediments and/or facilitators to successful translation of this evidence-based public health guideline; 3) identify optimal strategies for enhancing widespread adoption and institutionalization of this effective public health intervention. A robust coalition of specialists in implementation of evidence-based guidelines, quality improvement, infectious diseases, microbiology, molecular epidemiology, hospital epidemiology, public health, healthcare delivery, and healthcare policy will study the implementation of this evidence-based guideline to control MRSA. This proposal has 6 specific aims: 1) Assess knowledge, current preventive practices, and needs regarding MRSA control in acute-care hospitals, long-term-care facilities, and in the outpatient setting; 2) Implement IHI's MRSA bundle at the University of Iowa Hospitals and Clinics, the Iowa City Veterans Affairs Medical Center, and at acute care hospitals across Iowa; 3) Determine whether MRSA carriage at sites other than the nares, carriage by healthcare workers, and environmental contamination decreases the effectiveness of IHI's MRSA Bundle; 4) Assess the implementation of IHI's MRSA Bundle in individual hospitals and in Iowa's hospitals in general; 5) Assess the effectiveness of IHI's MRSA bundle at individual hospitals and in Iowa's hospitals in general; 6) Develop resources to help the community prevent spread of MRSA; control of MRSA in the community might enhance the effectiveness of IHI's MRSA bundle in hospitals. The methods will involve observing practice, calculating rates of nosocomial MRSA bloodstream infections and of MRSA transmission, feeding these rates back to the clinicians, evaluating progress, implementing more change, and measuring rates again (rapid-cycle change). Statistical analysis will be done by time series analysis methods adapted for data with frequent zeros to assess whether implementing the evidence-based guideline was successful. Summative surveys and focus groups, using methods from appreciative inquiry, positive deviance, and critical incident analysis, will be conducted to identify facilitators and obstacles to implementation. Methicillin-resistant Staphylococcus aureus (MRSA), which is the most common resistant bacteria causing serious infections in both healthy people and people whose immune systems are impaired, continues to spread in healthcare facilities and in the community. Yet numerous studies have demonstrated that concerted efforts, particularly in hospitals, can decrease MRSA infections and prevent spread of this organism. The goal of this proposal is to implement these effective practices in hospitals and in high risk areas of the community across Iowa to prevent MRSA infections and to learn how best to translate medical knowledge into everyday medical practice.

描述（由申请方提供）：耐甲氧西林（苯唑西林）金黄色葡萄球菌（MRSA）是迄今为止最常见的耐药细菌病原体。尽管采取了一致的努力来减少传播，但这种微生物的流行率在医疗机构和社区中继续增加。此外，这种微生物现在在没有MRSA感染的传统风险因素的人中引起严重感染，并且它可以在医疗保健环境和社区中悄悄传播。很少有医院已经实施了预防MRSA传播的循证指南的所有组成部分。拟议研究的目的是：1）鼓励所有爱荷华州医院实施医疗保健改善研究所（IHI）MRSA包，并向爱荷华州独特的医疗保健相关感染自愿报告系统报告医院MRSA感染数据; 2）确定成功翻译该循证公共卫生指南的障碍和/或促进因素;（3）确定最佳战略，促进广泛采用这种有效的公共卫生干预措施并使之制度化。在实施循证指南、质量改进、传染病、微生物学、分子流行病学、医院流行病学、公共卫生、医疗保健服务和医疗保健政策方面，一个强大的专家联盟将研究实施这一循证指南来控制MRSA。该提案有6个具体目标：1）评估急性护理医院、长期护理设施和门诊环境中关于MRSA控制的知识、当前预防实践和需求; 2）在爱荷华州大学医院和诊所、爱荷华州市退伍军人事务医疗中心和爱荷华州的急性护理医院实施IHI的MRSA捆绑包; 3）确定在除鼻孔以外的部位的MRSA携带、医护人员的携带以及环境污染是否降低IHI的MRSA捆绑包的有效性; 4）评估IHI的MRSA捆绑包在个别医院和一般爱荷华州的医院中的实施; 5）评估IHI的MRSA捆绑包在个别医院和爱荷华州医院的总体效果; 6）开发资源，帮助社区预防MRSA的传播;社区MRSA的控制可能会提高IHI的MRSA捆绑包在医院的效果。这些方法将涉及观察实践，计算医院内MRSA血流感染和MRSA传播的比率，将这些比率反馈给临床医生，评估进展，实施更多的变化，并再次测量比率（快速周期变化）。将通过适用于频繁出现零的数据的时间序列分析方法进行统计分析，以评估循证指南的实施是否成功。将进行总结性调查和焦点小组，使用赞赏性询问、积极偏离和关键事件分析等方法，以确定执行的促进因素和障碍。耐甲氧西林金黄色葡萄球菌（MRSA）是最常见的耐药细菌，在健康人群和免疫系统受损的人群中引起严重感染，继续在医疗机构和社区中传播。然而，许多研究表明，协调一致的努力，特别是在医院，可以减少MRSA感染，并防止这种微生物的传播。该提案的目标是在爱荷华州的医院和社区的高风险地区实施这些有效的做法，以预防MRSA感染，并学习如何最好地将医学知识转化为日常医疗实践。