The I-STRAT trial: Do Isolation Strategies reduce endemic levels of MRSA and Clostridium difficle associated diarrhoea

大多数人进医院害怕什么？感染超级细菌，如耐甲氧西林金黄色葡萄球菌或艰难梭菌！尽管政府采取了一系列措施来减少这些行为，但它们似乎仍然猖獗。当然，他们的控制应该很简单。保持医院清洁！确保员工洗手！马上把感染这些病毒的人隔离起来！然而，事实证明，正是这最后一种干预——孤立——才如此困难。感染控制人员经常抱怨缺乏有效的隔离设施。管理人员表示，他们负担不起提供更多的隔离床，特别是在没有来自适当试验的良好证据证明这种方法有效的情况下。这项研究将深入了解提供有效隔离的困难。它将通过全国协商和与25-30个信托机构的密集合作，帮助信托机构在组织和个人层面消除实现有效隔离的障碍。这将帮助他们想出如何提供隔离设施并充分利用这些设施的想法。信托公司能够设计出他们认为最有可能奏效的隔离政策吗？试驾吗?这些都在初步试验中，然后可以推广到更多的医院，以找到通过隔离减少MRSA和艰难梭菌的最佳方法。I-STRAT试验的两位首席研究员巴里·库克森（Barry Cookson）和谢尔登·斯通（Sheldon Stone）说：世界上没有任何地方研究过如何最好地使隔离发挥作用。部分原因是要进行适当的试验有很多困难。人们认为隔离可能很昂贵，或者很难提供指定的工作人员。甚至没有人确切知道哪些病人应该被隔离，或者我们应该如何衡量成功。这项研究将解决这些问题，与信托基金密切合作，帮助他们提出自己的干预措施，设计一个可行的“迷你试验”。如果这看起来可行，那么我们就可以进行全面的试验，这可能会为我们提供一些关于隔离在对抗这些所谓的“超级细菌”中的作用的明确答案。

What do most people fear about coming into hospital? Catching a superbug infection such as MRSA or Clostridium difficile! Despite a tranche of Government initiatives to reduce these, they appear rampant. Surely their control should be simple. Keep the hospitals clean! Make sure staff clean their hands! Put people with these infections into isolation straight away! However, it is this last intervention , isolation, that proves so difficult. Infection Control staff often bemoan the lack of effective isolation facilities. Managers say they cannot afford to make more isolation beds available, especially as there is no good evidence from a proper trial to prove this works. This study will get to the bottom of the difficulties in providing effective isolation. It will help Trusts, through a nationwide consultation, and intensive work with 25-30 trusts, to work out the barriers, at organizational and individual levels, to effective isolation. It will help them come up with ideas of how to make isolation facilities available and make the most of those facilities that they have. Trusts will be able to design the isolation policies they think most likely to work, a small number will ?test drive? these in a preliminary trial that can then be rolled out to a larger number of hospitals, to find the best way to reduce MRSA and Clostridium difficile through isolation.The two lead researchers in the I-STRAT trial, Barry Cookson and Sheldon Stone, say ?Nowhere in the world has looked at how best to make isolation work. Part of the reason for that is that there are so many difficulties in running a proper trial of this. People think that isolation may be expensive, or that is it hard to provide designated staff. No one is even sure exactly which patients should be isolated, or how we should measure success. This study is going to address these issues, working closely with Trusts, to help them come up with their own interventions to design a feasible ?mini-trial?. If that looks practical, then we could move to a full scale trial which might provide us with some definite answers about the role of isolation in fighting these so-called ?superbugs?