Modifying Contact Precautions for MRSA in Extended Care

修改长期护理中针对 MRSA 的接触预防措施

• 批准号: 8151625
• 负责人: Mary-Claire Roghmann
• 金额: $ 49.42万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8151625
• 关键词: Modifying; Contact; Precautions; MRSA; Extended

DESCRIPTION (provided by applicant): Methicillin-resistant S. aureus (MRSA) is an opportunistic pathogen and an important cause of healthcare-associated infections. MRSA is transmitted through direct or indirect contact in the healthcare setting. In acute care settings, we use Contact Precautions (health care workers [HCW] wear gowns and gloves for all patient contact) for patients colonized with MRSA to prevent transmission to other patients. Current Centers for Disease Control and Prevention (CDC) Isolation Guidelines suggest modifying Contact Precautions in long term care facilities (LTCF), but there is little evidence to guide how to modify them. The goal of this project is to develop an intervention to minimize MRSA transmission in community-based LTCF. We will determine the optimal modifications of Contact Precautions for LTCF in order to reduce the risk of MRSA transmission and allow care in a home-like, patient-centered environment. LTCFs provide multiple levels of care including rehabilitation care, skilled nursing care and maintenance care. In the PI's current VA Merit award, we demonstrated that MRSA transmission is four fold higher in rehabilitation care than maintenance care. This suggests that the types of care delivered modify the risk of transmission. Recently we developed a novel surrogate measure of MRSA transmission, detection of MRSA on HCW gown and gloves during HCW-patient interaction. Using this new methodology, we will test the hypothesis that MRSA transmission will vary significantly by type of contact (e.g. catheter or drain care) in community-based long term care facilities. Our first aim is to estimate the frequency of and risk factors for MRSA transmission to protective gowns worn by HCW interacting with MRSA colonized LTC residents using an observational study. Our second aim is to estimate the cumulative risk of MRSA transmission to protective gowns worn by HCW interacting with MRSA colonized LTC residents in rehabilitation care, skilled nursing care and maintenance care to assess different modifications to Contact Precautions in long term care facilities using mathematical models. Our third aim is to estimate the costs of these different modifications to Contact Precautions using activity-based costing. The results of our proposed study will improve the quality of care in community-based LTCF by providing evidence for when protective gowns are needed. PUBLIC HEALTH RELEVANCE: Methicillin-resistant S. aureus (MRSA) is an important cause of healthcare-associated infections. These are infections that patients acquire during the course of receiving treatment for other conditions within the health care system. Preventing MRSA transmission and infections is an important quality of care goal for healthcare systems. MRSA colonization is more common in long term care facilities than in acute care hospitals; however, the optimal infection control precautions to prevent MRSA transmission in long term care facilities are unknown. The goal of this project is to develop an intervention which minimizes MRSA transmission in LTCF and allows care in a home-like, patient-centered environment.

性状（由申请人提供）：耐甲氧西林S.金黄色葡萄球菌（MRSA）是一种机会性病原体，是医疗相关感染的重要原因。MRSA通过医疗环境中的直接或间接接触传播。在急性护理环境中，我们对MRSA定植患者使用接触预防措施（卫生保健工作者[HCW]在所有患者接触中穿戴长袍和手套），以防止传播给其他患者。目前的疾病控制和预防中心（CDC）隔离指南建议修改长期护理机构（LTCF）的接触预防措施，但几乎没有证据指导如何修改它们。本项目的目标是开发一种干预措施，以尽量减少MRSA在社区LTCF中的传播。我们将确定LTCF接触预防措施的最佳修改，以降低MRSA传播的风险，并允许在家庭式，以患者为中心的环境中进行护理。LTCF提供多层次的护理，包括康复护理、专业护理和维护护理。在PI目前的VA优异奖中，我们证明了康复护理中的MRSA传播是维持护理的四倍。这表明所提供的护理类型改变了传播风险。最近，我们开发了一种新的替代措施的MRSA传播，检测MRSA的HCW长袍和手套在HCW患者互动。使用这种新的方法，我们将测试的假设，MRSA的传播将显着不同类型的接触（如导管或排水管护理）在社区为基础的长期护理设施。我们的第一个目的是估计频率和风险因素的MRSA传播到防护服穿HCW与MRSA定植的LTC居民使用观察性研究。我们的第二个目的是估计MRSA传播到HCW与MRSA定植的LTC居民在康复护理，专业护理和维护护理中相互作用所穿的防护服的累积风险，以评估长期护理设施中使用数学模型对接触预防措施的不同修改。我们的第三个目标是使用基于作业的成本法来估计这些不同的接触预防措施的修改成本。我们提出的研究结果将通过提供何时需要防护服的证据来提高以社区为基础的LTCF的护理质量。 公共卫生相关性：耐甲氧西林S.金黄色葡萄球菌（MRSA）是医疗保健相关感染的重要原因。这些是患者在医疗保健系统内接受其他疾病治疗期间获得的感染。预防MRSA传播和感染是医疗保健系统的重要护理质量目标。MRSA定植在长期护理机构中比在急性护理医院中更常见;然而，在长期护理机构中预防MRSA传播的最佳感染控制预防措施尚不清楚。该项目的目标是开发一种干预措施，最大限度地减少LTCF中的MRSA传播，并允许在家庭式，以患者为中心的环境中进行护理。