Keep It Clean for Kids: The KICK Project

描述（由申请人提供）：为儿童保持清洁：KICK项目医疗保健相关感染（HAI）是长期护理机构（LTCF）发病率和死亡率的主要原因，每年造成近40万人死亡。儿科LTCF中的儿童是一个高度脆弱的患者人群，患有多种并发症，具有感染由多重耐药微生物以及病毒病原体引起的HAI的高风险。虽然这类感染一直是主流媒体关注的焦点，但很少有实证研究来预防LTCF中的HAI，特别是在儿科LTCF中。本研究的目的是通过改善患者安全环境和感染预防实践来减少儿科LTCF中的HAI。 本研究的具体目的是：1. 描述儿科长期护理机构中与医疗保健相关的细菌和病毒感染的发生率和类型; 2.评估基于理论的群体水平行为干预对儿科长期护理机构HAI发生率的影响（主要结局）; 3.测量基于理论的群体水平行为干预对爆发次数、患者抗菌药物使用、患者住院、工作人员缺勤（次要临床结局）的影响;以及4.使用创新的自动化监测和反馈系统来提供实时反馈，以及患者安全环境（次级过程结果），检查基于理论的组级行为干预对手部卫生频率的影响。 纽约大都会区的三家儿科长期护理机构（284张床位）将被纳入多学科干预措施，即以世卫组织干预措施、可操作的反馈模式和急性护理成功计划为模型的“为儿童保持清洁”（KICK）项目。KICK项目包括五个关键组成部分：明确的领导承诺、工作人员的积极参与、进行工作流程评估、对工作人员进行世卫组织“手部卫生五个时刻”的培训以及手部卫生的电子监测和反馈。由临床和行政领导组成的KICK团队将计划和实施变更。将对主要结局（HAI发生率）和次要结局进行中断时间序列分析。 公共卫生相关性：接受儿科长期护理的儿童占儿童总体医疗支出的40%，是一个脆弱的患者群体，他们面临着感染由多重耐药微生物和病毒病原体引起的医疗保健相关感染的高风险。尽管如此，对预防这一群体感染的关注很少。这项研究将是第一个提供有关利率和 这些儿童的感染类型，并测试一种可推广到多个慢性病护理设施的干预措施，以减少流行病和地方病感染。

DESCRIPTION (provided by applicant): Keep It Clean for Kids: The KICK Project Healthcare-associated infections (HAIs) are the leading cause of morbidity and mortality in long term care facilities (LTCF) and are responsible for nearly 400,000 deaths each year in this population. Children in pediatric LTCF represent a highly vulnerable patient population with numerous co morbid conditions at high risk of contracting HAIs caused by multidrug-resistant organisms as well as by viral pathogens. Although such infections have been the focus of mainstream media attention, little empirical research has been conducted to prevent HAIs in LTCF, particularly in pediatric LTCF. The goal of this study is to reduce HAIs in pediatric LTCF by improving the patient safety climate and infection prevention practices. Specific aims of this study are to: 1. Describe the rates and types of healthcare-associated bacterial and viral infections in pediatric long term care facilities; 2. Assess the impact of a theoretically-based group-level behavioral intervention on rates of HAIs in pediatric long term care facilities (primary outcome); 3. Measure the impact of a theoretically-based group-level behavioral intervention on the number of outbreaks, antimicrobial utilization in patients, hospitalizations of patients, staff absenteeis (secondary clinical outcomes); and 4. Examine the impact of a theoretically-based group-level behavioral intervention on hand hygiene frequency using an innovative automated monitoring and feedback system to provide real-time feedback, and patient safety climate (secondary process outcomes). Three pediatric long term care facilities (284 beds) in the greater NYC metropolitan area will be included in a multi-disciplinary intervention, Keep It Clean for Kids (KICK) Project, modeled after the WHO interventions, the actionable feedback model, and a successful program from acute care. The KICK Project includes five key components: explicit leadership commitment, active participation of the staff, conducting work flow assessments, staff training in the WHO '5 Moments for Hand Hygiene' and electronic monitoring and feedback of hand hygiene. KICK teams comprised of clinical and administrative leaders will plan and implement changes. An interrupted time series analyses of the primary outcome (rates of HAIs) and secondary outcomes will be conducted. PUBLIC HEALTH RELEVANCE: Children in pediatric long term care account for 40% of all medical expenditures for children overall and represent a vulnerable patient population at high risk of contracting healthcare-associated infections caused by multidrug-resistant organisms and viral pathogens. Despite this, there has been minimal attention to the prevention of infections in this group. This study will be the first to provide vital information about rates and types of infections in these children and to test an intervention that will be generalizable to multiple chronic care facilities to reduce epidemic and endemic infections.