Gown and Glove Use to Prevent the Spread of Infection in VA Community Living Cent

描述(由申请人提供)： 耐甲氧西林金黄色葡萄球菌(MRSA)感染是退伍军人发病和死亡的主要原因。耐甲氧西林金黄色葡萄球菌在医疗保健环境中通过直接或间接接触传播。在急性护理环境中，我们对感染MRSA的患者采取接触预防措施(医护人员[HCW]对所有患者接触都穿长袍和戴手套)，以防止传播给其他患者。目前疾病控制和预防中心(CDC)的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这些预防措施。这项修订提案的目标是确定LTCF接触预防措施的最佳修改，以降低MRSA传播的风险，并允许在与社区生活中心文化转型一致的家庭式、以患者为中心的环境中进行护理。长期护理中心提供多层次的护理，包括康复、熟练护理和维护护理。在PI目前的VA优秀奖中，我们证明了康复护理中MRSA的传播率是其他长期护理中的四倍。这表明，提供的护理类型增加了传播的风险。MRSA向其他居民的传播很难研究。最近，我们开发了一种新的MRSA传播替代方法，即在HCW与患者互动过程中检测HCW长袍和手套上的MRSA。使用这一新方法，我们将根据疾控中心隔离指南中的专家意见建议，测试两个主要假设。1.感染耐甲氧西林金黄色葡萄球菌的风险因与居民接触的类型而异，每项活动都有其自身的传播风险。一些活动，如与分泌物接触的活动(如引流伤口、造口护理)将比其他活动(如生命体征、用药)风险更高。2.对于任何特定类型的接触，居民的特征增加了传播的风险(例如，完全依赖保健人员提供医疗保健和日常生活活动的居民，或其分泌物或排泄物无法控制的居民)。我们的目标是在来自四个州和哥伦比亚特区的退伍军人社区生活中心进行的一项多地点观察研究中，估计MRSA传播到HCW佩戴的防护服和手套的频率和风险因素，并与400名MRSA定居的退伍军人长期护理居民进行互动。

DESCRIPTION (provided by applicant): Methicillin-resistant S. aureus (MRSA) infections are a major cause of morbidity and mortality in veterans. 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 revised proposal is to determine the optimal modifications of Contact Precautions for LTCF in order reduce the risk of MRSA transmission and allow care in a home-like, patient-centered environment consistent the Community Living Centers Cultural Transformation. LTCFs provide multiple levels of care including rehabilitation, skilled nursing and maintenance care. In the PI's current VA Merit award, we demonstrated that MRSA transmission is four-fold higher in rehabilitation care than in other long term care. This suggests that the types of care delivered increase the risk of transmission. MRSA transmission to other residents is difficult to study. 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 two major hypotheses based on expert opinion recommendations from the CDC Isolation Guidelines. 1. Risk of MRSA transmission will vary by type of contact with the resident and each activity will have its own risk of transmission. Some activities such as those involving contact with secretions (e.g. draining wounds, ostomy care) will be of higher risk than others (e.g. vital signs, medication administration). 2. For any given type of contact, resident characteristics increases the risk of transmission (e.g. residents totally dependent upon healthcare personnel for healthcare and activities of daily living or residents whose secretions or drainage cannot be contained). Our aim is to estimate the frequency of and risk factors for MRSA transmission to protective gowns and gloves worn by HCW interacting with 400 MRSA colonized VA long term care residents in a multi-site observational study in VA Community Living Centers from four states and the District of Columbia.