Modifying Contact Precautions for MRSA in Extended Care

耐甲氧西林金黄色葡萄球菌(MRSA)是一种条件致病菌，也是引起肺炎的重要原因。 医疗保健相关感染。耐甲氧西林金黄色葡萄球菌通过直接或间接接触传播 医疗保健设置。在急性护理环境中，我们使用接触预防措施(卫生保健工作者[HCW] 所有与患者接触的人都要穿长袍和戴手套)，以防止感染MRSA的患者 传染给其他病人。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 指导如何修改它们的证据。该项目的目标是开发一种干预措施，以 在基于社区的长期合作伙伴关系中最大限度地减少MRSA的传播。我们将确定最优的修改 为减少耐甲氧西林金黄色葡萄球菌传播的风险并允许在 像家一样，以病人为中心的环境。长期护理中心提供多层次的护理，包括 康复护理、熟练护理和维持护理。在PI目前的VA功勋奖中，我们 证明在康复护理中MRSA的传播率是维持治疗中的四倍 关心。这表明，提供的护理类型改变了传播的风险。最近我们 开发了一种新的MRSA传播替代方法，检测HCW礼服上的MRSA HCW与患者互动过程中的手套。使用这种新的方法，我们将检验这样的假设 MRSA的传播将因接触类型(如导尿管或引流护理)而显著不同 以社区为基础的长期护理设施。我们的首要目标是估计疾病发生的频率和风险 耐甲氧西林金黄色葡萄球菌传播至防护服的影响因素 LTC居民使用观察性研究。我们的第二个目标是估计 耐甲氧西林金黄色葡萄球菌感染人群穿防护服与耐甲氧西林金黄色葡萄球菌感染 住院医师在康复护理、技能型护理和维持性护理方面的评价不同 使用数学模型修改长期护理机构中的接触预防措施。我们的第三个 目的是估计这些不同修改的成本，以使用活动- 基于成本的计算。我们建议的研究结果将提高以社区为基础的护理质量 LTCF通过提供何时需要防护服的证据。

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.