Health Information Technology to Reduce Healthcare-Associated Infections: HIT-HAI

描述（由申请人提供）：在国家护理研究所的资助下（抗菌素耐药感染的成本分布，R 01 NR 010822），我们开发了一个数据库，其中包含2006- 2008年来自四家城市（曼哈顿）医院的> 319，000例患者出院。该数据库已被用于回答有关医疗相关感染（HAI）的各种临床问题，但继续是有用的和相关的;我们已经扩展并整合了该数据库，作为一个有针对性的研究数据注册到一个大型医疗保健系统的临床数据仓库。这些数据将继续得到更新和维持，以便能够跟踪多年来的趋势。本次竞争性更新的具体目标是对2006-2012年的数据进行三项比较有效性研究（CER），以：（1）使用传输可视化技术评估遵守基于传输的隔离预防措施在急性护理环境中预防感染传播的有效性;（2）检查护理组织因素（例如，人员配备、技能组合、周转率）对住院患者HAI发生率和类型的影响;以及（3）比较重症监护室（ICU）中普遍接触预防措施与标准实践在降低多重耐药微生物（MDRO）和艰难梭菌引起的获得和感染率方面的有效性。此外，作为我们数据共享计划的一部分，我们建议制定和/或采用以下政策和程序：数据贡献者和用户协议以及数据管理政策（首先使用权、机构和数据保密性和保护、研究质量、数据管理的监测和完整性），这将有助于新兴的数据治理科学。然后，我们将向其他CER项目的研究人员更广泛地提供注册表，以评估减少HAI的实践。

DESCRIPTION (provided by applicant): With funding from the National Institute of Nursing Research (Distribution of the Costs of Antimicrobial Resistant Infections, R01 NR010822), we have developed a database of >319,000 patient discharges from four urban (Manhattan) hospitals for the years 2006-8. This database has been used to answer a variety of clinical questions regarding healthcare-associated infections (HAI), but to continue to be useful and relevant; we have expanded and integrated the database as a targeted research data registry into the Clinical Data Warehouse of a large health care system. The data will continue to be updated and sustained so that trends over years can be tracked. Specific aims of this competitive renewal are to conduct three comparative effectiveness research (CER) studies on data from 2006-2012 to: (1) evaluate the effectiveness of adherence to transmission-based isolation precautions for preventing the spread of infections in acute care settings using transmission visualization techniques; (2) examine the impact of nursing organizational factors (e.g., staffing, skill mix, turnover) on rates and types of HAI among hospitalized patients; and (3 compare the effectiveness of universal contact precautions with standard practice in intensive care units (ICUs) to reduce rates of acquisition and infection caused by multidrug-resistant organisms (MDROs) and Clostridium difficile. In addition, as part of our Data Sharing Plan we propose to develop and/or adopt the following policies and procedures: data contributor and user agreements and data stewardship policies (right of first use, institutional and data confidentiality and protection, quality of the research, monitoring and integrity of data management) which will contribute to the burgeoning science of data governance. We will then make the registry more widely available to researchers for other CER project to assess practices to reduce HAI.