"Improving Practice: Automated Compliance Monitoring in Infection Control"

“改进实践：感染控制中的自动合规性监控”

• 批准号: 7891275
• 负责人: Eli N Perencevich
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-01-01 至 2012-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7891275
• 关键词: Acute; Adherence; Alcohols; Antibiotic Resistance; Bacteria; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Cohort Studies; Commit; Contracts; Control Groups; Cross-Over Studies; Cross-Sectional Studies; Data; Disease Outbreaks; Economics; Effectiveness; Elements; Experimental Designs; Failure; Feedback; Frequencies; Future; General Ward; Genetic Crossing Over; Goals; Guidelines; Hand; Handwashing; Health Personnel; Healthcare; Hospital Units; Hospitals; Hour; Human; Human Resources; Hygiene; Infection; Infection Control; Intensive Care Units; Intervention; Link; Measures; Methods; Modeling; Monitor; Morbidity - disease rate; Multi-Drug Resistance; Nurses; Nursing Staff; Patients; Patients' Rooms; Persons; Prevalence; Process; Process Measure; Psychological reinforcement; Research; Resources; Risk; Risk Factors; Safety; Source; Staff Work Load; Time; Time Series Analysis; United States; Veterans; base; cost; cost effective; drug resistant bacteria; efficacy testing; health care delivery; high risk; improved; methicillin resistant Staphylococcus aureus; mortality; patient safety; prevent; shift work; tool; transmission process; ward

Title: Improving Practice: Automated Compliance Monitoring in Infection Control Anticipated Impacts on Veteran's Healthcare: Methicillin-resistant Staphylococcus aureus (MRSA) is an antibiotic-resistant bacterium that is associated with 94,000 invasive infections and 18,000 deaths annually in the United States. Since March 15, 2007 a National VA MRSA Initiative (VHA Directive 2007-002) has required all VA hospitals to screen for and isolate patients colonized with MRSA by placing them on contact precautions. The Initiative's aim is to reduce MRSA infections and related mortality by preventing MRSA from spreading from patient-to-patient in VA hospitals. This project seeks to improve the effectiveness of the MRSA Initiative by improving healthcare worker compliance with infection control best practice (hand washing and wearing gloves/gowns) and thus reduce the spread of MRSA in VA Hospitals. Project Background: The VA MRSA Initiative's potential to reduce MRSA infections will only be realized if healthcare workers are compliant with hand hygiene and contact precautions (wearing gown and glove by healthcare workers each time they enter a patient's room). Thus, if healthcare workers do not wash their hands and wear gloves/gowns when they see patients, the very expensive MRSA Initiative may be ineffective. Two factors are known to improve compliance with infection control practice: 1) Continuous monitoring of compliance and 2) Direct feedback of compliance rates to healthcare workers with a goal to get compliance up to 100%. However, direct observation of hand hygiene and glove wearing is labor intensive, expensive and rarely occurs during night shifts. Project Objectives: The objectives of this study are: (1) Develop and validate an automated method for compliance monitoring of infection control practice including hand hygiene and contact precautions. The automated method uses monthly supply-chain delivery of bottles of alcohol-based hand rub and gloves. (2) Provide sustained feedback of automated monthly supply delivery counts of alcohol-based hand rub and gloves to specific hospital wards and demonstrate improved compliance with actual directly observed compliance and reduced MRSA infections. Project Methods: This proposal contains two distinct studies. The first study that will develop and validate supply chain delivery of alcohol-based hand rub and glove use as a viable estimate of the related actual infection control compliance measure will utilize an observational cohort study, while controlling for potential confounders. The second study will test the efficacy of sustained feedback of automated monthly supply delivery counts of alcohol-based hand rub and gloves in improving compliance and reducing MRSA infections in 6 hospital intensive care units in 3 VA acute care hospitals using an interrupted time-series analysis quasi-experimental design with non-equivalent control groups.

标题：改进实践：感染控制中的自动遵从性监测 对退伍军人医疗保健的预期影响：耐甲氧西林金黄色葡萄球菌(MRSA)是一种 抗生素耐药细菌，每年与94,000例侵袭性感染和18,000例死亡有关 在美国。自2007年3月15日以来，一项国家退伍军人管理局MRSA倡议(VHA指令2007-002) 要求所有退伍军人医院筛查和隔离感染MRSA的患者，使他们与患者接触 预防措施。该倡议的目的是通过预防耐甲氧西林金黄色葡萄球菌减少耐甲氧西林金黄色葡萄球菌感染和相关死亡率 在退伍军人医院的病人之间传播。这一项目旨在提高 通过提高医护人员对感染控制最佳实践的遵从性，实施MRSA倡议(HAND 洗涤和戴手套/长袍)，从而减少MRSA在退伍军人医院的传播。 项目背景：退伍军人管理局MRSA倡议减少MRSA感染的潜力只有在以下情况下才能实现 医护人员遵守手部卫生和接触预防措施(穿着长袍和手套 医护人员每次进入病人的房间时)。因此，如果医护人员不清洗他们的 当他们看病人时，手和手套/长袍，非常昂贵的MRSA倡议可能是 效果不佳。已知有两个因素可以改善感染控制实践的遵从性：1)持续 监测合规性和2)直接向医护人员反馈合规率，目标是 使合规性达到100%。然而，直接观察手部卫生和戴手套是一种劳动。 强度大、费用高，而且很少在夜班期间发生。 项目目标：本研究的目标是：(1)开发和验证自动化方法 感染控制措施的遵守情况监测，包括手卫生和接触预防措施。这个 自动化方法使用供应链每月交付的含酒精的洗手液和手套。(2) 持续反馈酒精类洗手液的每月自动供货数量和 为特定的医院病房配戴手套，并证明符合实际情况 遵从性和减少MRSA感染。 项目方法：本提案包含两项截然不同的研究。将开发和验证的第一项研究 基于酒精的手摩擦和手套使用的供应链交付作为相关实际使用的可行估计 感染控制遵从性措施将利用观察性队列研究，同时控制潜在的 混血儿。第二项研究将测试每月自动供应的持续反馈的有效性 提高依从性和降低耐甲氧西林金黄色葡萄球菌的酒精手擦和手套的交付次数 用中断时间序列分析3所退伍军人医院的6个重症监护室的感染情况 分析非等价对照组的准实验设计。