From Functional Disability to Antimicrobial Resistance in Nursing Home Residents

疗养院居民从功能障碍到抗菌素耐药性

• 批准号: 8498737
• 负责人: Lona Mody
• 金额: $ 36.93万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-15 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8498737
• 关键词: Activities of Daily Living; Antibiotic-resistant organism; Antimicrobial Resistance; Area; Bathing; Caregivers; Categories; Chlorhexidine; Clinical; Control Groups; Cross-Sectional Studies; Data; Diarrhea; Disabled Persons; Discipline of Nursing; Dose; Education; Effectiveness; Elderly; Elements; Environment; Environmental Pollution; Epidemiologic Studies; Family; Feedback; Hand; Health; Health Care Costs; Health Personnel; Hospitals; Hygiene; Impairment; Infection Control; Infection Control Practitioners; Infection prevention; Intervention; Lead; Leadership; Modeling; Molecular; Molecular Profiling; Nursing Homes; Organism; Pathway interactions; Pattern; Prevalence; Prevention program; Prevention strategy; Prospective Studies; Protocols documentation; Quality of life; Randomized; Recreation; Rehabilitation therapy; Research; Research Design; Resources; Risk; Risk Factors; Role; Stratification; Surface; Testing; Time; Work; base; cost shifting; design; disability; disability burden; environmental intervention; functional disability; group intervention; high risk; implantable device; innovation; microbial; multi-component intervention; prevent; primary outcome; programs; prospective; response; translational study; transmission process

DESCRIPTION (provided by applicant): Antimicrobial-resistant organisms (AROs) are endemic in nursing homes (NH) with prevalence rates surpassing those in hospitals. The basic question of interaction between a disabled host, institutional environment, and caregiver contact in ARO acquisition (and transmission) remains unanswered. We hypothesize that specific activities of daily living (ADL) disability patterns in NH residents will predict acquisition risk or new AROs. We will examine whether disability and risk of acquisition are proportional to healthcare worker contact time and contact intensity. Our proposed Specific Aims are: Aim 1: Develop and examine a risk-stratification model utilizing resident-, HCW-, and environmental-level factors to identify three categories of NH residents: (1) never acquire an ARO; (2) intermittently acquire an ARO; and (3) newly acquire an ARO and remain persistently colonized. Resident-level factors include incremental levels and specific patterns of ADL impairment, presence of wounds, and use of indwelling devices. HCW factors include contact time and intensity, as well as varying levels of nursing resource utilization. The environment factors include presence of AROs on inanimate objects in resident rooms, common areas, and rehabilitation rooms. We will also establish a "molecular fingerprint" between the strains of AROs colonizing functionally-impaired residents and those isolated from their environment and the hands of caregivers. Using this risk-stratification model, we will establish the optimal ARO prevention strategy in highest-risk functionally-disabled NH residents. Aim 2: Design and evaluate the effectiveness of a multi-component intervention to reduce new acquisition of AROs in the highest-risk functionally-disabled NH residents. This intervention will incorporate resident level, environmental, and caregiver-based strategies. The proposed translational study is innovative and timely because it will develop a risk-stratification model to identify functionally-disabled NH residents who are most likely, if colonized, to transmit AROs; define a molecular "fingerprint" of resident-caregiver-environment ARO contamination; and design and implement a multi-component comprehensive intervention targeting high-risk functionally-disabled residents. The impact of this research will be an effective, efficient, and infection prevention program for NHs to limit ARO acquisition and more importantly transmission. We expect our results to have widespread application in NHs, enhance residents' quality of life, reduce hospital transfers, reduce healthcare costs and shift the evolving paradigm of infection control and prevention in NHs.

描述(由申请人提供)：抗菌素耐药菌(ARO)在疗养院(NH)流行，患病率超过医院。在ARO获得(和传播)过程中，残疾宿主、机构环境和照顾者接触之间的相互作用这一基本问题仍然没有得到回答。我们假设NH居民特定的日常生活能力(ADL)残疾模式将预测获得性风险或新的ARO。我们将研究残疾和感染风险是否与医护人员接触时间和接触强度成正比。我们提出的具体目标是：目标1：利用居民、人口数和环境水平的因素建立和检验风险分层模型，以识别三类NH居民：(1)从未获得ARO；(2)间歇性获得ARO；(3)新获得ARO并持续定居。居民水平的因素包括ADL损害的递增水平和具体模式、伤口的存在和留置装置的使用。HCW因素包括接触时间和强度，以及不同程度的护理资源利用。环境因素包括在居室、公共区域和康复室的无生命物体上存在ARO。我们还将在居住在功能受损居民手中的ARO菌株与那些从他们的环境和照顾者手中分离出来的菌株之间建立“分子指纹”。利用这个风险分层模型，我们将在高危功能性残疾的NH居民中建立最优的ARO预防策略。目的2：设计和评估多组分干预措施的有效性，以减少高风险、功能性残疾的NH居民的ARO新获得性。这项干预将包括居民 基于层次、环境和照顾者的策略。拟议的翻译研究具有创新性和及时性，因为它将开发一个风险分层模型，以确定如果被殖民，最有可能传播ARO的NH功能残疾居民；定义居民-照顾者-环境ARO污染的分子“指纹”；并设计和实施针对高危功能性残疾居民的多成分综合干预。这项研究的影响将是NHS有效、高效和感染预防计划，以限制ARO的获得，更重要的是传播。我们希望我们的成果在NHS中得到广泛应用，提高居民的生活质量，减少医院转院，降低医疗成本，并改变NHS不断发展的感染控制和预防模式。