Applying Human Factors and Mathematical Modeling Approaches to Prevent Transmission of High-Consequence Pathogens

 描述(由申请人提供)：本提案的目的是将基础、流行病学和技术发现转化为新的战略，以防止与医疗保健相关的埃博拉病毒和其他高后果病原体的传播。与医疗保健相关的高后果病原体的传播，如埃博拉病毒、SARS冠状病毒、MERS冠状病毒、新型呼吸道病原体、多药耐药细菌和艰难梭菌，对患者、家庭和医护人员(HCW)构成重大风险，导致 发病率和死亡率，以及大幅增加的医疗成本。最近有关埃博拉病毒的经验表明，目前的感染预防战略可能不足以防止高后果病原体在医疗保健环境中的传播。利用我们广泛的经验和专业知识以及我们成功合作的历史，我们提出了一个多方面的创新框架，整合了感染预防、人为因素工程和数学建模方法，以解决当前感染预防方法中的知识缺口，并开发新的干预措施，以防止高后果病原体在医疗保健环境中的传播。我们假设：1)通过阐明HCW自身污染的风险因素并设计有效的风险缓解策略来防止HCW自身污染事件，可以防止HCW在脱下个人防护装备(PPE)时的自身污染；2)通过阐明环境服务(EVS)工作人员培训、沟通、培养和流程中的特定风险因素并设计有效的干预措施来优化环境清洁和消毒，可以有效防止来自环境来源的病原体传播；3)数学建模将提高对医疗保健环境中耐碳青霉烯类肠杆菌(CRE)的耐药性机制如何影响传播途径的理解，以及接触预防CRE传播的有效性。我们将应用人的因素和数学模型(T0)方法来收集关于在HCW PPE道夫过程中导致病原体传播的风险因素和潜在故障模式的数据，EVS环境的清洁和消毒，以及对定居或感染CRE的患者的护理。然后，我们将使用识别的风险因素和流行病学传播数据来制定(T1)、实施(T2)和评估大型三级保健医院内和整个医院卫生系统的新战略(T3)。除了我们在感染预防监测、干预试验和抗菌素管理方面的专业知识外，在这项提案中，我们还展示了我们整合不同科学学科并引入基于证据的风险缓解策略的新应用以扩大感染预防科学的能力。这项建议的结果将为疾控中心为前线卫生工作者提供指导意见，提供简明实用的循证建议，以防止病原体传播，以减少对患者和医护人员的伤害。

 DESCRIPTION (provided by applicant): The purpose of this proposal is to translate basic, epidemiologic, and technologic discoveries into new strategies to prevent healthcare-associated transmission of Ebola and other high-consequence pathogens. Healthcare-associated transmission of high-consequence pathogens such as the Ebola virus, SARS coronavirus, MERS coronavirus, novel respiratory pathogens, multidrug resistant bacteria, and Clostridium difficile poses a significant risk to patients, families, and healthcare workers (HCWs), leading to morbidity and mortality and dramatically increased healthcare costs. Recent experience with Ebola has shown that current infection prevention strategies may be inadequate to prevent transmission of high-consequence pathogens in healthcare settings. Using our broad experience and expertise and our history of successful collaboration, we propose a multifaceted and innovative framework integrating infection prevention, human factors engineering, and mathematical modeling approaches to address knowledge gaps in current infection prevention methods and to develop new interventions to prevent the transmission of high-consequence pathogens in healthcare settings. We hypothesize that: 1) self-contamination of HCW while doffing personal protective equipment (PPE) can be prevented by elucidating risk factors for HCW self-contamination and designing effective risk mitigation strategies to prevent HCW self-contamination events, 2) pathogen transmission from environmental sources can be effectively prevented by elucidating specific risk factors in environmental service (EVS) worker training, communication, culture and processes and designing effective interventions to optimize environmental cleaning and disinfection, 3) mathematical modeling will improve understanding of how resistance mechanisms impact transmission routes of carbapenem-resistant Enterobacteriaciae (CRE) in healthcare settings and the effectiveness of contact precautions for the prevention of CRE transmission. We will apply human factors and mathematical modeling (T0) approaches to gather data on risk factors and potential failure modes that contribute to pathogen transmission during HCW PPE doffing, EVS cleaning and disinfection of the environment, and the care of patients who are colonized or infected with CRE. We will then use the identified risk factors and epidemiologic transmission data to develop (T1), implement (T2) and assess new strategies within a large tertiary care hospital and across a health system of hospitals (T3). In addition to our expertise in infection prevention surveillance, intervention trils, and antimicrobial stewardship, in this proposal we demonstrate our capacity to integrate distinct scientific disciplines and introduce novel applications of evidence-based risk mitigation strategies to expand the science of infection prevention. The findings from this proposal will inform CDC guidance for frontline HCWs by providing concise and practical, evidence-based recommendations to prevent pathogen transmission in order to reduce harm to patients and healthcare workers.