Epicenters for the Prevention of Healthcare Associated Infections (HAI) - Cycle II

 描述(由申请人提供)：医疗保健相关感染(HAIs)增加了患者的发病率和死亡率。细菌和病毒的传播是一个需要进一步研究的领域。我们集团在医疗保健相关感染领域有160多份出版物，其中40多份出版物的应用重点是传染病病原体的传播和确定提高个人防护装备有效性的新策略。我们已经将大量的T0结果转化为T2研究，以防止传染性病原体的传播。我们有开发和实施跨医疗保健领域的多点研究的经验。我们已经获得了CDC、NIH、VA和AHRQ资助的超过16笔赠款，用于研究防止细菌病原体传播的最佳方法。我们已经成功地在32个州的50多个机构中进行了9项多中心研究。我们还有一个与马里兰州卫生局合作的项目，由我们牵头，涉及40个机构，包括30个急性护理机构和10个长期护理机构。 因此，我们相信我们完全有资格被选为CDC预防医疗相关感染中心的成员。我们的目标直接针对资金公告；它们是：目标1：进行一项多地点重症监护病房(ICU)队列研究，以确定哪些患者风险因素，包括疾病的共病条件和严重程度，以及哪些医护人员与患者的互动导致碳青霉烯耐药肠杆菌科(CRE)和耐甲氧西林金黄色葡萄球菌(MRSA)的更大传播。目的2：利用两个州社区疗养院现有的居民队列，估计耐药革兰氏阴性菌的总体传播风险，以及哪些患者风险因素和医疗保健活动导致更大的传播。目的3：进行一项随机的非自卑试验，以确定在一次患者就诊期间出现手卫生迹象时，使用基于酒精的手部按摩来“清洁”戴手套的手是否与目前建议的更换手套一样有效。目的4：在实验室环境下评估个人防护装备(PPE)在使用抗生素耐药细菌和类似埃博拉和流感病毒后净化的有效性。

 DESCRIPTION (provided by applicant): Healthcare-associated infections (HAIs) increase patient morbidity and mortality. The transmission of bacteria and viruses is an area that needs further study. Our group has over 160 publications in the area of healthcare-associated infections, with over 40 publications in the application focus of transmission of infectious pathogens and identification of novel strategies to improve the effectiveness of personal protective equipment. We have translated numerous T0 results into T2 studies to prevent transmission of infectious pathogens. We have experience developing and implementing multi-site studies across the spectrum of healthcare. We have had over 16 grants funded by CDC, NIH, VA and AHRQ to study optimal methods to prevent the transmission of bacterial pathogens. We have successfully performed nine multi-center studies across over 50 institutions in 32 states. We also had a project with the Maryland state health department that we led involving 40 facilities including 30 acute care facilities and 10 long-term care facilities. Thus, we believe we are well-qualified to be chosen to be a member of the CDC Prevention Epicenters for the Prevention of Healthcare Associated Infections. Our aims directly address the funding announcement; they are: Aim 1: Perform a multi-site intensive-care unit (ICU) cohort study to determine which patient risk factors, including comorbid conditions and severity of illness markers, and which healthcare worker-patient interactions lead to greater transmission of carbapenem-resistant Enterobacteriaceae (CRE) and methicillin-resistant Staphylococcus aureus (MRSA). Aim 2: Using an existing cohort of residents from community-based nursing homes in two states, estimate the overall transmission risk for resistant Gram-negative bacteria, as well as which patient risk factors and healthcare activities lead to greater transmission. Aim 3: Perform a randomized non-inferiority trial to determine if using an alcohol-based hand rub to "clean" gloved hands when an indication for hand hygiene arises during a single patient encounter is as effective as the current recommendation of changing gloves. Aim 4: Evaluate the effectiveness of practices to decontaminate personal protective equipment (PPE) after use for antibiotic-resistant bacteria and viruses similar to Ebola and Influenza in a laboratory settin.