Comparative safety and effectiveness of isolation in VHA community living centers

VHA 社区生活中心隔离的安全性和有效性比较

• 批准号: 8486572
• 负责人: Daniel J Morgan
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8486572
• 关键词: Accounting; Acute; Adherence; Admission activity; Adopted; Adverse effects; Adverse event; Affect; Anxiety; Behavior; Belief; Boston; Caring; Centers for Disease Control and Prevention (U.S.); Cities; Data; Data Quality; Data Set; Databases; Decubitus ulcer; Delirium; Disease Outbreaks; Education; Effectiveness; Elements; Environment; Equilibrium; Evaluation; Foundations; Frequencies; Future; Goals; Hand; Health Personnel; Healthcare; Healthcare Systems; Home environment; Hygiene; Infection; Infection Control; Infection prevention; Inpatients; Interview; Iowa; Knowledge; Lead; Long-Term Care; Maryland; Measures; Medical; Mental Depression; Mental Health; Methods; Modeling; Observational Study; Outcome; Patient Care; Patient-Centered Care; Patients; Pattern; Perception; Physicians; Policies; Population; Prevention; Prevention Guidelines; Prevention Protocols; Prevention education; Prevention strategy; Procedures; Process Measure; Protocols documentation; Publications; Rehabilitation Nursing; Research; Role; Safety; Sampling; Science; Site; Standard precautions; Structure; Surveys; System; Techniques; Testing; Variant; Veterans; Visit; abstracting; adverse outcome; base; community living; comparative; comparative effectiveness; design; disorder prevention; falls; improved; methicillin resistant Staphylococcus aureus; patient safety; residence

DESCRIPTION (provided by applicant): Abstract: The VHA has been a leader in infection control with the MRSA Prevention Initiative to prevent infections in both acute-care and long-term care. A cornerstone of the MRSA Prevention Initiative is testing all patients for MRSA on admission, discharge and semi-annually. No other healthcare system in the US obtains this amount of MRSA data. Those acute-care patients found to have MRSA are isolated in a private room and healthcare workers (HCW) are required to use of gown and gloves for contact. In acute-care isolation has been associated with fewer HCW visits and greater depression, anxiety, delirium, worse process measure and more adverse events (primarily falls and pressure ulcers). Current infection prevention practices in long-term care facilities (LTCFs) are adopted from those designed for acute-care settings and may not be appropriate for a LTCF population. In Community Living Centers (CLCs), the VHA is committed to providing Veterans with long-term, residential care that embodies the attributes of a home-like environment. The use of isolation in CLCs varies by facility from very aggressive (long-term isolation of those unable to perform personal hygiene or with active infections-facilities adhering to the VA MRSA PI) to conservative (using standard precautions for all patients-primarily hand hygiene-facilities adhering to CDC guidelines). These policies are based on low quality data and the effect of this practice variation between CLCs is unknown; however these issues are of critical significance to the nearly 45,000 Veterans residing in CLCs (according to a recent VHA/CDC publication up to 58% of CLC residents have MRSA). CLC residents often require transfer to acute-care facilities for infections and have led to outbreaks n acute-care. Because CLCs constitute both a home-like residence and a medical facility, understanding MRSA isolation practices in CLCs requires a multi-method approach that accounts for both national comparative effectiveness data and front-line perspectives on the barriers to adhering to infection prevention policies. To pursue a nationwide comparative effectiveness study we will first develop and administer a survey to all CLCs to assess MRSA isolation practice (as an exposure) and use unique VHA secondary databases for outcomes MRSA acquisition and infection (IPEC) and unintended consequences (MDS 3.0). Direct observation methods will be employed to quantify HCW-resident interactions at these 10 CLCs. Survey results will inform recruitment for one-on-one interviews with CLC HCWs at 10 geographically dispersed CLCs to understand HCW beliefs, knowledge and perceptions of barriers to adherence with infection prevention practices. These interviews will identify educational needs for infection prevention education. Through these integrated projects that use unique VHA data we expect to determine which aspects of isolation are associated with 1) MRSA prevention and 2) unintended consequences and how future infection prevention efforts can best improve overall patient safety. This information will advance the science of patient safety in long-term care and inform more rational policy and education for infection prevention in VHA CLCs.

描述（由申请人提供）： 摘要：VHA一直是MRSA预防倡议，以防止急性护理和长期护理中的感染。 MRSA预防计划的基石是在入院，出院和半年度中测试所有患者的MRSA。美国没有其他医疗保健系统获得了这一数量的MRSA数据。那些发现患有MRSA的急性护理患者是在私人房间中孤立的，医护人员（HCW）必须使用礼服和手套进行接触。在急性护理中，隔离与较少的HCW访问和更大的抑郁，焦虑，del妄，过程度量较差和不良事件（主要是跌落和压力溃疡）有关。为急性护理设置而采用了长期护理设施（LTCF）的当前预防措施（LTCF），可能不适合LTCF人群。在社区生活中心（CLC）中，VHA致力于为退伍军人提供长期的住宅护理，以体现像家庭般环境的属性。 CLC中隔离的使用因设施从非常激进的设施（长期隔离那些无法进行个人卫生的人或遵守VA MRSA PI的主动感染影响力）到保守的（使用所有对所有患者使用标准的预防措施（对所有手动卫生措施遵循CDC指南）的预防措施）。这些政策基于低质量数据，CLC之间这种实践变化的影响尚不清楚。但是，这些问题对于居住在CLC中的近45,000名退伍军人至关重要（根据最近的VHA/CDC出版物，高达58％的CLC居民患有MRSA）。 CLC居民通常需要转移到急性护理设施以进行感染，并导致爆发N急性护理。由于CLC既是家庭式的住所又构成了医疗设施，因此了解CLC中MRSA隔离实践需要一种多方法方法，该方法既说明了国家比较有效性数据，又是对遵守感染预防政策的障碍的前线观点。为了进行全国性的比较有效性研究，我们将首先对所有CLC进行调查，以评估MRSA隔离实践（作为暴露），并使用独特的VHA二级数据库进行MRSA获取和感染（IPEC）和意外后果（MDS 3.0）。将采用直接观察方法来量化这10个CLC的HCW居民相互作用。调查结果将为招聘提供招聘，以在10个地理位置分散的CLC上对CLC HCW进行一对一的访谈，以了解HCW的信念，知识和对遵守感染预防实践的障碍的看法。这些访谈将确定预防感染教育的教育需求。通过这些使用独特的VHA数据的集成项目，我们期望确定隔离的哪些方面与1）MRSA预防和2）意外后果以及未来的预防感染努力如何最好地改善整体患者的安全。该信息将在长期护理中提高患者安全科学，并为VHA CLC中的预防感染提供更多理性的政策和教育。