The SAFER Lines Project: Standardizing Assessment For Effective Response

 描述（由申请人提供）：虽然积极的感染预防工作显著减少了住院环境中的医疗保健相关感染（HAI），但复杂的医疗保健已经从医院急剧转移到疗养院、门诊护理环境，甚至是具有上门健康护理的家庭。外周插入的中心静脉导管（CVC）的出现允许安全的药物递送而无需住院，使得现在可以在家中、在诊所或由专业护理机构的护士进行长时间的静脉内治疗。 然而，在美国养老院的300万美国人中，超过67%的人经历了与医疗保健相关的感染，每年导致超过150，000人再次入院和超过380，000人死亡。其中许多感染与医疗器械有关。因此，熟练的护理机构、肿瘤输注中心和家庭保健护士在护理由于年龄、合并症、伤口和医疗器械而具有感染高风险的患者时需要保持警惕。 尽管事实上，更多的可预防的HAI发生在医院外比在医院，很少有人知道的负担和最佳管理的HAI在医院外的设置。目前针对中心静脉导管相关血流感染（CLABSI）的感染预防策略侧重于住院患者需求，例如无菌插入实践，这与插入后院外CVC管理无关。此外，无数的门诊设置导致高度可变的方法来监测和记录CVC评估和护理。在院外环境中预防CLABSI的综合方法将包括强调CVC的无菌进入，监测插入部位局部炎症的早期迹象，提醒负责的医疗保健提供者注意问题，并触发有效的响应方案以移除有问题的线。这种方法应该可以在各种院外环境中翻译。 SAFER（有效反应标准化评估）线项目将评估全面的感染预防包，以减少感染并改善临床结果。该捆绑包包括关于CVC无菌接入的教育，以及基于网络的应用程序，该应用程序可以常规使用标准化中心静脉导管插入部位评估（CLISA）评分工具，自动提醒医生获得高分，并激活响应团队以快速移除具有CLABSI迫在眉睫风险的导管。该项目将包括五个养老院，两个家庭健康机构和两个门诊诊所。

 DESCRIPTION (provided by applicant): While aggressive infection prevention efforts have significantly reduced healthcare-associated infections (HAIs) in the inpatient setting, there has been a dramatic shift of complex medical care from the hospital to nursing homes, ambulatory care settings, and even homes with visiting home health nursing care. The advent of the peripherally-inserted central venous catheter (CVC) allows for safe drug delivery without the need for hospitalization such that prolonged intravenous therapy can now be administered at home, at clinic, or by nurses at skilled nursing facilities. Nevertheless, among the 3 million Americans in U.S. nursing homes, over 67% of them experience a healthcare-associated infection, resulting in over 150,000 readmissions and over 380,000 deaths annually. Many of these infections are related to medical devices. Thus, skilled nursing facilities, oncology infusio centers, and home health nurses need to be vigilant in their care of patients at high risk for infection due to their age, comorbidities, wounds, and medical devices. Despite the fact that more preventable HAIs occur outside of hospitals than in hospitals, little is known about the burden and optimal management of HAIs in the out-of-hospital setting. Current infection prevention strategies for central line associated bloodstream infections (CLABSIs) focus on inpatient needs such as sterile insertion practices, which are not as relevant to post-insertion out-of-hospital CVC management. Furthermore, the myriad of outpatient settings results in highly variable approaches to monitoring and documenting CVC assessment and care. A comprehensive approach to CLABSI prevention in the out-of-hospital setting would include an emphasis on sterile access of the CVC, monitoring for early signs of localized inflammation at the insertion site, alerting responsible healthcare providers to problems, and triggering an efficient response protocol to remove problematic lines. This approach should be translatable across various out-of-hospital settings. The SAFER (Standardizing Assessment For Effective Response) Lines Project will evaluate a comprehensive infection prevention bundle to reduce infection and improve clinical outcomes. The bundle includes education on sterile access of CVCs, and a web-based application that enables routine use of a standardized central line insertion site assessment (CLISA) scoring tool, automated alerting of physicians for high scores, and activation of a response team to rapidly remove lines at imminent risk for CLABSI. The project will include five nursing homes, two home health agencies, and two outpatient clinic settings.