Volume of Contamination and Nosocomial Infection Control

 描述(申请人提供)：个人防护装备(PPE)保护医护人员和他们的病人免受感染。最近的埃博拉疫情既表明了个人防护装备在保护医护人员免受感染方面的重要性，也表明了安全穿戴和脱下个人防护装备的适当技术的重要性。环境来源与耐万古霉素肠球菌、艰难梭菌、不动杆菌、诺如病毒和其他病原体的医院传播有关。环境被多药耐药(MDR)细菌污染是卫生工作者在病人护理期间个人防护设备是否受到污染以及与个人防护设备污染相关的任务的最强独立预测因素。在脱下睡袍和手套时，HCW经常会污染他们的手。通过我们的文献回顾，我们确定了在医疗机构中安全有效地使用个人防护设备以保护卫生工作者和患者免受埃博拉病毒感染和多药耐药病原体交叉传播的4个障碍：1)与现有个人防护设备的合规性较差，并且无法实现个人防护设备监测的自动化；2)由于设计缺陷、穿/脱技术不当、培训不足以及缺乏抗菌安全网，个人防护设备在取下时存在自身污染；3)个人防护设备污染因接触微生物而传播到患者房间的表面，原因是冲水马桶产生受污染的马桶烟尘；4)卫生工作者的双重看法是，文献表明个人防护设备无效，个人防护设备的使用与不良事件有关。因此，我们提出了4个不同的项目，针对每一个障碍都有具体的目标。这4个拟议项目的总体目标是：1)确定我们是否可以利用商业化的Microsoft Kinect平台来可靠地检测HCW进入或离开病房时使用礼服、手套、口罩、面罩和鞋套的情况，区分HCW何时足够接近患者、触摸患者周围的环境或进入飞沫范围，并测量礼服、手套和口罩的粘附性以及HCW与流感患者之间潜在直接接触和飞沫范围接近事件的数量和长度；2)评估在卫生工作者去除个人防护用品时减少自身污染的方法，包括在卫生工作者护理病人之前在他们的手上涂抹ProvodineTM，这是一种长效的预制碘洗手液，并通过改进培训来改进个人防护用品的脱手技术；3)确定临时马桶盖是否减少了环境污染、手套污染、卫生工作者手的污染以及艰难梭菌感染的发生率；4)完成系统的审查和荟萃分析，以确定普遍的接触预防措施是否可以预防医疗保健相关感染(HAI)，评估接触预防措施与心理或身体不良事件之间的联系，并确定预防埃博拉病毒是否具有有益效果。为了实现这些目标，我们组建了一支方法多样的团队，他们拥有强大的多中心合作历史、200年的HAI研究经验和1400份同行评议的出版物。

 DESCRIPTION (provided by applicant): Personal protective equipment (PPE) protects both healthcare workers and their patients from infections. The recent Ebola outbreak demonstrated both the importance of PPE in protecting healthcare workers (HCW) from infection and the importance of proper technique for safely donning and doffing PPE. Environmental sources have been linked to nosocomial transmission of vancomycin-resistant enterococci, Clostridium difficile, Acinetobacter sp., norovirus, and other pathogens. Contamination of the environment with multidrug-resistant (MDR) bacteria is the strongest independent predictor of whether HCWs' PPE becomes contaminated during patient care and of the tasks associated with PPE contamination. HCW frequently contaminate their hands when removing gowns and gloves. Through our literature review, we identified 4 barriers to the safe and effective use of PPE for protecting HCW and patients from Ebola virus infection and from cross-transmission of MDR-pathogens in healthcare facilities: 1) poor compliance with existing PPE and inability to automate PPE surveillance; 2) self-contamination when removing PPE due to flawed design, improper donning/doffing technique, inadequate training, and lack of an antimicrobial safety net; 3) PPE contamination resulting from contact with microorganisms spread to surfaces in patients' rooms by contaminated toilet plumes generated by flushing toilets; 4) HCWs' dual perceptions that the literature suggests PPE is not effective and PPE use is associated with adverse events. Thus, we propose 4 distinct projects with specific aims targeting each of these barriers. The overall aims of the 4 proposed projects are to: 1) Determine if we can exploit the commercially available Microsoft Kinect platform to reliably detect use of gowns, gloves, face masks, face shields, and shoe covers as HCW enter or exit patient rooms, distinguish when HCW come close enough to touch a patient, touch the environment immediately surrounding the patient, or come within droplet range, and measure gown, glove, and mask adherence and the number and length of potential direct contacts and droplet-range proximity events between HCW and patients with influenza; 2) Assess methods to reduce self-contamination as HCW remove PPE including by applying ProvodineTM, a long- acting providone iodine hand rub, to HCWs' hands before they care for patients and by improving PPE doffing techniques through improved training; 3) Determine if temporary toilet covers reduce environmental contamination, glove contamination, contamination of HCWs' hands, and the incidence of C. difficile infections; 4) Complete systematic reviews and meta-analyses to determine if universal contact precautions prevent healthcare-associated infections (HAI), to assess the association between contact precautions and psychological or physical adverse events, and to determine if Ebola preparedness had beneficial effects. To complete these aims, we assembled a methodologically diverse team with a strong history of multicenter collaborations, > 200 years of HAI research experience, and > 1400 peer-reviewed publications.