Volume of Contamination and Nosocomial Infection Control

 描述（由申请人提供）：个人防护装备（PPE）可保护医护人员及其患者免受感染。最近的埃博拉疫情证明了PPE在保护医护人员（HCW）免受感染方面的重要性，以及安全穿戴PPE的适当技术的重要性。环境来源与万古霉素耐药肠球菌、艰难梭菌、不动杆菌属、诺如病毒和其他病原体。多重耐药（MDR）细菌对环境的污染是医务人员的PPE在患者护理期间是否受到污染以及与PPE污染相关的任务的最强独立预测因素。HCW在脱下手术衣和手套时经常污染他们的手。通过我们的文献综述，我们确定了在医疗机构中安全有效地使用PPE以保护HCW和患者免受埃博拉病毒感染和MDR病原体交叉传播的4个障碍：1）对现有PPE的依从性差，无法自动化PPE监测; 2）由于设计缺陷、穿戴/脱下技术不当、培训不足和缺乏抗菌安全网，在去除PPE时发生自身污染; 3）与微生物接触导致的个人防护设备污染，通过冲洗厕所产生的污染厕所羽流传播到病房表面; 4）医务人员的双重看法，即文献表明个人防护设备无效，使用个人防护设备与不良事件有关。因此，我们提出了4个不同的项目，针对这些障碍的具体目标。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上可用的Microsoft Kinect平台来可靠地检测当HCW进入或离开病房时长袍、手套、面罩、面罩和鞋套的使用，区分HCW何时足够接近以触摸患者、触摸患者周围的环境或进入液滴范围内，并测量长袍、手套、面罩和鞋套的使用。2）评估医务工作者去除个人防护装备时减少自身污染的方法，包括在医务工作者护理患者之前在其手上涂抹ProvodineTM（一种长效聚维酮碘手部擦药），以及通过改进培训提高个人防护装备的脱下技术; 3）确定临时马桶盖是否减少环境污染、手套污染、卫生工作者手的污染以及C.艰难感染; 4）完成系统性综述和荟萃分析，以确定通用接触预防措施是否能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关联，并确定埃博拉预防措施是否具有有益效果。为了完成这些目标，我们组建了一个方法多样化的团队，该团队具有强大的多中心合作历史，> 200年的HAI研究经验和> 1400篇同行评议的出版物。

 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.