Chicago Prevention and Intervention Epicenter (Chicago PIE)

芝加哥预防和干预中心（芝加哥 PIE）

• 批准号: 8850159
• 负责人: Robert Alan Weinstein
• 金额: $ 61万
• 依托单位: HEKTOEN INSTITUTE FOR MEDICAL RESEARCH
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2016-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8850159
• 关键词: Chicago; Prevention; Intervention; Epicenter; PIE

DESCRIPTION (provided by applicant): Healthcare-acquired infections (HAIs) are a major source of patient suffering and societal cost. Despite improved use of the most essential HAI control measure, hand hygiene by healthcare workers, adherence still lags and additional measures are needed. Three groups of interventions, comprising 6 studies, are proposed. First, multi-drug resistant organisms (MDROs) - methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant gram-negative bacilli - and Clostridium difficile-associated infections (CDIs) are increasing causes of HAIs. MDROs often ping-pong between hospitals and long-term care; this highlights the importance of a regional, rather than the traditional institution-based, approach to control. The Chicago Prevention and Intervention Epicenter proposes T0/1/2/3 regional interventions in acute and long-term care facilities that will include enhanced surveillance and communication and patient cleansing with chlorhexidine to decrease MDRO risk in Chicago. Successful projects can inform MDRO control in other geographic areas. CDIs result in part from the effect of antibiotics on intestinal microbes. Probiotics, mixtures of natural gut- stabilizing bacteria, given to patients receiving antibiotic therapy have the potential to reduce risk of CDI. A T0/1/2 demonstration project of a novel probiotic that has shown promise for preventing CDIs is proposed. Second, device-related infections are addressed. Catheter-related bloodstream infections (CLABSIs) have declined due to wide application of interventions recommended in 2002 by CDC. Now, it may be possible to eliminate CLABSIs by controlling the major remaining infection source-extrinsic contamination of catheter hubs and fluid pathways. A T0/1/2 ICU and lab study of aggressive asepsis of catheter hubs is proposed. Catheter-associated urinary tract infection (CAUTI), although of lower morbidity, is a major MDRO reservoir and source of spread from hospitals into long-term care. A CAUTI technical innovation that has many early adopters despite absence of well-demonstrated efficacy is the handheld bladder scanner. These devices are expensive but provide the opportunity to determine bladder volume non-invasively. A T0/2 prospective controlled trial of bladder scanners for infection control is proposed. Third, we are facing MDROs with no new drugs. A T1/2 intervention to provide more rational antimicrobial use in ICUs, hot spots of resistance, is proposed. Educational activities that have been successful in other venues will be compared with the value of a biologic marker of bacterial infection - procalcitonin - for directing antimicrobial therapy. The impact on ICU infection and prescribing characteristics of doctors will be assessed. To further assess the interventions, costs of averted outcomes and of the interventions will be compared. OPRIONAL OBEJCTIVE SCORE: 2

描述（由申请人提供）：医疗保健获得性感染（HAIs）是患者痛苦和社会成本的主要来源。尽管改善了最基本的国际卫生组织控制措施，即卫生保健工作者的手卫生，但依从性仍然滞后，需要采取其他措施。提出了三组干预措施，包括6项研究。首先，多重耐药生物(MDROs) -耐甲氧西林金黄色葡萄球菌（MRSA）和耐碳青霉烯革兰氏阴性杆菌和艰难梭菌相关感染（CDIs）是HAIs的增加原因。mdro经常在医院和长期护理机构之间来回切换；这突出了区域而不是传统的以机构为基础的控制方法的重要性。芝加哥预防和干预中心建议在急性和长期护理设施中进行T0/1/2/3区域干预，包括加强监测和沟通，并用氯己定清洁患者，以降低芝加哥的MDRO风险。成功的项目可以通知MDRO在其他地理区域的控制。cdi的部分原因是抗生素对肠道微生物的影响。益生菌，天然肠道稳定细菌的混合物，给予接受抗生素治疗的患者有可能降低CDI的风险。提出了一种新型益生菌预防cdi的T0/1/2示范项目。其次，解决与设备相关的感染。导管相关血流感染（CLABSIs）已经下降，由于广泛应用干预措施推荐在2002年CDC。现在，有可能通过控制主要的剩余感染源——导管中心和液体通路的外部污染来消除clabsi。提出了一项导管中心侵袭性无菌的T0/1/2 ICU和实验室研究。导尿管相关性尿路感染（CAUTI）虽然发病率较低，但却是MDRO的主要宿主和从医院传播到长期护理的来源。CAUTI的一项技术创新，尽管缺乏充分证明的功效，但已经有许多早期采用者，这就是手持式膀胱扫描仪。这些设备价格昂贵，但提供了无创测定膀胱容量的机会。提出膀胱扫描仪用于感染控制的T0/2前瞻性对照试验。第三，我们面临的是没有新药的耐药药。提出了T1/2干预措施，以提供更合理的抗菌药物使用icu，耐药热点。在其他地方取得成功的教育活动将与细菌感染的生物标志物——降钙素原的价值进行比较，以指导抗菌治疗。评估对ICU感染的影响和医生的处方特点。为了进一步评估干预措施，将比较避免结果的成本和干预措施的成本。