Pathway from Functional Disability to Antimicrobial Resistance in Nursing Homes

疗养院从功能障碍到抗菌素耐药性的途径

• 批准号: 8849327
• 负责人: Lona Mody
• 金额: $ 36.2万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-15 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8849327
• 关键词: Activities of Daily Living; Antibiotic-resistant organism; Antimicrobial Resistance; Area; Bathing; Caregivers; Categories; Chlorhexidine; Clinical; Control Groups; Cross-Sectional Studies; Data; Diarrhea; Disabled Persons; Discipline of Nursing; Dose; Education; Effectiveness; Elderly; Elements; Environment; Environmental Pollution; Epidemiologic Studies; Family; Feedback; Hand; Health; Health Care Costs; Health Personnel; Hospitals; Hygiene; Impairment; Infection Control; Infection Control Practitioners; Infection prevention; Intervention; Lead; Leadership; Modeling; Molecular; Molecular Profiling; Nursing Homes; Organism; Pathway interactions; Pattern; Prevalence; Prevention program; Prevention strategy; Prospective Studies; Protocols documentation; Quality of life; Randomized; Recreation; Rehabilitation therapy; Research; Research Design; Resources; Risk; Risk Factors; Role; Stratification; Surface; Testing; Time; Work; base; cost shifting; design; disability; disability burden; environmental intervention; functional disability; group intervention; high risk; implantable device; innovation; microbial; multi-component intervention; prevent; primary outcome; programs; prospective; response; translational study; transmission process

DESCRIPTION (provided by applicant): Antimicrobial-resistant organisms (AROs) are endemic in nursing homes (NH) with prevalence rates surpassing those in hospitals. The basic question of interaction between a disabled host, institutional environment, and caregiver contact in ARO acquisition (and transmission) remains unanswered. We hypothesize that specific activities of daily living (ADL) disability patterns in NH residents will predict acquisition risk or new AROs. We will examine whether disability and risk of acquisition are proportional to healthcare worker contact time and contact intensity. Our proposed Specific Aims are: Aim 1: Develop and examine a risk-stratification model utilizing resident-, HCW-, and environmental-level factors to identify three categories of NH residents: (1) never acquire an ARO; (2) intermittently acquire an ARO; and (3) newly acquire an ARO and remain persistently colonized. Resident-level factors include incremental levels and specific patterns of ADL impairment, presence of wounds, and use of indwelling devices. HCW factors include contact time and intensity, as well as varying levels of nursing resource utilization. The environment factors include presence of AROs on inanimate objects in resident rooms, common areas, and rehabilitation rooms. We will also establish a "molecular fingerprint" between the strains of AROs colonizing functionally-impaired residents and those isolated from their environment and the hands of caregivers. Using this risk-stratification model, we will establish the optimal ARO prevention strategy in highest-risk functionally-disabled NH residents. Aim 2: Design and evaluate the effectiveness of a multi-component intervention to reduce new acquisition of AROs in the highest-risk functionally-disabled NH residents. This intervention will incorporate resident level, environmental, and caregiver-based strategies. The proposed translational study is innovative and timely because it will develop a risk-stratification model to identify functionally-disabled NH residents who are most likely, if colonized, to transmit AROs; define a molecular "fingerprint" of resident-caregiver-environment ARO contamination; and design and implement a multi-component comprehensive intervention targeting high-risk functionally-disabled residents. The impact of this research will be an effective, efficient, and infection prevention program for NHs to limit ARO acquisition and more importantly transmission. We expect our results to have widespread application in NHs, enhance residents' quality of life, reduce hospital transfers, reduce healthcare costs and shift the evolving paradigm of infection control and prevention in NHs.

描述（由申请人提供）：抗微生物耐药微生物（ARO）在疗养院（NH）中流行，患病率超过医院。在ARO的获取（和传播）中，残疾人宿主、机构环境和护理者接触之间的相互作用的基本问题仍然没有答案。我们假设，具体的日常生活活动（ADL）残疾模式在NH居民将预测收购风险或新的ARO。我们将研究残疾和收购的风险是否与医护人员的接触时间和接触强度成正比。我们提出的具体目标是：目标1：开发和检查一个风险分层模型，利用居民，HCW，和环境水平的因素，以确定三类NH居民：（1）从未获得ARO;（2）间歇性获得ARO;（3）新获得ARO，并保持持续殖民。居民水平的因素包括ADL损伤的增量水平和特定模式、伤口的存在和留置器械的使用。HCW因素包括接触时间和强度，以及不同程度的护理资源利用。环境因素包括在居住室、公共区域和康复室中的无生命物体上存在ARO。我们还将建立一个“分子指纹”之间的菌株ARO殖民功能受损的居民和那些孤立于他们的环境和照顾者的手。使用这种风险分层模型，我们将建立最佳的ARO预防策略，在最高风险的功能障碍NH居民。目标二：设计和评估多成分干预的有效性，以减少最高风险的功能残疾NH居民新获得ARO。本次活动将包括居民 水平、环境和基于个人的战略。拟议的翻译研究是创新和及时的，因为它将开发一个风险分层模型，以确定功能残疾的NH居民谁是最有可能的，如果殖民化，传播ARO;定义一个分子“指纹”的居民照顾者环境ARO污染;和设计和实施一个多组件的综合干预措施，针对高风险的功能残疾居民。这项研究的影响将是一个有效的，高效的，和感染预防计划的NH限制ARO收购，更重要的是传播。我们希望我们的研究结果在NHS中得到广泛应用，提高居民的生活质量，减少医院转移，降低医疗成本，并改变NHS中感染控制和预防的发展模式。