Epicenter IV: Harvard Pilgrim-UCI Center for HAI Prevention

摘要-震中IV：哈佛朝圣者-UCI HAI预防中心(核心) 我们提出了五个核心目标，评估检测和预防医疗保健的新(T0-T1)策略- 与医疗保健相关的病原体之间的相关感染和抗生素耐药性的出现。 这些目标有很高的潜力导致健康结果的改善，利用以前在 这些领域，并加强我们的基础设施，以应对疾控中心可能要求震中 地址。涵盖的项目包括：1)使用统计软件检测医院疫情，以 评估从普遍非殖民化ICU观察到的好处是否通过预防 集群。这项T1工作将涉及对已完成的RECESS MRSA试验进行二次分析。两个项目 应对抗生素耐药性的预防：2)评估替代鼻用碘伏的影响 莫匹罗星与洗必泰配伍用于ICU普遍非殖民化。莫匹罗星--碘伏 SWAPOUT试验将是一项120家医院T2整群随机试验，评估碘伏在S。 金黄色葡萄球菌临床培养和全病原体血流感染。它将评估鼻腔防腐剂是否可以 减轻使用莫匹罗星后出现的耐药性。3)医院抗菌图谱再造 为治疗医生提供患者肺炎或尿路感染是由于 多重耐药病原体。这项T1研究将创建一种新的抗菌图谱，可能有助于经验性抗生素 选择并防止开出不必要的广谱抗生素。两个期末项目 参与制定或改进严重住院疾病的国家指标。4)评估 国家报告的败血症捆绑的依从性对患者预后的影响。这项T0工作将 严格评估各项指标，以防止败血症相关的不良后果。5)制定目标 非呼吸机院内获得性肺炎监测定义。这项T0工作将利用我们的 经验重新定义呼吸机相关肺炎的国家指标，并将类似地与明确的， 临床结果的可计算定义。

Abstract - Epicenter IV: Harvard Pilgrim-UCI Center for HAI Prevention (Core) We propose five core aims evaluating novel (T0-T1) strategies to detect and prevent healthcare- associated infections and the emergence of antibiotic resistance among healthcare-associated pathogens. These aims have high potential to lead to improvements in health outcomes, take advantage of prior work in these domains, and strengthen our infrastructure to respond to new topics CDC may ask the Epicenters to address. Projects covered include the following: 1) Detecting hospital outbreaks using statistical software to evaluate whether the benefit observed from universal decolonization ICUs was mediated by prevention of clusters. This T1 work will involve a secondary analysis of the completed REDUCE MRSA Trial. Two projects deal with prevention of antibiotic resistance: 2) Evaluating the impact of substituting nasal iodophor for mupirocin when paired with chlorhexidine for ICU universal decolonization. The Mupirocin-Iodophor Swapout trial will be a 120 hospital T2 cluster-randomized trial assessing the non-inferiority of iodophor on S. aureus clinical cultures and all-pathogen bloodstream infections. It will assess whether nasal antiseptics can mitigate the emergence of resistance seen with mupirocin use. 3) Re-engineering the hospital antibiogram to provide treating physicians with the likelihood that patient's pneumonia or a urinary tract infection is due to a multi-drug resistant pathogen. This T1 study will create a novel antibiogram that could aid empiric antibiotic selection and prevent extended spectrum antibiotics from being unnecessarily prescribed. Two final projects involve the development or improvement of national metrics for serious inpatient diseases. 4) Assessing the impact of nationally reported compliance with sepsis bundles on patient outcomes. This T0 work will critically evaluate metrics to prevent adverse outcomes associated with sepsis. 5) Developing an objective surveillance definition for non-ventilator hospital-acquired pneumonia. This T0 work will leverage our experience re-defining national metrics for ventilator-associated pneumonia and will similarly align explicit, computable definitions with clinical outcomes.