Epicenter IV: Harvard Pilgrim-UCI Center for HAI Prevention

摘要- Epicenter IV：哈佛朝圣者-UCI预防HAI中心（核心） 我们提出了五个核心目标，评估新的（T0-T1）战略，以检测和预防医疗保健- 相关感染和医疗保健相关病原体中出现抗生素耐药性。 这些目标很有可能导致健康结果的改善，利用先前的工作， 这些领域，并加强我们的基础设施，以应对疾病预防控制中心可能要求的新主题， 地址.所涵盖的项目包括：1）使用统计软件检测医院爆发， 评估观察到的普遍非殖民化ICU的益处是否通过预防 集群这项T1工作将涉及对已完成的REDUCE MRSA试验进行二次分析。两个项目 处理预防抗生素耐药性：2）评价替代鼻用碘伏的影响， 莫匹罗星与洗必泰联合用于ICU普遍去殖民化。莫匹罗星-碘伏 置换试验将是一项120家医院的T2随机分组试验，评估碘伏对S的非劣效性。 金黄色葡萄球菌临床培养和所有病原体血流感染。它将评估鼻腔防腐剂是否可以 减轻使用莫匹罗星时出现的耐药性。3)医院病历再造 为治疗医师提供患者的肺炎或尿路感染是由于 多重耐药病原体这项T1研究将创造一种新的抗生素，可以帮助经验性抗生素 选择和防止不必要地开超广谱抗生素。两个最终项目 涉及制定或改进严重住院疾病的国家指标。4)评估 国家报告的脓毒症治疗包依从性对患者结局的影响。这个T0工作将 严格评估指标，以防止与脓毒症相关的不良结局。5)制定目标 非呼吸机医院获得性肺炎的监测定义。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， 可计算的定义与临床结果。

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.