Combating Antimicrobial Resistance through Rapid Implementation of Available Guidelines and Evidence (CARRIAGE)

通过快速实施现有指南和证据来对抗抗菌素耐药性 (CARRIAGE)

• 批准号: 10200821
• 负责人: CHARLESNIKA T EVANS
• 金额: --
• 依托单位: VA SALT LAKE CITY HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-10-01 至 2021-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10200821
• 关键词: Address; Adherence; Advisory Committees; Antibiotic Resistance; Antibiotics; Antimicrobial Resistance; Bacterial Antibiotic Resistance; Behavior; Caring; Cause of Death; Centers for Disease Control and Prevention (U.S.); Clinical; Clostridium difficile; Collaborations; Combating Antibiotic Resistant Bacteria; Communicable Diseases; Consolidated Framework for Implementation Research; Data; Data Collection; Data Set; Development; Education; Engineering; Evaluation; Event; Evidence based practice; Feedback; Focus Groups; Fostering; Future; Goals; Government Agencies; Guidelines; Handwashing; Health; Health Care Costs; Health Services; Health care facility; Healthcare Systems; Hospitals; Infection; Infection Control; Infection prevention; Inpatients; Integrated Health Care Systems; Interview; Investments; Lead; Learning; Life; Mentors; Methods; Mission; Modeling; Occupational Health; Patient Care; Policies; Practice Guidelines; Prevention; Process; Provider; Public Health; Quality of Care; Records; Research; Research Design; Resistance; Safety; Scientist; Series; Services; Strategic Planning; Surveys; System; Time; Translating; Veterans; Work; acute care; antimicrobial; carbapenem-resistant Enterobacteriaceae; clinical decision support; clinical practice; contextual factors; design; drug resistant pathogen; health care delivery; health care quality; health care service organization; health care settings; healthcare-associated infections; implementation design; implementation intervention; implementation science; implementation strategy; improved; innovation; interest; multi-drug resistant pathogen; novel; pathogen; patient oriented; patient safety; prevent; programs; prospective; repaired; routine care; theories; transmission process; uptake

Background: Annually, at least two million illnesses and 23,000 deaths are caused by antibiotic-resistant bacteria in the US alone, with an annual impact of $20-35 billion in excess health care costs. The emergence of antibiotic resistance means the treatment of infections is becoming increasingly difficult, expensive, and, in some cases, nonexistent. Judicious use of antibiotics is essential to slow the emergence of resistance and extend the useful life of effective antibiotics, but prevention of resistance also requires efforts to control pathogen transmission across healthcare settings and reduce healthcare-associated infections. VA is not immune to this rising threat to patient safety, but our national, integrated healthcare system for Veterans offers unique opportunities to significantly alter the course of events and improve the outlook for our future through novel implementation and quality improvement efforts. Objectives: The goal of this QUERI program is to address the growing concern of antimicrobial resistance through strategies targeting improved use of antibiotics and prevention of healthcare-associated infections (HAI) across VA patient care settings. In doing so, we will address the priority goals of our VA operational partners, the QUERI Strategic Plans, the 2014 VHA Blueprint for Excellence, and the goals of the National Action Plan for Combating Antibiotic-resistant Bacteria as put forth by President Obama. Our specific objectives are to (a) promote judicious inpatient antibiotic use through a novel antibiotic self-stewardship "timeout" project that prompts VA providers to evaluate the continued need for antibiotics; (b) support and enhance the implementation of new VA guidelines to detect and prevent the spread of carbapenem-resistant Enterobacteriaceae in VA hospitals; (c) foster improved handwashing practice by repairing the broken audit- and-feedback mechanism in VA acute-care hospitals via a VISN-wide quality improvement project; and (d) evaluate and enhance the implementation of the national C. difficile bundle at VA acute-care facilities; Methods: Program projects will vary in study timeframe and start date over the five-year QUERI program timeframe. Research designs utilized across projects will include the experimental stepped wedge design for implementation of interventions, prospective observational designs of practice implementation of large-scale policy initiatives, and rigorous evaluation of VA national policies. The program will employ complementary implementation strategies and theories guided by an Implementation Core consisting of a team of notable VA implementation scientists with proven track records in designing and executing programs to control antimicrobial resistance and HAIs. Specific implementation strategies will include audit and feedback, clinical decision support, external facilitation, provider education and activation, and adherence engineering. The Promoting Action on Research in Health Services (PARiHS) framework will be used to assess contextual factors influencing implementation within facilities, while work system barriers and facilitators will be assessed using the Consolidated Framework for Implementation Research (CFIR) and the Systems Engineering Initiative for Patient Safety (SEIPS) model. Data collection methods will include the use of national VA datasets, direct observation, and primary data (i.e., surveys, interviews, and focus groups).

背景：每年至少有200万人患病，23，000人死亡是由耐药结核病引起的。 仅在美国，每年就有200 - 350亿美元的额外医疗费用。的出现 抗生素耐药性的增加意味着感染的治疗变得越来越困难，昂贵， 有些案子根本不存在明智地使用抗生素对减缓耐药性的出现至关重要， 延长有效抗生素的使用寿命，但预防耐药性也需要努力控制 病原体在医疗机构中的传播，并减少医疗相关感染。VA不 免疫这种不断上升的威胁，病人的安全，但我们的国家，综合医疗保健系统的退伍军人提供 我们有独特的机会，可以通过以下方式显著改变事态的发展，改善我们未来的前景： 新的实施和质量改进工作。 目的：QUERI项目的目的是解决日益增长的抗菌素耐药性问题 通过旨在改进抗生素使用和预防保健相关感染的战略 (HAI)在退伍军人事务部的病人护理机构中。在这样做的时候，我们将解决我们的VA业务的优先目标 合作伙伴，QUERI战略计划，2014年VHA卓越蓝图，以及国家目标 奥巴马总统提出的对抗抗生素耐药细菌的行动计划。我们的具体 目的是（a）通过一种新的抗生素自我管理， “超时”项目，提示VA提供者评估是否继续需要抗生素;（B）支持和 加强实施新的VA指南，以检测和预防耐碳青霉烯类药物的传播 （c）通过修复破损的审计，促进改善洗手习惯- 在退伍军人事务部的急症护理医院，透过一个全部门的质素改善计划，建立一个反馈机制;及（d） 评估和加强国家C. VA急性护理机构的困难束; 方法：在为期五年的QUERI项目中，项目的研究时间表和开始日期各不相同 时间表跨项目使用的研究设计将包括实验性阶梯楔设计， 实施干预措施，前瞻性观察设计的做法，实施大规模的 政策倡议，并严格评估VA国家政策。该计划将采用互补的 由一个由著名的VA团队组成的实施核心指导的实施策略和理论 实施科学家在设计和执行控制程序方面拥有良好的记录， 抗菌素耐药性和HAI。具体实施策略将包括审核和反馈、临床 决策支持、外部促进、提供者教育和激活以及依从性工程。的 促进卫生服务研究行动（PARiHS）框架将用于评估 影响设施内实施的因素，同时将评估工作系统障碍和促进因素 使用实施研究的统一框架（CFIR）和系统工程 患者安全倡议（SEIPS）。数据收集方法将包括使用国家VA数据集， 直接观察和原始数据（即，调查、访谈和焦点小组）。

项目成果

Epidemiology and outcomes associated with carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Pseudomonas aeruginosa: a retrospective cohort study.

• DOI: 10.1186/s12879-022-07436-w
• 发表时间: 2022-05-24
• 期刊: BMC INFECTIOUS DISEASES
• 影响因子: 3.7
• 作者: Vivo, Amanda;Fitzpatrick, Margaret A.;Suda, Katie J.;Jones, Makoto M.;Perencevich, Eli N.;Rubin, Michael A.;Ramanathan, Swetha;Wilson, Geneva M.;Evans, Martin E.;Evans, Charlesnika T.
• 通讯作者: Evans, Charlesnika T.

Evaluation of carbapenem-resistant Enterobacteriaceae (CRE) guideline implementation in the Veterans Affairs Medical Centers using the consolidated framework for implementation research.

• DOI: 10.1186/s43058-021-00170-5
• 发表时间: 2021-06-29
• 期刊: Implementation science communications
• 作者: Goedken CC;Guihan M;Brown CR;Ramanathan S;Vivo A;Suda KJ;Fitzpatrick MA;Poggensee L;Perencevich EN;Rubin M;Reisinger HS;Evans M;Evans CT
• 通讯作者: Evans CT

Laboratory practices for identification and reporting of carbapenem-resistant Enterobacteriaceae in Department of Veterans Affairs facilities.

• DOI: 10.1017/ice.2019.24
• 发表时间: 2019-04
• 期刊: Infection control and hospital epidemiology
• 影响因子: 4.5
• 作者: Fitzpatrick MA;Suda KJ;Ramanathan S;Guihan M;Brown C;Safdar N;Evans M;Jones MM;Pfeiffer CD;Klutts JS;Icardi M;Perencevich E;Rubin M;Evans CT;QUERI CARRIAGE Program
• 通讯作者: QUERI CARRIAGE Program

Research Agenda for Antimicrobial Stewardship in the Veterans Health Administration.

退伍军人健康管理局抗菌药物管理研究议程。

• DOI: 10.1017/ice.2017.299
• 发表时间: 2018
• 期刊: Infection control and hospital epidemiology
• 影响因子: 4.5
• 作者: Suda,KatieJ;Livorsi,DanielJ;Goto,Michihiko;Forrest,GraemeN;Jones,MakotoM;Neuhauser,MelindaM;Hoff,BrianM;Ince,Dilek;Carrel,Margaret;Nair,Rajeshwari;Knobloch,MaryJo;Goetz,MatthewB
• 通讯作者: Goetz,MatthewB

A survey of infection control strategies for carbapenem-resistant Enterobacteriaceae in Department of Veterans' Affairs facilities.

• DOI: 10.1017/ice.2020.328
• 发表时间: 2022-07
• 期刊: Infection control and hospital epidemiology
• 影响因子: 4.5
• 作者: Ramanathan S;Suda KJ;Fitzpatrick MA;Guihan M;Goedken CC;Safdar N;Evans M;Jones M;Pfeiffer CD;Perencevich EN;Rubin M;Evans CT;QUERI CARRIAGE Program
• 通讯作者: QUERI CARRIAGE Program