Infection Prevention and Antimicrobial Stewardship: Minding the Gaps: The Iowa Prevention Epicenter

感染预防和抗菌药物管理：弥补差距：爱荷华州预防中心

• 批准号: 10406852
• 负责人: Loreen A Herwaldt
• 金额: $ 161.3万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10406852
• 关键词: Infection; Prevention; Antimicrobial; Stewardship; Minding

ABSTRACT We designed this proposal to address multiple CDC Epicenters' research priorities: preventing healthcare personnel (HCP) contamination, understanding and decreasing transmission of epidemiologically important pathogens including emerging respiratory viruses such as COVID-19, extending antimicrobial stewardship (AS), decreasing antimicrobial resistant infections, exploring sepsis epidemiology and prevention, quantifying and decreasing environmental contamination, implementing a decolonization program to obtain source control and decrease surgical site infections (SSI), applying innovative research methodology, and training the next generation of healthcare epidemiologists. Our proposed projects range from translational stage T0 to T2 and involve academic medical centers, a VA Medical Center, acute care hospitals, quick/urgent care centers (UCC), surgical patients, patients discharged from hospitals, and healthcare personnel (HCP) exposed to viral respiratory pathogens. Our long-term objectives are to: 1) improve the integration of infection prevention measures into HCP's patient care processes, 2) improve personal protective equipment (PPE) design and use to decrease HCP contamination and transmission, 3) improve surveillance for healthcare-associated infections (HAI), 4) identify practical ways to decrease spread of viral pathogens, 4) improve antibiotic use and decrease antimicrobial resistance, and 5) prevent hospital-onset sepsis (HOS) and HAI, including SSI. Core Project (CP) I uses methods from human factors engineering, ethnography, industrial hygiene, environmental microbiology, and computer visioning to improve PPE design, decrease HCP self-contamination, improve integration of PPE use and hand hygiene during patient care, and decrease bacterial and viral environmental contamination. CP II employs novel software via cellphones to expand surveillance for SSI and C. difficile infections after discharge and to monitor HCP exposed to respiratory viruses for signs or symptoms of infection. CP III and the Medium Optional Collaborative Project (OCP) address neglected opportunities for AS--UCC and patients at hospital discharge--by creating and testing novel AS metrics to decrease antibiotic prescriptions for acute respiratory tract infections in UCC (CP III) and by conducting a cluster-randomized trial of post-prescription audit-and-review to reduce unnecessary antibiotic use after discharge (Medium OCP). CP IV mines large administrative data sets and analyzes data from individual medical records to define the epidemiology of HOS, validate CDC's acute sepsis event algorithm for HOS, and identify remediable HOS risk factors that could be targets for preventive measures. The Large OCP will conduct a stepped wedge trial of a simple, inexpensive intervention—2 doses of intranasal povidone iodine—to prevent SSI in patients with high- energy lower extremity fractures, who are a high-risk population with few available preventive measures. The Small OCP seeks to improve antibiograms and, therefore, antibiotic use by including geospatial information in antibiograms. This information should provide clinicians with information more specific to their patients.

摘要 我们设计了这个提案，以解决多个疾病预防控制中心的研究重点：预防医疗保健 人员（HCP）污染，了解和减少流行病学重要的传播 包括新出现的呼吸道病毒（如COVID-19）在内的病原体， (AS)，减少抗生素耐药性感染，探索脓毒症流行病学和预防，量化 减少环境污染，实施非殖民化计划以获得源头控制 减少手术部位感染（SSI），应用创新的研究方法，并培训下一个 一代卫生保健流行病学家。我们提出的项目范围从翻译阶段T0到T2， 涉及学术医疗中心、退伍军人医疗中心、急性护理医院、快速/紧急护理中心 (UCC)手术患者、出院患者和暴露于病毒的医护人员（HCP） 呼吸道病原体我们的长期目标是：1）改善感染预防的一体化 在HCP的患者护理过程中采取措施，2）改进个人防护设备（PPE）的设计和使用 减少HCP污染和传播，3）改善对医疗相关感染的监测 (HAI)，4）确定减少病毒病原体传播的实用方法，4）改善抗生素的使用， 抗菌素耐药性，和5）预防医院发病败血症（HOS）和HAI，包括SSI。核心项目 (CP)我使用的方法从人因工程，人种学，工业卫生，环境 微生物学和计算机视觉，以改善PPE设计，减少HCP自身污染， 在病人护理过程中，将个人防护设备的使用和手部卫生结合起来，减少细菌和病毒的环境污染。 污染. CP II通过手机使用新型软件来扩大对SSI和C的监控。艰难 出院后感染，并监测暴露于呼吸道病毒的HCP的体征或症状， 感染CP III和中期可选合作项目（OCP）解决了被忽视的机会， AS-UCC和出院患者-通过创建和测试新的AS指标来减少抗生素 UCC（CP III）中急性呼吸道感染的处方，并进行一项随机分组试验 处方后审计和审查，以减少出院后不必要的抗生素使用（中等OCP）。CP IV挖掘大型管理数据集并分析来自个人病历的数据， HOS的流行病学，验证CDC的HOS急性脓毒症事件算法，并确定可补救的HOS风险 这些因素可能是预防措施的目标。大型OCP将进行一次阶梯式楔形试验， 简单，廉价的干预-2剂量的鼻内聚维酮碘-以预防高胰岛素血症患者的SSI， 能量下肢骨折，他们是一个高危人群，几乎没有可用的预防措施。的 小型OCP旨在通过将地理空间信息包括在 电子邮件这些信息应该为临床医生提供更具体的患者信息。