Environmental hygiene strategies to decrease the burden of antibiotic-resistant organisms in Intensive Care Unit SINKs (ICU SINK)

项目摘要 抗生素耐药微生物（ARO）引起的感染是全球公共卫生的主要威胁， 这是医疗保健相关感染（HAI）的重要原因。ARO尤其威胁要 重症监护室（ICU）中的免疫功能低下患者，其中免疫系统减弱， 癌症化疗和抗生素暴露导致ARO引起的HAI风险增加。一个潜在 ARO的传播源是医院环境。ARO可以在ICU中的物体和表面上存活 长期间隔，导致ARO持续传播给脆弱患者的固定水库。 要创建和优化感染预防策略，关键是要了解医院之间的联系 环境和HAI，并优化环境卫生干预策略，以预防HAI， ARO。 为了表征ICU中ARO负荷最大的环境区域，我们的小组培养了， 确定并创建了一个生物标本库，其中包含从ICU表面收集的1，109个潜在ARO， 患者粪便样本和来自骨内患者的临床血流感染（BSI）分离株 骨髓移植（BMT）ICU。我们初步的选择性微生物培养技术和全基因组 测序（WGS）数据表明，从水槽排水管中分离出的ARO与 临床BSI分离株。这就提出了一个假设，即水槽排水管中的ARO正在ICU和ICU之间转移。 环境和患者（或反之亦然），环境可能是ARO传播的储存库。 基于这些初步数据，我们的目标是确定ICU环境中ARO之间的联系 和HAI患者，并设计和测试干预措施，以减轻ICU中ARO的负担 环境 在这个项目中，我们将利用抗菌药物敏感性试验和WGS来纵向确定 ARO在医院环境中的存在和传播，并确定 这些菌株在BMT ICU中的患者中引起BSI。此外，我们将实施和衡量 漂白剂和过氧化氢为基础的环境卫生干预对 ICU水槽排水管中存在ARO。完成这些具体目标将使我们能够广泛地描述 ARO在环境表面和患者中的传播动力学，并评估 环境卫生干预，重点是水槽表面和排水沟。

PROJECT SUMMARY Infections due to antibiotic resistant organisms (ARO) are a major threat to public health worldwide and a significant cause of healthcare-associated infections (HAI). AROs are especially threatening to immunocompromised patients in intensive care units (ICUs), where a weakened immune system combined with cancer chemotherapy and antibiotic exposures results in increased risk for HAIs due to AROs. A potential source of ARO transmission is the hospital environment. AROs can survive on objects and surfaces in the ICU for prolonged time intervals, resulting in fixed reservoirs for ongoing ARO transmission to vulnerable patients. To create and optimize infection prevention strategies, it is crucial to understand the link between the hospital environment and HAIs, and to optimize environmental hygiene intervention strategies to prevent HAIs due to AROs. To characterize the environmental areas with the greatest ARO burden in the ICU, our group cultured, identified, and created a biospecimen repository of 1,109 potential AROs from collected from ICU surfaces, patient fecal samples, and clinical bloodstream infection (BSI) isolates from patients admitted to the bone marrow transplant (BMT) ICU. Our preliminary selective microbiologic culture techniques and whole genome sequencing (WGS) data indicate that there is a genetic link between AROs isolated from sink drains and clinical BSI isolates. This raises the hypothesis that AROs in sink drains are being transferred between the ICU environment and patients (or vice-versa), and that the environment may be a reservoir for ARO transmission. Based on these preliminary data, our goal is to define the link between AROs found in the ICU environment and patients with HAIs, and to design and test interventions to reduce the burden of AROs in the ICU environment. In this project, we will utilize antimicrobial susceptibility testing and WGS to longitudinally determine the presence and transmission of AROs across the hospital environment, and determine the genetic link between these strains to those causing BSIs in patients in a BMT ICU. Further, we will implement and measure the impact of a bleach and hydrogen peroxide-based environmental hygiene intervention on the concentration of AROs present in ICU sink drains. Completion of these specific aims will allow us to extensively characterize the transmission dynamics of AROs across environmental surfaces and patients, and to evaluate an environmental hygiene intervention that focuses on sink surfaces and drains.