Johns Hopkins Prevention Epicenter: Transdisciplinary Research Approaches to Prevent Healthcare Associated Infections and Antibiotic Resistance (TRAP HAI & AR)

约翰霍普金斯大学预防中心：预防医疗相关感染和抗生素耐药性的跨学科研究方法（TRAP HAI

• 批准号: 10650209
• 负责人: Sara Elizabeth Cosgrove
• 金额: $ 153.31万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 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/10650209
• 关键词: Johns; Hopkins; Prevention; Epicenter; Transdisciplinary

PROJECT SUMMARY/ABSTRACT The purpose of this proposal is to translate basic, epidemiologic, and technologic discoveries into new strategies to prevent healthcare-associated infections and antibiotic resistance and to improve how antibiotics and diagnostic tests are used across all healthcare settings. This work includes six Core Projects and three Optional Collaborative Projects. The Core Projects include: (1) using a human factors engineering approach to improve environmental cleaning in diverse long-term care settings; (2) developing and testing a clinician- informed, electronic antibiotic-associated adverse event harm score for adults and children using data from the electronic health record (EHR) with the goal of changing antibiotic prescribing behaviors in the hospital; (3) developing a measure to detect episodes of organisms transmission from patients sequentially occupying the same hospital room using data from the EHR and piloting its use as an indicator for improved room cleaning; (4) characterizing the molecular epidemiology of extended spectrum β-lactamase-producing Enterobacterales, predicting what patients are colonized with them, and determining the role of infection control lapses and antibiotic exposure in their transmission; (5) characterizing the nasal microbiota of neonates that develop Staphylococcus aureus bacteremia to understand how to prevent this deadly infection; and (6) developing an algorithm using EHR data to identify rapidly healthcare workers and patients who have been exposed to an index patient with a transmissible infectious disease with the goal of quickly mitigating the risk of secondary exposures. The Optional Collaborative Projects include: (1) developing a benchmark for blood culture and blood culture positivity rates and a consensus definition of blood culture inappropriateness and using these results to implement and evaluate an evidence-based algorithm to improve blood culture practices in a multi- institution cohort of adult medicine patients; (2) characterizing the risk for and microbiology and geographical patterns of central line-associated bloodstream infections that are acquired outside of the hospital (e.g., at home, in long-term care facilities, at dialysis) and pilot a prevention toolkit to reduce the risk of infection for patients requiring a central catheter upon hospital discharge, and (3) determining how postnatal age impacts the association between birthweight and bacteremia rates in the neonatal intensive care unit (NICU) in order to develop a practical approach for reporting NICU-onset bacteremia rates that adjusts for birthweight and postnatal age. This proposal demonstrates capacity to integrate expertise in healthcare epidemiology and antibiotic stewardship with other disciplines—human factors engineering, data science, machine learning, microbiology, mathematical modeling, microbiome science, and implementation science—with the goal of identifying novel approaches to prevent healthcare associated infections and antibiotic resistance and that can inform CDC guidance and be applied across multiple settings to reduce harm to patients and healthcare workers.

项目总结/摘要 这项提案的目的是将基础、流行病学和技术发现转化为新的 预防医疗保健相关感染和抗生素耐药性的战略， 和诊断测试在所有医疗机构中使用。该项目包括六个核心项目和三个 可选的合作项目。核心项目包括：（1）使用人因工程方法， 在各种长期护理环境中改善环境清洁;（2）开发和测试临床医生- 成人和儿童的知情电子药物相关不良事件伤害评分，使用来自 电子健康记录（EHR），旨在改变医院的抗生素处方行为;（3） 制定一项措施，以检测生物体从顺序占据 使用来自EHR的数据的同一医院房间，并将其用作改善房间清洁的指标; (4)描述产超广谱β-内酰胺酶肠球菌的分子流行病学特征， 预测哪些患者被它们定殖，并确定感染控制失误的作用， 抗生素暴露在其传播;（5）表征新生儿的鼻微生物群， 金黄色葡萄球菌菌血症，以了解如何预防这种致命的感染;（6）制定一项 使用EHR数据的算法，以快速识别暴露于 指示患有传染性疾病的患者，目的是迅速降低继发性 暴露。可选的合作项目包括：（1）制定血液培养的基准， 血培养阳性率和血培养不适当的共识定义，并使用这些 结果，实施和评估循证算法，以改善血液培养的做法，在一个多， 成人内科患者的机构队列;（2）表征微生物学和地理的风险 在医院外获得的中心线相关血流感染的模式（例如，在 家庭、长期护理设施、透析），并试行预防工具包，以减少 出院时需要中心导管的患者，以及（3）确定出生后年龄如何影响 新生儿重症监护室（NICU）中出生体重与菌血症发生率之间的关系， 制定一种实用的方法来报告NICU发病菌血症率，该方法根据出生体重进行调整， 出生后年龄该提案表明，有能力整合卫生保健流行病学方面的专业知识， 抗生素管理与其他学科-人因工程，数据科学，机器学习， 微生物学、数学建模、微生物组科学和实施科学-目标是 确定新的方法来预防医疗保健相关的感染和抗生素耐药性， 为疾病预防控制中心提供指导，并应用于多种环境，以减少对患者和医疗保健的伤害 工人