Statewide Implementation of Guidelines to Control MRSA

描述（由申请人提供）：耐甲氧西林（oxacillin）金黄色葡萄球菌（MRSA）是迄今为止最常见的耐药细菌病原体。尽管为减少传播作出了协调一致的努力，但在卫生保健机构和社区中，这种有机体的流行率继续增加。此外，这种微生物现在在没有MRSA感染的传统危险因素的人身上引起严重感染，它可以在医疗机构和社区中无声地传播。很少有医院执行了预防MRSA传播的循证指南的所有组成部分。拟议研究的目的是：1)鼓励爱荷华州所有医院实施卫生保健改善研究所（IHI）的MRSA捆绑治疗，并向爱荷华州独特的医疗保健相关感染自愿报告系统报告院内MRSA感染数据；2)确定成功翻译这一循证公共卫生指南的障碍和/或促进因素；3)确定最佳战略，以促进这种有效的公共卫生干预措施的广泛采用和制度化。一个由循证指南实施、质量改进、传染病、微生物学、分子流行病学、医院流行病学、公共卫生、医疗服务和医疗政策方面的专家组成的强大联盟将研究这一循证指南的实施，以控制MRSA。本提案有6个具体目标：1)评估急症护理医院、长期护理机构和门诊环境中关于MRSA控制的知识、当前预防措施和需求；2)在爱荷华大学医院和诊所、爱荷华市退伍军人事务医疗中心以及爱荷华州的急症护理医院实施IHI的MRSA套餐；3)确定在医院以外的地点携带MRSA、医护人员携带MRSA和环境污染是否会降低IHI的MRSA捆绑治疗的有效性；4)评估IHI的MRSA Bundle在个别医院和爱荷华州医院的总体实施情况；5)在个别医院和爱荷华州医院总体上评估IHI的MRSA捆绑治疗的有效性；6)开发资源，帮助社区预防MRSA的传播；在社区控制MRSA可能会提高IHI在医院的MRSA捆绑治疗的有效性。这些方法将包括观察实践，计算院内MRSA血流感染率和MRSA传播率，将这些比率反馈给临床医生，评估进展，实施更多变化，并再次测量比率（快速周期变化）。统计分析将采用时间序列分析方法，适用于频繁出现零的数据，以评估实施循证指南是否成功。总结性调查和焦点小组，使用赞赏询问，积极偏差和关键事件分析的方法，将进行，以确定实施的促进因素和障碍。耐甲氧西林金黄色葡萄球菌（MRSA）是在健康人群和免疫系统受损人群中引起严重感染的最常见耐药细菌，它继续在卫生保健机构和社区中传播。然而，许多研究已经证明，特别是在医院里，共同努力可以减少MRSA感染并防止这种有机体的传播。该提案的目标是在爱荷华州的医院和社区的高风险地区实施这些有效的做法，以预防MRSA感染，并学习如何最好地将医学知识转化为日常医疗实践。

DESCRIPTION (provided by applicant): Methicillin (oxacillin)-resistant Staphylococcus aureus (MRSA) is by far the most common resistant bacterial pathogen. Despite concerted efforts to decrease transmission, the prevalence of this organism continues to increase in healthcare facilities and in the community. Moreover, this organism now causes serious infections in persons who do not have the traditional risk factors for MRSA infections and it can spread silently in the healthcare setting and in the community. Few hospitals have implemented all components of the evidence-based guidelines for preventing spread of MRSA. The purpose of the proposed study is to 1) encourage all Iowa hospitals to implement the Institute for Healthcare Improvement's (IHI) MRSA bundle and to report data on nosocomial MRSA infections to Iowa's unique voluntary reporting system for healthcare-associated infections; 2) identify impediments and/or facilitators to successful translation of this evidence-based public health guideline; 3) identify optimal strategies for enhancing widespread adoption and institutionalization of this effective public health intervention. A robust coalition of specialists in implementation of evidence-based guidelines, quality improvement, infectious diseases, microbiology, molecular epidemiology, hospital epidemiology, public health, healthcare delivery, and healthcare policy will study the implementation of this evidence-based guideline to control MRSA. This proposal has 6 specific aims: 1) Assess knowledge, current preventive practices, and needs regarding MRSA control in acute-care hospitals, long-term-care facilities, and in the outpatient setting; 2) Implement IHI's MRSA bundle at the University of Iowa Hospitals and Clinics, the Iowa City Veterans Affairs Medical Center, and at acute care hospitals across Iowa; 3) Determine whether MRSA carriage at sites other than the nares, carriage by healthcare workers, and environmental contamination decreases the effectiveness of IHI's MRSA Bundle; 4) Assess the implementation of IHI's MRSA Bundle in individual hospitals and in Iowa's hospitals in general; 5) Assess the effectiveness of IHI's MRSA bundle at individual hospitals and in Iowa's hospitals in general; 6) Develop resources to help the community prevent spread of MRSA; control of MRSA in the community might enhance the effectiveness of IHI's MRSA bundle in hospitals. The methods will involve observing practice, calculating rates of nosocomial MRSA bloodstream infections and of MRSA transmission, feeding these rates back to the clinicians, evaluating progress, implementing more change, and measuring rates again (rapid-cycle change). Statistical analysis will be done by time series analysis methods adapted for data with frequent zeros to assess whether implementing the evidence-based guideline was successful. Summative surveys and focus groups, using methods from appreciative inquiry, positive deviance, and critical incident analysis, will be conducted to identify facilitators and obstacles to implementation. Methicillin-resistant Staphylococcus aureus (MRSA), which is the most common resistant bacteria causing serious infections in both healthy people and people whose immune systems are impaired, continues to spread in healthcare facilities and in the community. Yet numerous studies have demonstrated that concerted efforts, particularly in hospitals, can decrease MRSA infections and prevent spread of this organism. The goal of this proposal is to implement these effective practices in hospitals and in high risk areas of the community across Iowa to prevent MRSA infections and to learn how best to translate medical knowledge into everyday medical practice.