Implementation of Chlorhexidine Bathing to Reduce Healthcare-Associated Infections-the Icare study

 描述(由申请人提供)：与医疗保健相关的感染导致发病率、死亡率和医疗费用增加。据估计，每年有72.2万人患上与医疗保健相关的感染(每25名住院患者中就有一人)，7.5万人死于HAIS。近年来，用于减少医疗保健相关感染的干预措施的证据基础大幅增长，人类免疫缺陷病毒感染被认为在很大程度上是可以预防的，是一个患者安全问题。然而，在医疗保健相关感染预防领域的证据和实践之间仍然存在相当大的差距。因此，减少美国医疗保健相关感染的健康和经济负担的一个重要机遇和挑战是将干预措施转化为多个现实世界环境。每天洗澡是一种有效的干预措施，可以减少与医疗保健相关的感染。要将这一干预措施推广到广泛的实践中，需要解决的关键问题包括：使干预措施适应在多种环境和人群中使用；研究干预措施对设施和个人参与者的可行性、可接受性、覆盖面和接受度；以及执行情况评估，包括障碍和促进者评估。我们建议使用一种创新的系统工程方法，即在多个非ICU环境中实施患者安全系统工程倡议，来实施和评估实施每日洗必泰沐浴干预的过程。我们将采用有指导的实施方法，并将使用多个案例研究方法来评估实施情况，包括通过直接观察、洗必泰使用情况、电子健康记录文件和洗必泰浓度的微生物学评估，评估每日洗必泰洗澡干预措施的障碍和促进者以及忠诚度。我们还将探讨每日洗必泰洗澡干预对医疗保健相关感染的影响。这项研究将为实施和评估医疗保健相关感染预防的其他循证干预措施提供一个框架。

 DESCRIPTION (provided by applicant): Healthcare-associated infections cause increased morbidity, mortality and medical costs. It is estimated that 722,000 people get a healthcare-associated infection every year (1 in 25 hospitalized patients) and 75,000 people with HAIs die. In recent years, the evidence base for interventions to reduce healthcare-associated infections has grown substantially and HAIs are considered largely preventable and a patient safety issue. However, a considerable gap continues to exist between evidence and practice in the field of healthcare-associated infection prevention. Thus, an important opportunity and challenge to reduce the health and economic burden of healthcare-associated infection in the United States is the translation of interventions in multiple real world settings. Daily chlorhexidine bathing isan efficacious and effective intervention that can reduce healthcare-associated infections. Key issues to address to disseminate this intervention into widespread practice include the adaptation of the intervention for use in multiple settings and populations; research on the feasibility, acceptability, reach and uptake of the intervention for both the facility and individul participants and implementation evaluation including barriers and facilitators assessment. We propose to implement and evaluate the process of implementing a daily chlorhexidine bathing intervention using an innovative systems engineering approach, the Systems Engineering Initiative for Patient Safety in multiple non ICU settings. We will employ a mentored implementation approach and will evaluate the implementation using a multiple case study approach including assessment of barriers and facilitators and fidelity to the daily chlorhexidine bathing intervention using direct observations, chlorhexidine usage, electronic health record documentation and microbiologic assessment of chlorhexidine concentrations. We will also explore the impact of the daily chlorhexidine bathing intervention on healthcare-associated infections. This study will provide a framework to implement and evaluate other evidence-based interventions for healthcare- associated infection prevention.