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

摘要 我们设计这项提案是为了解决疾控中心多个中心的研究重点：预防医疗保健 人员(HCP)污染、了解和减少重要流行病的传播 包括新冠肺炎等新兴呼吸道病毒在内的病原体，延长了抗菌药物的管理 (AS)，减少耐药感染，探索脓毒症流行病学和预防，量化 以及减少环境污染，实施非殖民化方案以获得源头控制 并减少手术部位感染(SSI)，应用创新的研究方法，并培训下一步 一代保健流行病学家。我们建议的项目范围从翻译阶段T0到T2和 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)、外科患者、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)提高感染预防的整体性 改进个人防护装备(PPE)的设计和使用 为了减少HCP污染和传播，3)改善对医疗保健相关感染的监测 (HAI)，4)确定减少病毒病原体传播的可行方法，4)改善抗生素的使用并减少 抗菌素耐药性，以及5)预防医院感染(HOS)和医院感染(HAI)，包括SSI。核心项目 (CP)I使用人因工程学、人种学、工业卫生学、环境学等方法 微生物学和计算机视觉，以改进PPE设计，减少HCP自身污染，改善 在患者护理过程中将个人防护用品的使用与手卫生相结合，减少细菌和病毒环境 污染。CP II通过手机使用新型软件来扩大对SSI和艰难梭菌的监测 出院后感染，并监测接触呼吸道病毒的HCP的迹象或症状 感染。CP III和中型可选合作项目(OCP)解决了以下方面被忽视的机会 AS-UCC和出院患者--通过创造和测试减少抗生素的新指标 UCC中急性呼吸道感染的处方(CP III)和进行整群随机试验 处方后审核和复查，以减少出院后不必要的抗生素使用(中度OCP)。CP IV挖掘大型管理数据集并分析来自个人医疗记录的数据，以定义 居屋的流行病学，验证疾控中心针对居屋的急性败血症事件算法，并确定可补救的居屋风险 可能成为预防措施目标的因素。大型OCP将进行阶梯式楔形试验 简单、廉价的干预措施--2剂聚维酮碘鼻腔注射--用于预防高血压病患者SSI。 他们是高危人群，几乎没有可用的预防措施。这个 Small OCP试图通过将地理空间信息包括在 抗生素图谱。这些信息应该为临床医生提供更多针对他们患者的信息。

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.