Epicenter V: Harvard Pilgrim Health Care Institute Center for Excellence in HAI Surveillance and Prevention

摘要 震中V：哈佛朝圣者医疗保健研究所中心 HAI监测和预防方面的卓越：核心项目 这个震中将追求六个目标，以开发基本信息来指导改善管理 脓毒症、非呼吸机医院获得性肺炎与医院间艰难梭菌感染的预防 住院病人。 败血症工作将以对300家医院的电子健康记录数据进行分析为基础 来自HCA Healthcare和Cerner的HealthFact数据库，共同涵盖2013至2019年，以及 涉及一百万个败血症住院病人。这些研究将使用先进的因果推理方法来解决 与败血症管理和国家任务规定直接相关的三个主要问题 报销政策。这些问题是：1)病情的严重程度如何影响 血液感染患者使用抗生素的时间与生存的关系？2)如何 短程经验性抗生素治疗的不良反应常见且严重 疑似脓毒症的患者是否有非感染性疾病？3)未能解除感染的后果是什么？ 在排除感染后，升级为疑似脓毒症患者开的经验性抗生素？ 首个非呼吸机医院获得性肺炎(NV-HAP)的目标将解决一个关键的未知问题 关于这种常见且经常致命的疾病--NV-HAP相关死亡在多大程度上是可以预防的？ 此评估将使用先前经过验证的方法，专家临床医生将通过这些方法审查全文医疗 来自教学医院和社区医院的记录，以确定死亡原因并确定其 与NV-HAP的关系。这些发现将告知实施国家监控和 报告NV-HAP的发生，并设计和测试缓解战略。 第二个NV-HAP AIM将设计和测试药剂师主导的选择退出协议，以停止使用 20%被诊断为NV-HAP且临床症状正常的住院患者使用抗生素。这是随机的 试验将评估对抗生素使用的影响，并为以后的最终决定奠定基础 对患者预后影响的试验。 最终目标将解决在高危人群中预防艰难梭菌医院感染的方法。 病人。我们将通过VRE监测拭子的聚合酶链式反应测试来鉴定感染艰难梭菌的患者 在入院时获得。在干预期间，被殖民的患者将收到一份预防捆绑包，包括 抗生素和抗酸剂的管理以及预防性益生菌和口服万古霉素的考虑。

Abstract Epicenter V: Harvard Pilgrim Health Care Institute Center for Excellence in HAI Surveillance and Prevention: Core Projects This Epicenter will pursue six aims to develop essential information to guide improved management of sepsis, non-ventilator hospital acquired pneumonia, and prevention of C. difficile infection among hospital inpatients. The sepsis work will be grounded in analyses of electronic health record data from 300 hospitals drawn from HCA Healthcare and Cerner’s HealthFacts database, together covering the years 2013 through 2019, and involving 1 million sepsis admissions. These studies will use advanced causal inference methods to address three major questions with direct relevance both to management of sepsis and to national mandates and reimbursement policies. These questions are: 1) How does severity of illness at presentation affect the relationship between time-to-antibiotic and survival among patients with bloodstream infections? 2) How common and serious are adverse effects of short course empiric antibiotic therapy among patients with suspected sepsis who prove to have non-infectious conditions? 3) What are the consequences of failure to de- escalate empiric antibiotics prescribed for suspected sepsis after infection is ruled out? The first non-ventilator hospital acquired pneumonia (NV-HAP) aim will address a critical unknown about this common and frequently fatal condition – to what extent are NV-HAP associated deaths preventable? This assessment will use previously validated methods by which expert clinicians review full text medical records from both teaching and community hospitals to determine the cause of death and to determine its relationship to NV-HAP. These findings will inform the urgency of implementing national surveillance and reporting of NV-HAP occurrence, and of designing and testing mitigation strategies. The second NV-HAP aim will design and test a pharmacist led opt-out protocol for discontinuing antibiotics for the 20% of inpatients diagnosed with NV-HAP who have normal clinical signs. This randomized trial will be powered to assess the impact on antibiotic utilization and lay the groundwork for a later definitive trial of the impact on patient outcomes. The final aim will address methods for preventing hospital-onset C. difficile infection amongst high risk patients. We will identify patients colonized with C. difficile via PCR testing of VRE surveillance swabs obtained on admission. Colonized patients in the intervention period will receive a prevention bundle including antibiotic and antacid stewardship as well as consideration of prophylactic probiotics and oral vancomycin.