Chicago Prevention and Intervention Epicenter (Chicago PIE)

芝加哥预防和干预中心（芝加哥 PIE）

• 批准号: 8437085
• 负责人: Robert Alan Weinstein
• 金额: $ 40.06万
• 依托单位: HEKTOEN INSTITUTE FOR MEDICAL RESEARCH
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-03-01 至 2016-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8437085
• 关键词: Chicago; Prevention; Intervention; Epicenter; PIE

DESCRIPTION (provided by applicant): Healthcare-acquired infections (HAIs) are a major source of patient suffering and societal cost. Despite improved use of the most essential HAI control measure, hand hygiene by healthcare workers, adherence still lags and additional measures are needed. Three groups of interventions, comprising 6 studies, are proposed. First, multi-drug resistant organisms (MDROs) - methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant gram-negative bacilli - and Clostridium difficile-associated infections (CDIs) are increasing causes of HAIs. MDROs often ping-pong between hospitals and long-term care; this highlights the importance of a regional, rather than the traditional institution-based, approach to control. The Chicago Prevention and Intervention Epicenter proposes T0/1/2/3 regional interventions in acute and long-term care facilities that will include enhanced surveillance and communication and patient cleansing with chlorhexidine to decrease MDRO risk in Chicago. Successful projects can inform MDRO control in other geographic areas. CDIs result in part from the effect of antibiotics on intestinal microbes. Probiotics, mixtures of natural gut- stabilizing bacteria, given to patients receiving antibiotic therapy have the potential to reduce risk of CDI. A T0/1/2 demonstration project of a novel probiotic that has shown promise for preventing CDIs is proposed. Second, device-related infections are addressed. Catheter-related bloodstream infections (CLABSIs) have declined due to wide application of interventions recommended in 2002 by CDC. Now, it may be possible to eliminate CLABSIs by controlling the major remaining infection source-extrinsic contamination of catheter hubs and fluid pathways. A T0/1/2 ICU and lab study of aggressive asepsis of catheter hubs is proposed. Catheter-associated urinary tract infection (CAUTI), although of lower morbidity, is a major MDRO reservoir and source of spread from hospitals into long-term care. A CAUTI technical innovation that has many early adopters despite absence of well-demonstrated efficacy is the handheld bladder scanner. These devices are expensive but provide the opportunity to determine bladder volume non-invasively. A T0/2 prospective controlled trial of bladder scanners for infection control is proposed. Third, we are facing MDROs with no new drugs. A T1/2 intervention to provide more rational antimicrobial use in ICUs, hot spots of resistance, is proposed. Educational activities that have been successful in other venues will be compared with the value of a biologic marker of bacterial infection - procalcitonin - for directing antimicrobial therapy. The impact on ICU infection and prescribing characteristics of doctors will be assessed. To further assess the interventions, costs of averted outcomes and of the interventions will be compared. OPRIONAL OBEJCTIVE SCORE: 2

描述（由申请人提供）：医疗保健获得性感染（HAI）是患者痛苦和社会成本的主要来源。尽管改善了最基本的HAI控制措施的使用，但医护人员的手部卫生，依从性仍然滞后，需要采取额外的措施。提出了三组干预措施，包括6项研究。首先，多重耐药微生物（MDRO）-耐甲氧西林金黄色葡萄球菌（MRSA）和耐碳青霉烯革兰氏阴性杆菌-和艰难梭菌相关感染（CDIs）是HAI的增加原因。MDRO经常在医院和长期护理之间来回切换;这突出了区域性而不是传统的机构控制方法的重要性。芝加哥预防和干预中心建议在急性和长期护理设施中采取T0/1/2/3区域干预措施，包括加强监测和沟通以及用洗必泰清洗患者，以降低芝加哥的MDRO风险。成功的项目可以为其他地理区域的MDRO控制提供信息。抗生素对肠道微生物的影响部分导致了CDIs。益生菌是天然肠道稳定细菌的混合物，给予接受抗生素治疗的患者有可能降低CDI的风险。提出了一种新型益生菌的T0/1/2示范项目，该项目已显示出预防CDIs的前景。第二，解决与器械相关的感染。导管相关性血流感染（CLABSI）已下降，由于广泛应用的干预措施建议在2002年由CDC。现在，有可能通过控制主要的剩余感染源-导管座和液体通路的外源性污染来消除CLABSI。提出了导管座积极无菌的T0/1/2 ICU和实验室研究。导管相关性尿路感染（MDRO）虽然发病率较低，但却是MDRO的主要储存库，也是从医院传播到长期护理的来源。尽管缺乏充分证明的疗效，但有许多早期采用者的一项技术创新是手持式膀胱扫描仪。这些设备是昂贵的，但提供了机会，以确定膀胱体积非侵入性。提出了一项膀胱扫描仪用于感染控制的T0/2前瞻性对照试验。第三，我们面对的是没有新药的MDRO。T1/2干预，以提供更合理的抗菌药物使用ICU，耐药的热点，提出了。在其他场所成功的教育活动将与细菌感染的生物标志物-降钙素原-指导抗菌治疗的价值进行比较。将评估对ICU感染和医生处方特征的影响。为了进一步评估干预措施，将对避免的结果和干预措施的成本进行比较。 主观评分：2分