Prevention of Nosocomial Infections and Cost Effectiveness in Nursing Homes

描述（由申请人提供）：大约有160万美国人住在全国16，000家养老院（NHs）中，“体弱老人”占居民的90%。预计未来几年这一群体将大幅增加，并变得更加多样化。据报道，在美国，每年有160万至380万人感染。医疗保健相关感染（HAI）是居民发病和死亡的主要原因，这一脆弱人群被认为是感染和定植多药耐药微生物（MDRO）的高风险人群。我们发现，15%的美国卫生保健机构每年都会收到感染控制方面的缺陷引文，这表明明显需要将重点放在预防上 在这种情况下。在NHS中，很少有研究记录感染控制相关结构或过程在预防HAI中的功效。一些州已经对国家卫生机构的HAI强制性报告进行了监管，其他州已经实施了全州范围的学习协作;然而，这些举措的有效性尚不清楚。显然需要进行研究，以了解与HAI预防相关的最佳实践以及在这种情况下感染控制的价值。基于我们以前在急性护理方面的工作，并与在NHS进行研究的专家合作，我们提出了一项为期4年的混合方法比较有效性研究，以解决这些差距。我们的目标是：1）描述全国NH中HAI（肺炎、败血症、尿路感染、伤口感染和MDRO感染/定植）的发生率以及相关的州水平特征（例如，强制报告和全州协作），设施级特征（例如，所有权、床位大小和护士配备）和住院医师护理过程（例如，隔离）; 2）确定具有持续高和低HAI率的NHS以及HAI率、州和设施水平特征与居民护理过程之间的关系; 3）使用描述性探索性方法描述NHS中的感染控制现象; 4）确定当前感染控制结构和过程在预防老年居民HAI方面的比较有效性;以及5）确定NHS中有效感染控制过程的成本效益。目标3的分析策略包括完善的定性程序，最大限度地提高数据的完整性和真实性。目标1、2、4和5的分析策略包括最先进的多元计量经济学方法，旨在最大限度地减少潜在的偏差和解决数据聚类问题。我们的跨学科团队是唯一有资格进行这项研究。结果将告知全国各地的床旁临床医生和政策制定者如何最好地消除NHS中的HAI，并为未来的指南提供信息。

DESCRIPTION (provided by applicant): Approximately 1.6 million Americans live in the nation's 16,000 nursing homes (NHs) and the "frail elderly" account for 90% of the residents. This population is expected to increase dramatically and become more diverse in the coming years. It is reported that between 1.6 and 3.8 million infections occur each year in U.S. NHs. Healthcare associated infections (HAI) are leading causes of morbidity and mortality among residents and this vulnerable population is considered high risk for infection and colonization with multi-drug resistant organisms (MDRO). We have found that 15% of U.S. NHs receives deficiency citations for infection control each year indicating a clear need to focus on prevention in these settings. In NHs there is little research documenting the efficacy of infection control related structures or processes in preventing HAI. Some states have regulated mandatory reporting of HAI in NHs and other states have implemented statewide learning collaborative; however, the effectiveness of these initiatives is not known. Research is clearly needed to understand best practices related to HAI prevention and the value of infection control in this setting. Building upon our previous work in acute care and partnering with experts conducting research in NHs, we propose a 4- year, mixed-method, comparative effectiveness study that will address these gaps. Our aims are: 1) Describe the incidence of HAI (pneumonia, sepsis, urinary tract infections, wound infections and MDRO infections/colonization) in NHs across the nation and associated state level characteristics (e.g., mandatory reporting and statewide collaborative), facility level characteristics (e.g., ownership, bed size and nurse staffing) and resident care processes (e.g., isolation); 2) Identify NHs that have persistently high and low HAI rates and the relationship between the HAI rates, state and facility level characteristics and resident care processes; 3) Use a descriptive exploratory approach to describe the phenomenon of infection control in NHs; 4) Determine the comparative effectiveness of current infection control structures and processes in preventing HAIs in elderly residents; and 5) Determine the cost-effectiveness of efficacious infection control processes in NHs. The analytic strategy for Aim 3 includes well-developed qualitative procedures that maximize completeness and truthfulness of the data. The analytic strategies for Aims 1, 2, 4 and 5 include state of the art multivariate econometric methods designed to minimize potential bias and address clustering of data. Our interdisciplinary team is uniquely qualified to conduct this study. Results will inform bedside clinicians and policy makers across the nation on how to best eliminate HAIs in NHs and inform future guidelines.