Transmission of Antibiotic-resistant Gram-negative Bacteria in Nursing Homes

 描述（由申请人提供）：医疗保健相关感染（HAI）在疗养院中很常见，通常由多重耐药微生物（MDRO）如MRSA和抗生素耐药革兰氏阴性菌（R-GNB）引起。这些MDRO在居民中定殖，并可通过医护人员在居民之间传播。长袍和手套的使用可以防止这种传播，降低HAI的风险;然而，它们的使用有损于家庭般的环境，这是养老院的一个重要优先事项。在养老院什么时候穿长袍和戴手套以及居民穿什么的证据都缺乏。为了告知在这种情况下的感染控制实践，我们最近完成了一个AHRQ资助的项目（1 R18 HS 019979 - 01 A1），研究MRSA传播到与疗养院居民互动的医护人员所穿的长袍和手套。来自马里兰州和密歇根州13个社区养老院的400多名居民参加了研究。从每个居民的前鼻孔和肛周皮肤获得培养物。然后，我们要求医护人员在常规护理访视（例如洗澡）时穿戴长袍和手套。一名研究协调员观察并记录了所提供的护理类型。在每次访视结束时，研究协调员在处置之前擦拭医疗保健人员的长袍和手套。从401名登记的居民中，我们确定了113名居民与MRSA定殖。我们发现，在隔离衣（14%）和手套（24%）上的MRSA污染率很高。重要的是，有特定类型的护理和特定的居民特征具有MRSA传播的高风险。这些结果表明，使用长袍和手套来减少MRSA传播的几种新的循证方法。确定R-GNB的传播与MRSA的传播是否相似或不同是决定这些方法中最佳方法的关键。本申请的目的是使用这一独特的现有标本收集来估计R-GNB的总体和护理活动特定传播风险。我们将使用基于培养的方法从我们先前收集的肛周拭子中检测R-GNB。我们的初步数据表明，R-GNB的传播低于MRSA。我们将测试以下假设：假设1：R-GNB传播到长袍和手套的风险低于MRSA传播到长袍和手套的风险。假设2：R-GNB传播的风险因与居民接触的类型而异。一些活动，如涉及MRSA传播高风险护理（如洗澡）的风险高于不涉及MRSA传播低风险护理（如药物）的风险。这项研究将扩大MRSA传播到R-GNB的研究结果，为确定长袍和手套的最佳使用提供进一步的证据，以防止社区养老院中MDRO的传播。

 DESCRIPTION (provided by applicant):Healthcare associated infections (HAI) are common in nursing homes and are often caused by multidrug- resistant organisms (MDRO) such as MRSA and antibiotic resistant Gram-negative bacteria (R-GNB). These MDROs colonize residents and can be spread from resident to resident by healthcare personnel. The use of gowns and gloves can prevent this spread decreasing the risk of HAI; however, their use detracts from a home-like environment which is an important priority for nursing homes. The evidence for when to wear gowns and gloves in nursing homes and with which residents is lacking. In order to inform infection control practices in this setting, we recently completed an AHRQ funded project (1R18HS019979-01A1) to study MRSA transmission to gowns and gloves worn by healthcare personnel interacting with nursing home residents. Over 400 residents from 13 community-based nursing homes in Maryland and Michigan were enrolled. Cultures were obtained from each resident's anterior nares and perianal skin. We then asked healthcare personnel to wear gowns and gloves during usual care visits (e.g. bathing). A research coordinator observed and recorded the types of care delivered. At the end of each visit, the research coordinator swabbed the healthcare personnel's gown and gloves prior to disposing of them. From 401 enrolled residents, we identified 113 residents colonized with MRSA. We found high rates of MRSA contamination on both gowns (14%) and gloves (24%). Importantly there were specific types of care and specific resident characteristics with a high risk of MRSA transmission. These results suggest several novel, evidence-based approaches to the use of gowns and gloves to reduce MRSA transmission. Determining whether the transmission of R-GNB is similar or different to the transmission of MRSA is key to deciding on the best of these approaches. The aim of this application is to estimate the overall and care- activity specific transmission risk for R-GNB using this unique existing collection of specimens. We will use culture based methods to detect R-GNB from our previously collected perianal swabs. Our preliminary data suggests that R-GNB transmission is lower than MRSA. We will test the following hypotheses: Hypothesis 1: Risk of R-GNB transmission to gowns and gloves is lower than the risk of MRSA transmission to gowns and gloves. Hypothesis 2: Risk of R-GNB transmission varies by type of contact with the resident. Some activities such as those involving care at high risk for MRSA transmission (e.g. bathing) are of higher risk than those not involving care at low risk for MRSA transmission (e.g. medications). This study will extend the findings on MRSA transmission to R-GNB providing further evidence for determining the optimal use of gowns and gloves to prevent the transmission of MDROs in community-based nursing homes.