Decreasing Bioburden to Reduce Healthcare-Associated Infections and Readmissions

卫生保健相关感染（HAI）是可预防的发病率和死亡率的主要原因。 由于HAI的高发病率，预防HAI是国家对患者安全和最佳实践的优先事项， 死亡率和成本，每年产生超过65亿美元的医疗费用。大多数感染是由 通常生活在皮肤上或鼻子里的普通细菌，正常防御 由于侵入性医疗设备、手术切口或住院治疗的生理效应。研究 重症监护病房（ICU）表明病人非殖民化 皮肤用洗必泰，鼻孔用 莫匹罗星可以预防许多HAI。然而，缺乏证据表明非殖民化在以下方面的有效性： 非ICU环境，大多数HAI发生的地方，以及医疗护理、感染风险、患者间 相互作用、病原体传播和洗澡习惯与ICU环境有很大不同。 因此，在这些情况下很少使用非殖民化，尽管它有可能有意义地降低HAI率。 ABATE感染试验（在入院时消除感染）将有效地 评价去殖民化对ICU外一般患者人群中HAI的影响。这个集群是随机的 试验将随机选择50家医院，治疗近40万名患者，以评估1）通用每日 洗必泰沐浴，以防止所有病原体的感染，结合2）鼻腔去殖民化， 莫匹罗星用于已知的耐甲氧西林金黄色葡萄球菌（MRSA）携带者， HAI的原因虽然非殖民化在短期停留的高风险地区取得了成功，如ICU，但这项试验 将解决非ICU内科和外科病房中更大的HAI问题。该患者人群 由于足够大的随机试验的复杂性和成本， 证明有效性已经超出了传统的医院试验的范围。 这项试验将提供急需的去殖民化评估，以降低医院感染风险 和感染性再入院的病例。它将提供必要的信息， 每天用氯己定洗澡进行常规去殖民化是否应该成为标准做法， 仅在美国，每年就有4000万患者住院。或者，它会建议量身定制 对于ICU外的这些患者，需要与ICU环境中有效的策略不同的策略。 这项试验还将说明一种新的临床有效性研究模式的优势， 并通过将研究嵌入到通常的交付中， 医疗保健，并利用大型医院系统的组织和信息优势。

Healthcare-associated infections (HAIs) are a leading cause of preventable morbidity and mortality. Prevention of HAIs is a national priority for patient safety and best practice because of their high morbidity, mortality, and cost, incurring over $6.5 billion dollars of healthcare costs each year. Most infections result from common bacteria that normally live on the skin or in the nose and which overcome the bodys normal defenses because of invasive medical devices, surgical incisions, or the physiologic effects of hospitalization. Studies in intensive care units (ICUs) indicate that decolonization of patients skin with chlorhexidine, and nares with mupirocin can prevent many HAIs. However, evidence is lacking about the effectiveness of decolonization in non-ICU settings, where the majority of HAIs occur, and where medical care, risk of infection, patient-to-patient interactions, pathogen transmission, and bathing practices differ considerably from ICU settings. Decolonization is thus rarely used in these settings, despite its potential to meaningfully decrease the HAI rate. The ABATE Infection Trial (Addressing Bioburden while Admitted To Eliminate Infection) will efficiently evaluate the impact of decolonization on HAIs in the general patient population outside ICUs. This clusterrandomized trial will randomize 50 hospitals treating nearly 400,000 patients to evaluate 1) universal daily chlorhexidine bathing to prevent infections from all pathogens, combined with 2) nasal decolonization with mupirocin for known carriers of methicillin-resistant Staphylococcus aureus (MRSA), one of the most common causes of HAIs. While decolonization has been successful in short-stay high risk areas, such as ICUs, this trial will address the much larger problem of HAIs in non-ICU medical and surgical wards. This patient population has typically not been evaluated because the complexity and cost of sufficiently large randomized trials to demonstrate effectiveness have been beyond the reach of conventional hospital-based trials. This trial will provide a critically needed evaluation of decolonization to reduce hospital infection risk and infectious readmissions in nearly all hospitalized patients. It will provide essential information to determine whether routine decolonization through daily bathing with chlorhexidine should become standard practice for 40 million patients hospitalized each year in the United States alone. Alternatively, it will suggest that tailored strategies distinct from those effective in ICU settings are needed for these patients outside ICUs. This trial will also illustrate the strengths of a new model of clinical effectiveness research that quickly and efficiently addresses critical management questions by embedding research into the usual delivery of health care, and using the organizational and informatics strengths of a large hospital system.