The SAFER Lines Project: Standardizing Assessment For Effective Response

 描述(由申请人提供)：虽然积极的感染预防努力显著减少了住院环境中的医疗保健相关感染(HAI)，但复杂的医疗保健已经从医院转向疗养院、非卧床护理环境，甚至是具有家访保健护理的家庭。外周插入中心静脉导管(CVC)的出现使得无需住院就可以安全地给药，因此现在可以在家中、在诊所或在熟练的护理机构由护士进行长期静脉治疗。然而，在美国养老院的300万美国人中，超过67%的人经历了与医疗保健相关的感染，导致每年超过15万人重新入院，超过38万人死亡。这些感染中有许多与医疗器械有关。因此，熟练的护理机构、肿瘤学输液中心和家庭健康护士在护理因年龄、合并症、伤口和医疗器械而导致感染风险高的患者时需要保持警惕。尽管在医院外发生的甲型HI病毒感染比在医院内发生的更多，但人们对院外环境下甲型HAI病毒的负担和最佳管理知之甚少。目前中心线相关性血流感染(CLABSI)的感染预防策略侧重于住院患者的需求，如无菌插管实践，这些与插管后的院外CVC管理不太相关。此外，无数的门诊设置导致监测和记录CVC评估和护理的方法非常不同。在院外环境下预防CLABSI的综合方法将包括强调CVC的无菌访问，监测插入部位局部炎症的早期迹象，向负责任的医疗保健提供者发出问题的警报，并触发有效的响应协议以移除问题线路。这种方法应该可以在不同的医院外环境中翻译。SAFER(有效反应标准化评估)LINES项目将评估一个全面的感染预防捆绑包，以减少感染并改善临床结果。该捆绑包包括关于CVC无菌访问的教育，以及一个基于Web的应用程序，该应用程序允许常规使用标准化的中心线插入部位评估(CLISA)评分工具，自动向医生发出高分警报，并激活响应团队以快速移除CLABSI迫在眉睫的风险线。该项目将包括五家疗养院、两家家庭健康机构和两家门诊设施。

 DESCRIPTION (provided by applicant): While aggressive infection prevention efforts have significantly reduced healthcare-associated infections (HAIs) in the inpatient setting, there has been a dramatic shift of complex medical care from the hospital to nursing homes, ambulatory care settings, and even homes with visiting home health nursing care. The advent of the peripherally-inserted central venous catheter (CVC) allows for safe drug delivery without the need for hospitalization such that prolonged intravenous therapy can now be administered at home, at clinic, or by nurses at skilled nursing facilities. Nevertheless, among the 3 million Americans in U.S. nursing homes, over 67% of them experience a healthcare-associated infection, resulting in over 150,000 readmissions and over 380,000 deaths annually. Many of these infections are related to medical devices. Thus, skilled nursing facilities, oncology infusio centers, and home health nurses need to be vigilant in their care of patients at high risk for infection due to their age, comorbidities, wounds, and medical devices. Despite the fact that more preventable HAIs occur outside of hospitals than in hospitals, little is known about the burden and optimal management of HAIs in the out-of-hospital setting. Current infection prevention strategies for central line associated bloodstream infections (CLABSIs) focus on inpatient needs such as sterile insertion practices, which are not as relevant to post-insertion out-of-hospital CVC management. Furthermore, the myriad of outpatient settings results in highly variable approaches to monitoring and documenting CVC assessment and care. A comprehensive approach to CLABSI prevention in the out-of-hospital setting would include an emphasis on sterile access of the CVC, monitoring for early signs of localized inflammation at the insertion site, alerting responsible healthcare providers to problems, and triggering an efficient response protocol to remove problematic lines. This approach should be translatable across various out-of-hospital settings. The SAFER (Standardizing Assessment For Effective Response) Lines Project will evaluate a comprehensive infection prevention bundle to reduce infection and improve clinical outcomes. The bundle includes education on sterile access of CVCs, and a web-based application that enables routine use of a standardized central line insertion site assessment (CLISA) scoring tool, automated alerting of physicians for high scores, and activation of a response team to rapidly remove lines at imminent risk for CLABSI. The project will include five nursing homes, two home health agencies, and two outpatient clinic settings.