Prevention Epicenter of Emory and Atlanta Consortium Hospitals (PEACH)

 描述（由申请人提供）：医疗保健工作者（HCW）在患者护理过程中有感染埃博拉病毒等病原体的风险，最近在美国医院特殊隔离病房外治疗的第一名患者的护理过程中发生了这种情况。该提案将解决预防感染的两个主要方面，以防止病原体通过接触传播：在护理通过接触传播的致命病原体（如埃博拉病毒）和手部卫生（HH）的患者时使用个人防护设备（PPE），这是预防病原体通过直接接触传播的最基本感染预防措施，但在大多数医疗机构中并不可靠。适当地穿戴和脱下高水平PPE是具有挑战性的，并且要求HCW在每次遭遇时坚持一系列复杂的步骤，并且正确且一致地这样做而不会自我污染。三个项目将采用多学科方法，目标是：1）对复杂的PPE落料进行综合的生物和人为因素分析，使用无害病毒评估污染（T0-T1）; 2）通过利用物理环境的变化来改善工艺和流程（T1），减少PPE落料过程中的自身污染;以及3）评估不同形式的反馈以改进由自动化监视系统（T0-T2）测量的HH依从性。第一个项目将在格鲁吉亚的所有5个埃博拉治疗中心进行，包括埃默里严重传染病单位，并将评估落纱过程中的脆弱性和测量PPE的污染，然后将这两个发现联系起来。第二个项目将使用全尺寸模拟设置，并涉及原型的快速循环测试，以找到改进落纱流程的设计元素。第三个项目将在两家医院进行，将使用一种新技术跟踪HCW手部卫生依从性，该技术还允许在房间内进行实时反馈;将使用分阶段研究设计将这种类型的反馈与个人或团体反馈进行比较，包括系统准确性的初步评估，各种形式的语音提醒和个人反馈的可接受性，以及人员的定期访谈。这项工作将由来自埃默里大学、格鲁吉亚州和格鲁吉亚理工学院的多学科团队进行，其中包括护士、医生、建筑师、人为因素工程师、微生物学家和医疗流行病学家。拟议的3个项目的结果将：1）确定落纱方案中容易出错的步骤; 2）创建设计改进，减少落纱过程中的错误和自污染风险; 3）提供实用的HH解决方案，可推广到许多医疗机构。由于HH是一种有效的干预措施，不仅可以对抗埃博拉病毒，还可以对抗通过接触传播的其他病原体，因此公共卫生影响可能比针对特定病原体的干预措施更广泛。总体而言，该提案的结果可以立即实施，以提高护理埃博拉患者的HCW的安全性，并防止通过接触传播的其他更常见病原体的传播。

 DESCRIPTION (provided by applicant): Healthcare workers (HCW) are at risk for acquiring pathogens such as Ebola virus during patient care, as recently occurred during the care of the first patient treated in a US hospital outside of a special containment unit. This proposal will address two major aspects of infection prevention to prevent the transmission of pathogens through contact: the use of personal protective equipment (PPE) when caring for patients with lethal pathogens transmitted by contact such as Ebola and hand hygiene, (HH), the most basic infection prevention measure to prevent transmission of pathogens by direct contact, but one that is not reliably performed in most healthcare settings. Appropriately donning and doffing high-level PPE is challenging and requires that HCWs adhere to a complex series of steps for every encounter, and do so correctly and consistently without self- contamination. Three projects will use a multidisciplinary approach and aim to 1) perform an integrated biological and human factors analysis of complex PPE doffing, using harmless viruses to assess for contamination (T0-T1); 2) reduce self-contamination during PPE doffing by using changes in the physical environment to improve process and flow (T1); and 3) assess different forms of feedback to improve HH compliance measured by an automated surveillance system (T0-T2). The first project will be conducted in all 5 Ebola treatment centers in Georgia, including the Emory Serious Communicable Diseases Unit and will assess vulnerabilities in the doffing process and measure contamination of PPE, then correlate these two findings. The second project will use a full-scale simulation setting and involve rapid cycle testing of prototypes to fnd design elements that improve the flow of doffing. The third project will occurs in two hospital, where HCW hand hygiene adherence will be tracked with a novel technology that also allows real-time feedback in the room; this type of feedback will compared to individual or group feedback using a staged study design, including initial assessment of system accuracy, acceptability of various forms of voice reminders and individual feedback, and periodic interviews of personnel. The work will be conducted by a multidisciplinary team from Emory University, Georgia State and the Georgia Institute of Technology and includes nurses, physicians, architects, human factors engineers, microbiologists and healthcare epidemiologists. The results from the proposed 3 projects will: 1) identify steps in the doffing protocol that are error prone; 2) create design improvements that reduce errors and the risk of self-contamination during doffing; and 3) provide pragmatic HH solutions that could be generalized to many healthcare settings. Because HH is an intervention effective against not just against Ebola but other pathogens that transmitted through contact, the public health impact may be broader than interventions focused on a specific pathogen. Overall, the results from this proposal could be immediately implemented to improve the safety of HCWs caring for patients with Ebola and prevent transmission of other more common pathogens transmitted by contact.