Prevention Epicenter of Emory and Atlanta Consortium Hospitals (PEACH)

 描述(由申请人提供)：医护人员(HCW)在患者护理过程中面临感染埃博拉病毒等病原体的风险，最近发生的情况是在护理第一名在特殊隔离单元以外的美国医院接受治疗的患者时发生的。这项提案将涉及预防感染的两个主要方面，以防止通过接触传播病原体：在护理通过接触传播致命病原体的患者时使用个人防护装备(PPE)，如埃博拉和手卫生；(HH)，这是防止通过直接接触传播病原体的最基本感染预防措施，但在大多数医疗保健环境中并不可靠。适当地穿上和脱下高级别的个人防护装备是具有挑战性的，要求卫生工作者在每次接触时都遵守一系列复杂的步骤，并正确和一致地这样做，而不会自我污染。三个项目将使用多学科方法，目标是1)对复杂的个人防护设备落纱进行综合的生物和人为因素分析，使用无害的病毒评估污染(T0-T1)；2)通过利用物理环境的变化来改善流程和流程，减少个人防护落纱过程中的自身污染(T1)；以及3)评估不同形式的反馈，以改善通过自动监测系统测量的HH合规性(T0-T2)。第一个项目将在佐治亚州的所有5个埃博拉治疗中心进行，包括埃默里严重传染病治疗中心，并将评估道夫过程中的脆弱性，测量个人防护用品的污染，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环境，并涉及原型的快速循环测试，以找到改善道夫流程的设计元素。第三个项目将在两家医院进行，在那里，将使用一种新技术跟踪HCW手卫生遵守情况，该技术还允许在房间内进行实时反馈；这种类型的反馈将与使用阶段性研究设计的个人或团体反馈进行比较，包括对系统准确性、各种形式的语音提醒和个人反馈的可接受性的初步评估，以及对人员的定期访谈。这项工作将由来自埃默里大学、佐治亚州立大学和佐治亚理工学院的多学科团队进行，成员包括护士、医生、建筑师、人为因素工程师、微生物学家和医疗保健流行病学家。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，以减少错误和落纱过程中自我污染的风险；以及3)提供可推广到许多医疗保健环境的实用HH解决方案。由于HH是一种干预措施，不仅对埃博拉病毒有效，而且对通过接触传播的其他病原体也有效，因此对公共卫生的影响可能比针对特定病原体的干预措施更广泛。总体而言，这项提议的结果可以立即实施，以提高护理埃博拉患者的卫生工作者的安全性，并防止通过接触传播其他更常见的病原体。

 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.