Patient Movement and Impact on Multidrug-Resistant Organism (MDRO) Transmission

耐多药生物(MDRO)在急性护理和疗养院(NHS)中都是地方病。然而， 老年人新的MDRO感染和向医疗保健专业人员(HCP)传播的预测因素和 环境，特别是病房外的环境，仍然不清楚。这与今天的 现代医疗系统，患者可在病房外移动进行医疗诊断和 治疗--如包括物理和职业治疗在内的康复，活组织检查等程序， 透析、输液诊所和娱乐活动等服务--展现了巨大的潜力 生物体的传播 通过这个项目和对高危NH退伍军人的关注，我们的目标是首先描述不断变化的 3VA NHS的MDRO的流行病学，明确的目标是开发一个描述患者运动指数的“患者运动指数” 外出就诊就医和娱乐在MDRO在全国传播中的作用 机构。使用分子和基因组方法，我们将加深对MDRO的影响的理解 传播，在英国国民健康保险制度和其他患者使用地区流行的主要菌株。使用‘干预’ 我们下一步将开发和试点综合多模式干预，包括 退伍军人、他们的家人、HCP以及领导层，以减少传播和感染。我们预料到了这一点 干预措施包括：1)对退伍军人和照顾者进行手部卫生和预防感染的教育；2) 提供关于MDRO预防战略和环境清洁的培训；以及3)领导力 包括感染预防团队、退伍军人事务部领导和常用区域经理在内的参与 我们的参与者经常光顾。患者在房间外的活动模式以及分子和 在特定目标1中获得的基因组数据将是我们进行干预的关键。 我们建议的翻译研究是创新和及时的，因为我们计划开发一个新的索引，将 描述退伍军人在殖民状态下在其周围环境中花费的时间 定义退伍军人-照顾者-环境污染的“指纹”。这些研究将开辟一条新的路线 调查使我们能够设计未来的项目，以表征患者的移动和传播 医院、专科等其他服务领域。我们预计我们的结果将得到广泛的应用 退伍军人事务部内外的应用，通过改善退伍军人的卫生做法来提高他们的生活质量 和预防感染，并帮助了解MDRO在不断发展的医疗系统中的传播。 我们的多学科团队在老龄化、流行病学包括分子流行病学方面拥有专业知识， 微生物学、传染病、健康结局、护理和以病人为中心的研究是独一无二的 定位于实现我们的目标并推动该领域的发展。

Multidrug-resistant organisms (MDROs) are endemic in both acute care and nursing homes (NHs). However, predictors for new MDRO acquisition in older adults and transmission to healthcare professionals (HCPs) and the environment, particularly outside of patient rooms, remain unclear. This is relevant in today’s contemporary healthcare systems with patient movement outside the rooms for medical diagnostics and treatment- such as rehabilitation including physical and occupational therapy, procedures such as biopsies, services such as dialysis, infusion clinics and recreational activities- presenting a tremendous potential for transmission of organisms With this project and a focus on high-risk NH Veterans, our aims are to first characterize the changing epidemiology of MDROs at 3 VA NHs with the explicit goal of developing a ‘Patient Movement Index’ depicting the role of out-of-room visits for medical appointments and recreation in MDRO transmission across the institution. Using molecular and genomic methods, we will develop an understanding of the impact of MDRO transmission, predominant strains circulating in the NHs and other patient use areas. Using an ‘Intervention Mapping Framework’ we will next develop and pilot an integrated multi-modal intervention involving Veterans, their families, HCP as well as leadership to reduce transmission and infections. We anticipate this intervention to include: 1) Veterans’ and caregivers’ hand hygiene and infection prevention education; 2) provider education on MDRO prevention strategies and environmental cleaning; and 3) leadership involvement including infection prevention team, VA NH leadership, and managers of common use areas frequented by our participants. Patterns of patient movements outside their rooms as well as the molecular and genomic data obtained in Specific Aim 1 will be critical in informing our intervention. Our proposed translational study is innovative and timely as we plan to develop a new index that will characterize the amount of time Veterans spend outside their immediate environment in a colonized state and define a “fingerprint” of Veteran-caregiver-environment contamination. These studies will open a new line of inquiry allowing us to design future projects in order to characterize patient movement and transmission in other service areas such as hospitals and specialized units. We expect our results to have widespread application within and outside the VA, enhance Veterans’ quality of life by improving their hygiene practices and preventing infections, and help understand MDRO transmission within an evolving healthcare system. Our multidisciplinary team with expertise in aging, epidemiology including molecular epidemiology, microbiology, infectious diseases, health outcomes, nursing and patient oriented research is uniquely positioned to achieve our goals and advance the field.