Strategies to Reduce Transmission of Antimicrobial Resis

本研究将确定2种耐药革兰氏阳性菌的定植率和感染率？耐甲氧西林金黄色葡萄球菌（MRSA）和耐万古霉素肠球菌（VRE）？与仅使用标准护理的ICU相比，使用强化感染控制策略加标准护理的ICU中成人重症监护病房（ICU）患者的感染率较低。强化控制策略包括：1）通过报告前鼻孔和粪便或肛周区域的监测培养结果来识别MRSA或VRE定植的患者; 2）通用手套（在与患者或患者互动期间使用手套？的环境），直到病人出院或他们的监测培养结果显示他们没有定植MRSA或VRE（以先发生者为准）;和3）接触预防措施（在与病人或病人的互动过程中使用手套和长袍？的环境），在护理的病人谁是定植与MRSA或VRE。标准护理包括适当的手部卫生（洗手或使用无水手部消毒剂）和使用标准预防措施（根据与粘膜、伤口和体液接触的相互作用需要使用手套和其他屏障），以及收集监测培养物，但不向这些研究中心报告结果。将通过在患者入住ICU时、此后每周一次以及从ICU出院时采集患者的鼻和粪便或肛周区域拭子进行监测培养。监测培养的结果将用于比较ICU中使用强化控制策略与仅使用标准治疗策略的MRSA和VRE定植率。 进度报告：这项研究是由国家过敏和传染病研究所（NIAID）支持的多中心试验，并通过细菌学和真菌学研究组进行，这是一个由NIAID资助的临床试验网络。在20家参与研究中心之一入住MICU、SICU或MICU/SICU的18岁及以上男性和女性患者有资格参加本研究。NIH提供本方案的微生物学，与患者无直接接触。NIH的实验室医学部对在参与研究中心收集的样本进行微生物学分析。NIH实验室将培养结果记录在BAMBU系统中。 本研究在4个月的基线密度数据收集期内入组了2982例患者。随机分配至强化对照组的ICU患者的6个月干预期从2006年1月1日开始。尚未进行数据分析。

This study will determine if rates of colonization and infection with 2 resistant Gram positive bacteria?methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococci (VRE)?among patients in adult intensive care units (ICUs) are lower in ICUs that use an intensive infection control strategy plus standard care compared to ICUs that use standard care alone. The intensive control strategy involves: 1) identifying patients who are colonized with MRSA or VRE by reporting the results of surveillance cultures of the anterior nares and stool or perianal area; 2) Universal Gloving (use of gloves during interactions with the patient or the patient?s environment) until the patients are discharged or their surveillance culture results show they are not colonized with MRSA or VRE (whichever happens first); and 3) Contact Precautions (use of gloves and gowns during interactions with the patient or the patient?s environment) during care of patients who are colonized with MRSA or VRE. Standard care involves proper hand hygiene (handwashing or use of a waterless hand antiseptic) and use of Standard Precautions (use of gloves and other barriers as needed for interactions involving contact with mucous membranes, wounds, and body fluids) and collection of surveillance cultures, but not reporting of results to these sites. The surveillance cultures will be performed by obtaining swabs of the nose and stool or perianal area from patients upon admission to the ICU, at weekly intervals thereafter, and upon discharge from the ICU. The results of the surveillance cultures will be used to compare the rate of colonization with MRSA and VRE in ICUs using the intensive control strategy with those that use standard care alone. Progress Report: This study is a multi-center trial supported by the National Institute of Allergy and Infectious Diseases (NIAID) and is conducted through the Bacteriology and Mycology Study Group, a clinical trials network funded by NIAID. Male and female patients, ages 18 and above, who are admitted to the MICU, SICU or MICU/SICU at one of the 20 participating sites are eligible for the study. The NIH provides the microbiology for this protocol and has no direct patient contact. The Department of Laboratory Medicine at the NIH performs the microbiology on the samples collected at the participating sites. The NIH lab records the culture results in the BAMBU system. This study has enrolled 2982 patients over a 4 month baseline density data collection period. The 6 month intervention period for those ICUs randomized to the intensive control arm begins January 1, 2006. No data analysis has yet occurred.