Prevention of Nosocomial Infections and Cost-Effectiveness Refined (P-NICER)

描述(由申请人提供)：医院感染的预防和成本效益改进(P-NICER)医疗保健相关感染(HAI)是增加发病率、死亡率和医院成本的主要因素；而且，大多数感染发生在重症监护病房(ICU)，许多与插入侵入性设备有关。减少HAIS是患者安全的一个重要组成部分。在多纳贝迪安质量理论的指导下，在我们2007年的母公司研究中，我们调查了国家医疗安全网络(NHSN)医院(n=289，应答率66%)的样本，并获得了415个成人ICU的结构、过程和结果的横断面数据。我们发现，很少有结构性因素(例如，医院特征)与设备相关的HAI比率相关。我们确实发现，过程的强度是不同的；只有当ICU对过程有95%或更高的遵从性(例如，中线束元素)时，HAI率才会降低。这项工作是对该领域的重大贡献。然而，随着耐甲氧西林金黄色葡萄球菌(MRSA)和艰难梭菌(艰难梭菌)引起的HAI增加，国家强制报告HAI的州从2004年的3个州增加到2009年的36个州，在进行我们的研究的过程中，我们确定了我们的团队唯一能够告知的一些差距。此外，20个州现在通过使用NHSN强制报告。正因为如此，以及开放注册，NHSN已经迅速发展到2198家急性护理医院。在这次竞争性更新中，提出了一项为期3年的混合方法研究，分为两个阶段。其目的是1)使用描述性探索性方法定性地描述医院感染预防、监测和控制的现象；2)评估感染控制过程的强度对全国成人和儿科ICU中相关设备和特定生物体的HAI比率的影响；以及3)确定国家规定的强制性报告对感染控制过程和HAI比率的影响。在第一阶段，我们将有目的地从家长研究中抽取12家医院，并深入访谈不同的人员(例如感染专业人员和护士)。这些叙事数据将使用迭代过程进行分析，以确定目标1中的主题。在第二阶段，我们将根据第一阶段的结果和我们之前的工作来完善我们的调查。然后，在2011年，将对NHSN医院(n=2,198)进行ICU感染控制流程强度的调查，并从受访者那里获得长达6年(2006-2011年)的NHSN特定HAI数据。目标2和目标3的分析策略包括最先进的多变量方法，旨在将潜在的偏见降至最低，并解决数据的聚集问题。这项创新的研究建立在我们与NHSN医院发展良好的关系、我们的调查、我们目前的数据和我们过去的发现的基础上。结果将通知全国各地的床边临床医生和政策制定者。 公共卫生相关性：每年约有200万名患者受到医疗保健相关感染(HAI)的困扰，其中近9万名患者估计死亡。据估计，HAI每年的医院费用超过250亿美元。大多数禽流感是可以预防的，它是一个主要的公共卫生问题。这项研究的结果将告知临床医生和政策制定者；这些结果还有可能改善床边的流程并降低HAI率。

DESCRIPTION (provided by applicant): Prevention of Nosocomial Infections and Cost Effectiveness Refined (P-NICER) Healthcare associated infections (HAIs) are a major contributor to increased morbidity, mortality and hospital costs; and, the majority of these occur in intensive care units (ICUs) and many are associated with insertion of an invasive device. Reducing HAIs is an important component of patient safety. Guided by Donabedian's theory of quality, in our parent study in 2007, we surveyed a sample of National Healthcare Safety Network (NHSN) hospitals (n = 289, 66% response rate) and received cross-sectional data on structures, processes and outcomes in 415 adult ICUs. We found few structural aspects (e.g., hospital characteristics) to be associated with device associated HAI rates. We did find that intensity of processes was varied; and, only when an ICU had 95% or greater compliance (e.g., Central Line Bundle elements) with processes were the HAI rates decreased. This work represents a significant contribution to the field. However, with increased HAIs caused by methicillin resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. difficile), state mandated reporting of HAI growing from 3 states in 2004 to 36 states in 2009, and in the process of conducting our study, we have identified a number of gaps that our team is uniquely positioned to inform. Additionally, 20 states now mandate reporting through use of the NHSN. Because of this, as well as open enrollment, NHSN has quickly grown to 2,198 acute care hospitals. In this competitive renewal, a 3-year mixed method study organized into two phases is proposed. The aims are 1) Use a descriptive exploratory approach to qualitatively describe the phenomena of infection prevention, surveillance, and control in hospitals; 2) Assess the impact of the intensity of infection control processes on device associated and organism specific HAI rates in adult and pediatric ICUs across the nation; and 3) Determine the impact of state regulated mandatory reporting on infection control processes and HAI rates. In Phase I, we will purposively sample 12 hospitals from the parent study and conduct in-depth interviews with various personnel (e.g., infection professionals and nurses). These narrative data will be analyzed using an iterative process to identify themes in Aim 1. In Phase II, we will refine our survey based upon the results of Phase I and our prior work. Then, in 2011 will survey NHSN hospitals (n = 2,198) on intensity of infection control processes in ICUs and obtain up to 6 years (2006-2011) of ICU-specific NHSN HAI data from our respondents. The analytic strategies for Aims 2 and 3 include state of the art multivariate methods designed to minimize potential bias and address clustering of data. This innovative study builds upon our well developed relationship with NHSN hospitals, our survey, our current data and our past findings. Results will inform bedside clinicians as well as policy makers across the nation. PUBLIC HEALTH RELEVANCE: Annually, approximately 2 million patients are stricken with healthcare associated infections (HAI) and nearly 90,000 of these patients are estimated to die. The annual hospital cost of HAI is estimated to be over 25 billion dollars. Most HAIs are preventable and it is a major public health problem. Results from this study will inform both clinicians and policy makers; these results also have the potential to improve processes at the bedside and reduce HAI rates.