Modifying Contact Precautions for MRSA in Extended Care

描述（由申请人提供）：耐甲氧西林金黄色葡萄球菌（MRSA）是一种机会性病原体，也是医疗保健相关感染的重要原因。MRSA在医疗环境中通过直接或间接接触传播。在急性护理环境中，我们对感染MRSA的患者使用接触预防措施（卫生保健工作者在所有与患者接触时都要穿长袍和手套），以防止传播给其他患者。目前美国疾病控制与预防中心（CDC）的隔离指南建议修改长期护理机构（LTCF）的接触预防措施，但几乎没有证据指导如何修改这些措施。该项目的目标是开发一种干预措施，以尽量减少MRSA在社区LTCF中的传播。我们将确定LTCF接触预防措施的最佳修改，以降低MRSA传播的风险，并允许在家庭般的、以患者为中心的环境中进行护理。长期护理中心提供多层次的护理，包括康复护理、熟练护理和保养护理。在PI当前的VA优异奖中，我们证明了MRSA在康复护理中的传播比维持护理高四倍。这表明所提供的护理类型会改变传播风险。最近，我们开发了一种新的MRSA传播替代测量方法，在HCW-患者相互作用期间检测MRSA在HCW长袍和手套上的MRSA。使用这种新方法，我们将检验MRSA传播在社区长期护理机构中因接触类型（如导管或引流护理）而有显著差异的假设。我们的第一个目的是通过一项观察性研究来估计MRSA传播到与MRSA定植的LTC居民相互作用的HCW所穿的防护服的频率和危险因素。我们的第二个目的是估计MRSA传播给在康复护理、熟练护理和维护护理中与MRSA定殖的LTC居民相互作用的HCW所穿的防护服的累积风险，以评估长期护理机构中接触预防措施的不同修改。我们的第三个目标是使用作业成本法估算这些不同的接触预防措施修改的成本。我们提出的研究结果将通过为何时需要防护服提供证据来提高社区LTCF的护理质量。

DESCRIPTION (provided by applicant): Methicillin-resistant S. aureus (MRSA) is an opportunistic pathogen and an important cause of healthcare-associated infections. MRSA is transmitted through direct or indirect contact in the healthcare setting. In acute care settings, we use Contact Precautions (health care workers [HCW] wear gowns and gloves for all patient contact) for patients colonized with MRSA to prevent transmission to other patients. Current Centers for Disease Control and Prevention (CDC) Isolation Guidelines suggest modifying Contact Precautions in long term care facilities (LTCF), but there is little evidence to guide how to modify them. The goal of this project is to develop an intervention to minimize MRSA transmission in community-based LTCF. We will determine the optimal modifications of Contact Precautions for LTCF in order to reduce the risk of MRSA transmission and allow care in a home-like, patient-centered environment. LTCFs provide multiple levels of care including rehabilitation care, skilled nursing care and maintenance care. In the PI's current VA Merit award, we demonstrated that MRSA transmission is four fold higher in rehabilitation care than maintenance care. This suggests that the types of care delivered modify the risk of transmission. Recently we developed a novel surrogate measure of MRSA transmission, detection of MRSA on HCW gown and gloves during HCW-patient interaction. Using this new methodology, we will test the hypothesis that MRSA transmission will vary significantly by type of contact (e.g. catheter or drain care) in community-based long term care facilities. Our first aim is to estimate the frequency of and risk factors for MRSA transmission to protective gowns worn by HCW interacting with MRSA colonized LTC residents using an observational study. Our second aim is to estimate the cumulative risk of MRSA transmission to protective gowns worn by HCW interacting with MRSA colonized LTC residents in rehabilitation care, skilled nursing care and maintenance care to assess different modifications to Contact Precautions in long term care facilities using mathematical models. Our third aim is to estimate the costs of these different modifications to Contact Precautions using activity-based costing. The results of our proposed study will improve the quality of care in community-based LTCF by providing evidence for when protective gowns are needed. PUBLIC HEALTH RELEVANCE: Methicillin-resistant S. aureus (MRSA) is an important cause of healthcare-associated infections. These are infections that patients acquire during the course of receiving treatment for other conditions within the health care system. Preventing MRSA transmission and infections is an important quality of care goal for healthcare systems. MRSA colonization is more common in long term care facilities than in acute care hospitals; however, the optimal infection control precautions to prevent MRSA transmission in long term care facilities are unknown. The goal of this project is to develop an intervention which minimizes MRSA transmission in LTCF and allows care in a home-like, patient-centered environment.