Gown and Glove Use to Prevent the Spread of Infection in VA Community Living Cent

描述（由申请人提供）： 耐甲氧西林表皮葡萄金黄色葡萄球菌（MRSA）感染是退伍军人发病和死亡的主要原因。MRSA通过医疗环境中的直接或间接接触传播。在急性护理环境中，我们对MRSA定植患者使用接触预防措施（卫生保健工作者[HCW]在所有患者接触中穿戴长袍和手套），以防止传播给其他患者。目前的疾病控制和预防中心（CDC）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它们。本修订提案的目标是确定LTCF接触预防措施的最佳修改，以降低MRSA传播的风险，并允许在与社区生活中心文化转型一致的家庭式、以患者为中心的环境中进行护理。LTCF提供多层次的护理，包括康复、熟练护理和维护护理。在PI目前的VA优异奖中，我们证明了康复护理中的MRSA传播是其他长期护理的四倍。这表明所提供的护理类型增加了传播风险。MRSA对其他居民的传播很难研究。最近，我们开发了一种新的替代措施的MRSA传播，检测MRSA的HCW长袍和手套在HCW患者互动。使用这种新的方法，我们将测试两个主要的假设，根据CDC隔离指南的专家意见建议。1. MRSA传播的风险将因与居民接触的类型而异，每种活动都有自己的传播风险。某些活动，例如涉及接触分泌物的活动（例如引流伤口、造口术护理）的风险高于其他活动（例如生命体征、给药）。2.对于任何特定类型的接触，居民特征都会增加传播风险（例如，完全依赖医护人员进行医疗保健和日常生活活动的居民，或无法控制分泌物或引流物的居民）。我们的目的是估计MRSA传播的频率和风险因素的防护服和手套穿HCW互动与400 MRSA殖民VA长期护理居民在多个站点的观察性研究中，在VA社区生活中心从四个州和哥伦比亚特区。

DESCRIPTION (provided by applicant): Methicillin-resistant S. aureus (MRSA) infections are a major cause of morbidity and mortality in veterans. 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 revised proposal is to determine the optimal modifications of Contact Precautions for LTCF in order reduce the risk of MRSA transmission and allow care in a home-like, patient-centered environment consistent the Community Living Centers Cultural Transformation. LTCFs provide multiple levels of care including rehabilitation, skilled nursing and maintenance care. In the PI's current VA Merit award, we demonstrated that MRSA transmission is four-fold higher in rehabilitation care than in other long term care. This suggests that the types of care delivered increase the risk of transmission. MRSA transmission to other residents is difficult to study. 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 two major hypotheses based on expert opinion recommendations from the CDC Isolation Guidelines. 1. Risk of MRSA transmission will vary by type of contact with the resident and each activity will have its own risk of transmission. Some activities such as those involving contact with secretions (e.g. draining wounds, ostomy care) will be of higher risk than others (e.g. vital signs, medication administration). 2. For any given type of contact, resident characteristics increases the risk of transmission (e.g. residents totally dependent upon healthcare personnel for healthcare and activities of daily living or residents whose secretions or drainage cannot be contained). Our aim is to estimate the frequency of and risk factors for MRSA transmission to protective gowns and gloves worn by HCW interacting with 400 MRSA colonized VA long term care residents in a multi-site observational study in VA Community Living Centers from four states and the District of Columbia.