Decreasing Bioburden to Reduce Healthcare-Associated Infections and Readmissions

医疗保健相关感染(HAI)是可预防的发病率和死亡率的主要原因。 预防禽流感是国家优先考虑的病人安全和最佳做法，因为它们的发病率很高， 死亡率和成本，每年产生超过65亿美元的医疗成本。大多数感染是由 一种常见的细菌，通常生活在皮肤或鼻子里，能克服身体的正常防御能力 由于侵入性医疗设备、外科手术伤口或住院的生理影响。研究项目： 重症监护病房(ICU)表明，患者皮肤用洗必泰非殖民化，鼻孔用洗必泰 莫匹罗星可以预防许多HAI。然而，缺乏关于非殖民化在#年的有效性的证据。 非ICU环境，大多数HAI发生的地方，以及医疗保健、感染风险、病人对病人的地方 相互作用、病原体传播和洗澡做法与ICU环境有很大不同。 因此，非殖民化在这些环境中很少使用，尽管它有可能显著降低人的健康保险比率。 缓解感染试验(在入院时处理生物细菌以消除感染)将有效 评估非殖民化对ICU外普通患者人群HAI的影响。这个集群是随机的 这项试验将随机抽取50家医院治疗近40万名患者，每天对Universal进行评估 洗必泰沐浴，以防止所有病原体的感染，结合2)鼻非殖民化与 莫匹罗星用于已知的耐甲氧西林金黄色葡萄球菌(MRSA)携带者，这是最常见的 HAI的原因。虽然非殖民化在短期高风险领域取得了成功，如重症监护病房，但这一试验 将解决非ICU内科和外科病房中更大的医院感染问题。这群病人 通常没有进行评估，因为足够大的随机试验的复杂性和成本 证明有效性已经超出了传统的基于医院的试验的范围。 这项试验将提供迫切需要的非殖民化评估，以降低医院感染风险 以及几乎所有住院患者的再次感染性住院。它将提供必要的信息来确定 是否应该通过每天用洗必泰洗澡来实现非殖民化成为标准做法 仅在美国，每年就有4000万名患者住院。或者，它会建议量身定做 对于这些在ICU之外的患者，需要不同于ICU环境下有效的策略。 这项试验还将展示一种新的临床有效性研究模式的优势 并通过将研究嵌入到日常交付中来高效地解决关键管理问题 医疗保健，并利用大型医院系统的组织和信息学优势。

Healthcare-associated infections (HAIs) are a leading cause of preventable morbidity and mortality. Prevention of HAIs is a national priority for patient safety and best practice because of their high morbidity, mortality, and cost, incurring over $6.5 billion dollars of healthcare costs each year. Most infections result from common bacteria that normally live on the skin or in the nose and which overcome the bodys normal defenses because of invasive medical devices, surgical incisions, or the physiologic effects of hospitalization. Studies in intensive care units (ICUs) indicate that decolonization of patients skin with chlorhexidine, and nares with mupirocin can prevent many HAIs. However, evidence is lacking about the effectiveness of decolonization in non-ICU settings, where the majority of HAIs occur, and where medical care, risk of infection, patient-to-patient interactions, pathogen transmission, and bathing practices differ considerably from ICU settings. Decolonization is thus rarely used in these settings, despite its potential to meaningfully decrease the HAI rate. The ABATE Infection Trial (Addressing Bioburden while Admitted To Eliminate Infection) will efficiently evaluate the impact of decolonization on HAIs in the general patient population outside ICUs. This clusterrandomized trial will randomize 50 hospitals treating nearly 400,000 patients to evaluate 1) universal daily chlorhexidine bathing to prevent infections from all pathogens, combined with 2) nasal decolonization with mupirocin for known carriers of methicillin-resistant Staphylococcus aureus (MRSA), one of the most common causes of HAIs. While decolonization has been successful in short-stay high risk areas, such as ICUs, this trial will address the much larger problem of HAIs in non-ICU medical and surgical wards. This patient population has typically not been evaluated because the complexity and cost of sufficiently large randomized trials to demonstrate effectiveness have been beyond the reach of conventional hospital-based trials. This trial will provide a critically needed evaluation of decolonization to reduce hospital infection risk and infectious readmissions in nearly all hospitalized patients. It will provide essential information to determine whether routine decolonization through daily bathing with chlorhexidine should become standard practice for 40 million patients hospitalized each year in the United States alone. Alternatively, it will suggest that tailored strategies distinct from those effective in ICU settings are needed for these patients outside ICUs. This trial will also illustrate the strengths of a new model of clinical effectiveness research that quickly and efficiently addresses critical management questions by embedding research into the usual delivery of health care, and using the organizational and informatics strengths of a large hospital system.