Health Information Technology to Reduce Healthcare-Associated Infections: HIT-HAI

描述(由申请人提供)：在国家护理研究所(抗菌素耐药感染费用分配，R01 NR010822)的资助下，我们开发了一个数据库，其中包括2006-8年间从四家城市(曼哈顿)医院出院的319,000名患者。该数据库已被用于回答有关医疗保健相关感染(HAI)的各种临床问题，但仍是有用和相关的；我们已扩展该数据库，并将其作为目标研究数据注册表集成到大型医疗保健系统的临床数据仓库中。这些数据将继续更新和维持，以便能够跟踪多年来的趋势。本次竞争更新的具体目的是对2006-2012年的数据进行三项比较有效性研究(CER)研究，以：(1)使用传输可视化技术评估遵守基于传播的隔离预防措施对预防急性护理环境中感染传播的有效性；(2)检查护理组织因素(例如人员配备、技能组合、更替)对住院患者HAI发生率和类型的影响；以及(3)比较通用接触预防措施与重症监护病房(ICU)标准做法在降低多药耐药菌(MDRO)和艰难梭菌引起的获得率和感染率方面的有效性。此外，作为我们的数据共享计划的一部分，我们建议制定和/或通过以下政策和程序：数据贡献者和用户协议以及数据管理政策(首次使用权、机构和数据保密和保护、研究质量、监测和数据管理的完整性)，这将有助于新兴的数据治理科学。然后，我们将为其他CER项目的研究人员提供更广泛的注册表，以评估减少HAI的做法。

DESCRIPTION (provided by applicant): With funding from the National Institute of Nursing Research (Distribution of the Costs of Antimicrobial Resistant Infections, R01 NR010822), we have developed a database of >319,000 patient discharges from four urban (Manhattan) hospitals for the years 2006-8. This database has been used to answer a variety of clinical questions regarding healthcare-associated infections (HAI), but to continue to be useful and relevant; we have expanded and integrated the database as a targeted research data registry into the Clinical Data Warehouse of a large health care system. The data will continue to be updated and sustained so that trends over years can be tracked. Specific aims of this competitive renewal are to conduct three comparative effectiveness research (CER) studies on data from 2006-2012 to: (1) evaluate the effectiveness of adherence to transmission-based isolation precautions for preventing the spread of infections in acute care settings using transmission visualization techniques; (2) examine the impact of nursing organizational factors (e.g., staffing, skill mix, turnover) on rates and types of HAI among hospitalized patients; and (3 compare the effectiveness of universal contact precautions with standard practice in intensive care units (ICUs) to reduce rates of acquisition and infection caused by multidrug-resistant organisms (MDROs) and Clostridium difficile. In addition, as part of our Data Sharing Plan we propose to develop and/or adopt the following policies and procedures: data contributor and user agreements and data stewardship policies (right of first use, institutional and data confidentiality and protection, quality of the research, monitoring and integrity of data management) which will contribute to the burgeoning science of data governance. We will then make the registry more widely available to researchers for other CER project to assess practices to reduce HAI.