Does Universal Glove and Gown use decrease carbapenem-resistant Gram-negative bacteria

 描述（由申请方提供）：抗生素耐药菌与相当大的发病率、死亡率和成本相关。耐药性革兰氏阴性菌的感染率继续增加。正如最近在科学和技术顾问总统理事会（PCAST）关于抗生素耐药性的报告中所概述的那样，需要新的干预措施来遏制包括碳青霉烯类耐药革兰氏阴性菌在内的耐药性细菌的传播。通过AHRQ合同，我们进行了一项20 ICU群集随机试验（BUGG研究），以确定与通常的护理标准相比，所有患者接触时佩戴手套和隔离衣是否减少了VRE和MRSA的获得;结果发表在JAMA上。该研究显示MRSA感染减少40%，但对VRE感染没有影响。MRSA和VRE的不同结果导致许多重症监护医师、传染病医生、医院流行病学家和医院管理者不确定是否在ICU实施通用手套和长袍的干预。储存来自BUG研究的原始肛周培养物，以便将来可以分析其他细菌，包括碳青霉烯类耐药革兰氏阴性菌。目前尚不清楚本申请将解决的问题是，ICU中所有患者接触时佩戴手套和隔离衣是否会导致耐药性革兰氏阴性菌减少。本申请的总体目的是确定所有患者接触时佩戴手套和隔离衣是否会导致碳青霉烯类耐药革兰氏阴性菌的获得减少。我们的中心假设是，干预措施将有效减少碳青霉烯类耐药革兰氏阴性菌的获得。这种应用的基本原理是，BUG研究留下了一个重要的问题没有回答：通用手套和罩衣对碳青霉烯类耐药革兰氏阴性菌有什么影响？本研究的目的是使用已经收集的肛周标本来评估戴手套和穿罩衣是否会减少碳青霉烯类耐药革兰氏阴性菌的获得。拟议研究的意义在于，它将确定在ICU环境中所有患者接触时佩戴手套和罩衣是否会导致碳青霉烯类耐药革兰氏阴性菌的获得减少。如果获得资助，该申请的成功概率非常高，因为拟议的二次分析是基于已经完成的随机聚类试验。所有的标本都已经获得，可以以一种非常具有成本效益的方式进行处理。这使得AHRQ能够回答一个重要的问题，而无需从头开始资助一项新的随机分组试验。

 DESCRIPTION (provided by applicant): Antibiotic-resistant bacteria are associated with considerable morbidity, mortality, and costs. Infection rates with antibiotic-resistant Gram-negative bacteria continue to increase. As was recently outlined in President's Council of Advisors on Science and Technology (PCAST) report on antibiotic resistance, novel interventions are needed to curb the spread of antibiotic-resistant bacteria including carbapenem-resistant Gram-negative bacteria. Through an AHRQ contract, we performed a 20 ICU cluster randomized trial (BUGG study) to determine if wearing gloves and gowns for all patient contact reduced VRE and MRSA acquisition compared to the usual standard of care; the results were published in JAMA. The study showed a 40% decrease in MRSA acquisition but no effect on VRE acquisition. The differing results for MRSA and VRE led many intensivists, infectious disease physicians, hospital epidemiologists, and hospital administrators to be uncertain about whether to implement the intervention of universal glove and gown in their ICU. The original peri-anal cultures from the BUGG study were stored so that they could be analyzed in the future for other bacteria including carbapenem-resistant Gram- negative bacteria. What is not known that this application will address is whether wearing gloves and gowns for all patient contact in the ICU leads to a decrease in antibiotic-resistant Gram- negative bacteria. The overall objective of this application is to determine whether wearing gloves and gowns for all patient contact leads to a decrease in the acquisition of carbapenem- resistant Gram-negative bacteria. Our central hypothesis is that the intervention will be effective at decreasing the acquisition of carbapenem-resistant Gram-negative bacteria. The rationale for this application is that the BUGG study left an important question unanswered: What is the effect of universal glove and gown on carbapenem-resistant Gram-negative bacteria? The aim of this study is to use already collected peri-anal specimens to assess whether wearing gloves and gowns decreases the acquisition of carbapenem-resistant Gram-negative bacteria. The significance of the proposed research is that it will determine whether wearing gloves and gowns for all patient contact in the ICU setting will lead to a decrease in the acquisition of carbapenem-resistant Gram-negative bacteria. This application, if funded, has an exceedingly high probability of success because the proposed secondary analysis is based on an already completed randomized cluster trial. All of the specimens have been obtained and can be worked up in a very cost-effective manner. This allows AHRQ to answer an important question without funding from scratch a new randomized cluster trial.