Patient Movement and Impact on Multidrug-Resistant Organism (MDRO) Transmission

多药耐药微生物（MDRO）在急性护理和疗养院（NH）都是地方性的。然而，在这方面， 老年人新发MDRO获得和传播给医疗保健专业人员（HCP）的预测因素， 环境，特别是病房外的环境，仍然不清楚。这与今天的 现代的医疗保健系统，病人在房间外移动进行医疗诊断， 治疗-如包括物理和职业治疗在内的康复，活组织检查等程序， 服务，如透析，输液诊所和娱乐活动-呈现出巨大的潜力 生物传播 通过这个项目和对高风险NH退伍军人的关注，我们的目标是首先描述不断变化的 3个VA NH的MDRO流行病学，明确目标是制定"患者运动指数"， 门诊就诊和娱乐在MDRO传播中的作用 机构。使用分子和基因组方法，我们将了解MDRO的影响， 传播，主要菌株在NH和其他患者使用区域循环。使用“干预” 我们下一步将制定和试行一项综合多模式干预措施， 退伍军人，他们的家人，HCP以及领导，以减少传播和感染。我们预料到这一点 干预措施包括：1）退伍军人和护理人员的手部卫生和预防感染教育; 2） 提供关于MDRO预防战略和环境清洁的教育;以及3）领导力 包括感染预防团队、VA NH领导层和通用区域管理人员的参与 我们的参与者经常光顾。患者在其房间外的运动模式以及分子和 在具体目标1中获得的基因组数据将对我们的干预至关重要。 我们提出的翻译研究是创新和及时的，因为我们计划开发一个新的索引， 描述退伍军人在殖民地国家的直接环境之外度过的时间， 定义退伍军人护理者环境污染的"指纹"。这些研究将开辟一条新的 调查使我们能够设计未来的项目，以表征患者的运动和传输， 其他服务领域，如医院和专科单位。我们希望我们的研究结果能广泛应用于 在退伍军人管理局内外的应用，通过改善他们的卫生习惯来提高退伍军人的生活质量 和预防感染，并帮助了解MDRO在不断发展的医疗保健系统中的传播。 我们的多学科团队在老龄化，流行病学，包括分子流行病学， 微生物学，传染病，健康结果，护理和以病人为导向的研究是独一无二的 能够实现我们的目标并推动该领域的发展。

Multidrug-resistant organisms (MDROs) are endemic in both acute care and nursing homes (NHs). However, predictors for new MDRO acquisition in older adults and transmission to healthcare professionals (HCPs) and the environment, particularly outside of patient rooms, remain unclear. This is relevant in today’s contemporary healthcare systems with patient movement outside the rooms for medical diagnostics and treatment- such as rehabilitation including physical and occupational therapy, procedures such as biopsies, services such as dialysis, infusion clinics and recreational activities- presenting a tremendous potential for transmission of organisms With this project and a focus on high-risk NH Veterans, our aims are to first characterize the changing epidemiology of MDROs at 3 VA NHs with the explicit goal of developing a ‘Patient Movement Index’ depicting the role of out-of-room visits for medical appointments and recreation in MDRO transmission across the institution. Using molecular and genomic methods, we will develop an understanding of the impact of MDRO transmission, predominant strains circulating in the NHs and other patient use areas. Using an ‘Intervention Mapping Framework’ we will next develop and pilot an integrated multi-modal intervention involving Veterans, their families, HCP as well as leadership to reduce transmission and infections. We anticipate this intervention to include: 1) Veterans’ and caregivers’ hand hygiene and infection prevention education; 2) provider education on MDRO prevention strategies and environmental cleaning; and 3) leadership involvement including infection prevention team, VA NH leadership, and managers of common use areas frequented by our participants. Patterns of patient movements outside their rooms as well as the molecular and genomic data obtained in Specific Aim 1 will be critical in informing our intervention. Our proposed translational study is innovative and timely as we plan to develop a new index that will characterize the amount of time Veterans spend outside their immediate environment in a colonized state and define a “fingerprint” of Veteran-caregiver-environment contamination. These studies will open a new line of inquiry allowing us to design future projects in order to characterize patient movement and transmission in other service areas such as hospitals and specialized units. We expect our results to have widespread application within and outside the VA, enhance Veterans’ quality of life by improving their hygiene practices and preventing infections, and help understand MDRO transmission within an evolving healthcare system. Our multidisciplinary team with expertise in aging, epidemiology including molecular epidemiology, microbiology, infectious diseases, health outcomes, nursing and patient oriented research is uniquely positioned to achieve our goals and advance the field.