Prevention of Nosocomial Infections and Cost-Effectiveness Refined (P-NICER)

描述（由申请人提供）：预防院内感染和成本效益改善（P-NICER）医疗相关感染（HAI）是发病率、死亡率和住院费用增加的主要原因;其中大多数发生在重症监护室（ICU），许多与插入侵入性器械有关。减少HAI是患者安全的重要组成部分。在Donabedian质量理论的指导下，在我们2007年的母研究中，我们调查了国家医疗安全网络（NHSN）医院的样本（n = 289，66%的应答率），并收到了415个成人ICU的结构，过程和结果的横截面数据。我们发现了一些结构方面（例如，医院特征）与器械相关HAI率相关。我们确实发现过程的强度是不同的;并且，只有当ICU具有95%或更高的依从性时（例如，中线束元素）与过程是HAI率下降。这项工作是对该领域的重大贡献。 然而，随着耐甲氧西林金黄色葡萄球菌（MRSA）和艰难梭菌（C。困难），国家授权的HAI报告从2004年的3个州增加到2009年的36个州，在进行我们的研究的过程中，我们已经确定了一些差距，我们的团队处于独特的位置，可以提供信息。此外，20个州现在要求通过使用NHSN进行报告。正因为如此，加上开放注册，NHSN已迅速发展到2，198家急症护理医院。 在本次竞争性更新中，建议进行为期3年的混合方法研究，分为两个阶段。目的是：1）使用描述性探索性方法定性描述医院感染预防、监测和控制现象; 2）评估感染控制过程强度对全国成人和儿科ICU中器械相关和微生物特异性HAI率的影响; 3）确定国家监管的强制性报告对感染控制过程和HAI率的影响。在第一阶段，我们将有目的地从母研究中抽取12家医院，并对各种人员进行深入访谈（例如，感染专业人员和护士）。这些叙述性数据将使用迭代过程进行分析，以确定目标1中的主题。在第二阶段，我们将根据第一阶段的结果和我们以前的工作改进我们的调查。然后，在2011年，将调查NHSN医院（n = 2，198）在ICU的感染控制过程的强度，并从我们的受访者中获得长达6年（2006-2011）的ICU特定NHSN HAI数据。目标2和3的分析策略包括最先进的多变量方法，旨在最大限度地减少潜在偏倚并解决数据聚类问题。这项创新的研究建立在我们与NHSN医院的良好关系，我们的调查，我们目前的数据和我们过去的发现。研究结果将为全国的临床医生和政策制定者提供信息。 公共卫生相关性：每年约有200万患者患有医疗相关感染（HAI），估计其中近90，000人死亡。每年HAI的医院费用估计超过250亿美元。大多数HAI是可以预防的，它是一个主要的公共卫生问题。这项研究的结果将为临床医生和政策制定者提供信息;这些结果也有可能改善床边流程并降低HAI率。

DESCRIPTION (provided by applicant): Prevention of Nosocomial Infections and Cost Effectiveness Refined (P-NICER) Healthcare associated infections (HAIs) are a major contributor to increased morbidity, mortality and hospital costs; and, the majority of these occur in intensive care units (ICUs) and many are associated with insertion of an invasive device. Reducing HAIs is an important component of patient safety. Guided by Donabedian's theory of quality, in our parent study in 2007, we surveyed a sample of National Healthcare Safety Network (NHSN) hospitals (n = 289, 66% response rate) and received cross-sectional data on structures, processes and outcomes in 415 adult ICUs. We found few structural aspects (e.g., hospital characteristics) to be associated with device associated HAI rates. We did find that intensity of processes was varied; and, only when an ICU had 95% or greater compliance (e.g., Central Line Bundle elements) with processes were the HAI rates decreased. This work represents a significant contribution to the field. However, with increased HAIs caused by methicillin resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. difficile), state mandated reporting of HAI growing from 3 states in 2004 to 36 states in 2009, and in the process of conducting our study, we have identified a number of gaps that our team is uniquely positioned to inform. Additionally, 20 states now mandate reporting through use of the NHSN. Because of this, as well as open enrollment, NHSN has quickly grown to 2,198 acute care hospitals. In this competitive renewal, a 3-year mixed method study organized into two phases is proposed. The aims are 1) Use a descriptive exploratory approach to qualitatively describe the phenomena of infection prevention, surveillance, and control in hospitals; 2) Assess the impact of the intensity of infection control processes on device associated and organism specific HAI rates in adult and pediatric ICUs across the nation; and 3) Determine the impact of state regulated mandatory reporting on infection control processes and HAI rates. In Phase I, we will purposively sample 12 hospitals from the parent study and conduct in-depth interviews with various personnel (e.g., infection professionals and nurses). These narrative data will be analyzed using an iterative process to identify themes in Aim 1. In Phase II, we will refine our survey based upon the results of Phase I and our prior work. Then, in 2011 will survey NHSN hospitals (n = 2,198) on intensity of infection control processes in ICUs and obtain up to 6 years (2006-2011) of ICU-specific NHSN HAI data from our respondents. The analytic strategies for Aims 2 and 3 include state of the art multivariate methods designed to minimize potential bias and address clustering of data. This innovative study builds upon our well developed relationship with NHSN hospitals, our survey, our current data and our past findings. Results will inform bedside clinicians as well as policy makers across the nation. PUBLIC HEALTH RELEVANCE: Annually, approximately 2 million patients are stricken with healthcare associated infections (HAI) and nearly 90,000 of these patients are estimated to die. The annual hospital cost of HAI is estimated to be over 25 billion dollars. Most HAIs are preventable and it is a major public health problem. Results from this study will inform both clinicians and policy makers; these results also have the potential to improve processes at the bedside and reduce HAI rates.