Healthcare-acquired Infection Risk and Toothbrush Contamination in the ICU

描述（由申请方提供）：医疗保健获得性感染（HAI）导致显著的发病率和死亡率，其中重症监护室（ICU）的感染率最高。识别HAI的危险因素可能会降低感染发生率和患者死亡率。虽然HAI的问题是复杂和多因素的，但一个潜在的风险因素是潜在病原微生物（PPM）的环境污染。直接护理患者时使用的受污染物品可能成为传播PPM的媒介，并导致HAI风险增加。患者护理中使用的牙刷可能存在污染风险，因为它们储存在患者护理环境中（环境污染），并且在没有去污的情况下重复使用（导致口腔中携带PPM的患者重复自体接种）。重症患者是一个脆弱的人群，由于宿主防御能力下降和正常口腔生理学的变化，PPM定植的风险更高。尚未探讨牙刷污染作为ICU中PPM的来源。在ICU中检查牙刷作为PPM的潜在来源对于评估口腔护理的潜在风险和益处以及告知危重患者的护理实践非常重要。本研究的主要目的是描述ICU中与牙刷污染相关的环境因素。第二个目的是描述牙刷污染和重症成人口腔定植之间的关系。本提案将采用横断面设计，在100对ICU受试者和72小时护理中使用的牙刷样本中，检查ICU环境、牙刷污染和患者口腔中PPM的存在。受试者将从大学教学医院的心脏、内科、神经和外科创伤ICU入组。在研究入组时，将获得基线口腔培养，并提供新的无菌牙刷。受试者将被随机分配到三个环境中刷牙时间（TIE）组中的一个，以收集入组后数据（24、48和72小时）。在24、48或72小时（TIE组），观察牙刷（在患者环境中的位置、床边储存容器、与其他物品接触）并测量湿度。使用标准微生物学方法，从每名患者的牙刷和口腔中培养PPM。将使用多位点序列分型（MLST）通过分子菌株分型检查口腔和牙刷分离株的一致性。将使用描述性统计、线性回归、ANOVA和多变量逻辑回归来评价关键变量之间的关系。从该提案中获得的结果可能有助于减少牙刷污染，这可能通过降低暴露于PPM的风险对患者结局产生积极影响。 公共卫生相关性：卫生保健获得性感染是危重患者的一个重要问题。本计画将描述与加护病房牙刷细菌污染相关的环境因素。该项目的发现有助于降低感染风险并改善患者预后。

DESCRIPTION (provided by applicant): Healthcare-acquired infections (HAIs) cause significant morbidity and mortality with the highest infection rates found in the intensive care unit (ICU). Identification of risk factors for HAIs may reduce infection occurrence and patient mortality. While the problem of HAIs is complex and multi-factorial, one potential risk factor is environmental contamination with potentially pathogenic microorganisms (PPMs). Contaminated objects used in direct patient care may become vectors, transmitting PPMs, and resulting in increased risk of HAIs. Toothbrushes used in patient care may be at risk for contamination because they are stored in the patient care environment (environmental contamination) and used repeatedly without decontamination (leading to repeated autoinoculation of a patient harboring PPMs in the oral cavity). Critically ill patients represent a vulnerable population at higher risk of colonization by PPMs due to decreased host defenses and changes in their normal oral physiology. Toothbrush contamination as a source of PPMs in the ICU has not been explored. Examining the toothbrush as a potential source of PPMs in the ICU is important for assessing potential risks and benefits of oral care and informing nursing practice for critically ill patients. The primary aim of this study is to describe environmental factors associated with toothbrush contamination in the ICU. A secondary aim is to describe the relationship between toothbrush contamination and oral colonization in critically ill adults. This proposal will use a cross sectional design to examine the ICU environment, toothbrush contamination and the presence of PPMs in the patient's oral cavity in 100 paired samples of ICU subjects and the toothbrushes used in their care over 72 hours. Subjects will be enrolled from cardiac, medical, neurological and surgical- trauma ICUs at a university teaching hospital. At study enrollment a baseline oral culture will be obtained and a new sterile toothbrush provided. Subjects will be randomly assigned to one of three toothbrush time in environment (TIE) groups for post enrollment data collection (24, 48 and 72 hours). At 24, 48 or 72 hours (by TIE group), toothbrushes will be observed (for location in patient environment, bedside storage container, contact with other articles) and measured for moisture. Using standard microbiological methods, PPMs will be cultured from the toothbrush and oral cavity of each patient. Concordance of oral and toothbrush isolates will be examined by molecular strain typing using Multi Locus Sequence Typing (MLST). Descriptive statistics, linear regression, ANOVA, and multivariable logistical regression will be used to evaluate the relationships among key variables. The results obtained from this proposal may help to reduce toothbrush contamination which may positively impact patient outcomes by reducing risk of exposure to PPMs. PUBLIC HEALTH RELEVANCE: Health-care acquired infections are a significant problem in critically ill patients. This project will describe environmental factors associated with bacterial contamination of toothbrushes in the intensive care unit. Findings from the project could help reduce risk of infections and improve patient outcomes.