Enhancing Patient Safety by Preventing Urinary Tract Infection in Post-Acute Care

通过在急性后期护理中预防尿路感染来增强患者安全

• 批准号: 10165786
• 负责人: Lona Mody
• 金额: $ 46.43万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10165786
• 关键词: Enhancing; Patient; Safety; Preventing; Urinary

ABSTRACT Over 1.4 million people currently reside in a U.S. nursing home (NH) with 2 million new admissions each year. NHs are crucial for meeting short and long-term care needs of older adults. With the burgeoning post-acute care population, many of these individuals are recovering from serious events and are at high risk of complications, including healthcare-associated infections. In fact, nearly 25% of the post-acute population returns to a hospital with an infection, accounting for 325,000 hospital transfers and over $4 billion in additional healthcare costs per year in the U.S. Robust prevention programs in NHs are therefore critical to prevent infections, reduce unnecessary antimicrobial use, reduce transmission of multidrug-resistant organisms, and enhance patient safety. However, NHs face special challenges in implementing an effective infection prevention program, including limited resources, diagnostic challenges in a frail functionally disabled long-stay population, and an unacceptably high prevalence of multidrug-resistant organisms. A model that integrates NH infection prevention initiatives with hospital infection prevention programs within an Accountable Care Organization framework has the potential to improve continuity and quality of care, reduce infection, inappropriate transfers, and the spread of antimicrobial resistance. With this proposal, our goals are to first develop and evaluate an integrated model using 3 healthcare systems including 3 major hospitals and 15 community-based NHs. Then, using a stepped-wedge cluster randomized trial design, we propose to test the effectiveness of an integrated UTI prevention program in reducing catheter-associated and non-catheter- associated UTIs, inappropriate antibiotic use in patients with asymptomatic bacteriuria, and UTI-related hospitalizations. We will achieve these goals through the following aims. Specific Aim 1: Develop an integrated model of hospital and NH infection prevention using UTI (catheter and non-catheter-associated) prevention and management as an exemplar, and pilot this model in 15 NHs and 3 referral hospitals. We will adapt existing tools, materials, resources and finalize study protocols. In particular, we will emphasize targeted collaborations and knowledge transfer pertaining to asymptomatic bacteriuria, use of diagnostic testing to detect infection, defining UTI using standardized criteria, and treatment decisions. Specific Aim 2: Using a stepped-wedge cluster randomized trial design, we will test an integrated infection prevention model in preventing all catheter and non-catheter-associated UTIs in 60 NHs. Specific Aim 2a: Evaluate provider and leadership satisfaction with the integrated infection prevention model, using qualitative and quantitative methods. Specific Aim 2b: Evaluate the impact of the integrated infection prevention model on other NHSN reportable outcomes and process measures (e.g., positive cultures for methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile, and other antimicrobial-resistant organisms; hand hygiene, glove and gown adherence).

抽象的 目前有超过 140 万人居住在美国疗养院 (NH)，每年新增入院人数达 200 万人。 NH 对于满足老年人的短期和长期护理需求至关重要。随着急性后 护理人群中，其中许多人正在从严重事件中恢复，并且面临着高风险 并发症，包括医疗相关感染。事实上，近 25% 的急性期后人群 因感染返回医院，导致 325,000 次医院转院和超过 40 亿美元的医疗费用 美国每年额外的医疗费用 因此，NH 中强有力的预防计划对于 预防感染，减少不必要的抗菌药物使用，减少多重耐药菌的传播 生物体，并增强患者安全。然而，NH 在实施有效的 感染预防计划，包括有限的资源、体弱功能障碍患者的诊断挑战 长期居住的人口以及多重耐药微生物的高患病率令人难以接受。一个模型 将 NH 感染预防举措与医院感染预防计划相结合 责任医疗组织框架有潜力提高护理的连续性和质量，减少 感染、不当转移以及抗菌素耐药性的传播。通过这个提案，我们的目标是 首先使用 3 个医疗保健系统（包括 3 个主要医院和 15 个医疗保健系统）开发和评估集成模型 以社区为基础的 NH。然后，使用阶梯楔形聚类随机试验设计，我们建议测试 综合尿路感染预防计划在减少导管相关性和非导管性尿路感染方面的有效性 相关尿路感染、无症状菌尿患者不适当使用抗生素以及尿路感染相关 住院治疗。我们将通过以下目标来实现这些目标。具体目标 1：开发 使用 UTI（导管和非导管相关）预防医院和 NH 感染的综合模型 以预防和管理为范例，在15个卫生机构和3个转诊医院试点这一模式。我们将 调整现有工具、材料、资源并最终确定研究方案。我们特别强调有针对性 与无症状菌尿有关的合作和知识转移，利用诊断测试 检测感染、使用标准化标准定义尿路感染以及治疗决策。具体目标 2：使用 阶梯楔形集群随机试验设计，我们将在 在 60 个国家预防所有导管和非导管相关的尿路感染。具体目标 2a：评估提供商和 领导层对综合感染预防模型的满意度（使用定性和定量） 方法。具体目标 2b：评估综合感染预防模型对其他 NHSN 的影响 可报告的结果和过程措施（例如，耐甲氧西林葡萄球菌的阳性培养物 金黄色葡萄球菌 (MRSA)、艰难梭菌和其他耐药微生物；手部卫生、手套和 礼服的遵守）。