Povidone-iodine to Stop Access-related Infections and Transmission of Staphylococcus aureus (PAINTS)

聚维酮碘可阻止与接触相关的金黄色葡萄球菌感染和传播 (PAINTS)

• 批准号: 10329904
• 负责人: Marin Leigh Schweizer
• 金额: $ 22.32万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2022-05-01
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10329904
• 关键词: Povidone; iodine; Stop; Access; related

Abstract Background: The long-term objective of the “Povidone-iodine to stop Access related INfections and Transmission of Staphylococcus aureus (PAINTS)” proposal is to decrease rates of healthcare- associated infections that occur outside of the hospital (i.e., community-onset infections). Recent data from the Centers for Disease Control and Prevention (CDC) demonstrated that 83% of methicillin- resistant Staphylococcus aureus (MRSA) bloodstream infections are community-onset. Hemodialysis patients are at high-risk for community-onset bloodstream infections, particularly S. aureus access- related bloodstream infections (ARBSI). These infections cause increased morbidity and mortality. Nasal povidone-iodine decolonization is a novel intervention that can potentially prevent S. aureus ARBSI in this patient population. Specific Aims: Aim 1: Assess whether nasal povidone-iodine decolonization reduces infections among hemodialysis patients using a multicenter, stepped-wedge cluster randomized trial. Primary outcome: S. aureus ARBSI. Secondary outcomes: Other S. aureus dialysis-associated infections as defined by the CDC National Healthcare Safety Network, ARBSI caused by pathogens other than S. aureus, all dialysis-associated infections caused by all pathogens, and S. aureus colonization and transmission. Aim 2: Evaluate patient satisfaction with nasal povidone- iodine decolonization, assess its role in patient activation, and assess barriers and facilitators to implementation using patient surveys. Aim 3: Examine healthcare worker satisfaction with implementation of nasal povidone-iodine decolonization and assess barriers and facilitators to the process via qualitative interviews and site visits. Research Design: We aim to perform a randomized stepped wedge study among 16 hemodialysis units affiliated with 5 geographically diverse healthcare centers to evaluate whether nasal povidone-iodine will reduce rates of S. aureus ARBSI among hemodialysis patients. These hemodialysis units represent both rural and inner-city patients who receive chronic care (AHRQ priority populations). We will survey all patients and qualitatively interview healthcare workers to assess the acceptability and feasibility of this intervention, as well as barriers and facilitators to implementation. We will test patients' noses for S. aureus colonization to determine whether nasal povidone-iodine decreases S. aureus colonization and S. aureus transmission. The sites that will participate in this study (University of Iowa, University of Illinois, University of Pennsylvania, Washington University, Emory Healthcare) have a good history of collaboration. Relevance: This study will help AHRQ address its goal to “build the evidence for fighting antibiotic resistance in the ambulatory setting,” and help meet the National Action Plan to Prevent Healthcare-Associated Infections recommendation that hemodialysis centers aim to improve ARBSI rates.

抽象的 背景：“聚维酮碘阻止接触相关感染和感染”的长期目标 金黄色葡萄球菌（PAINTS）的传播”提案旨在降低医疗保健费用 - 医院外发生的相关感染（即社区发病的感染）。 美国疾病控制与预防中心 (CDC) 的研究表明，83% 的甲氧西林 耐药金黄色葡萄球菌 (MRSA) 血流感染是社区发病的。 患者是社区发病的血流感染的高危人群，尤其是金黄色葡萄球菌感染—— 相关血流感染（ARBSI）。这些感染导致发病率和死亡率增加。 鼻腔聚维酮碘去定植是一种新型干预措施，有可能预防金黄色葡萄球菌 ARBSI 在该患者群体中的具体目标： 目标 1：评估是否鼻用聚维酮碘。 使用多中心阶梯楔形去定植减少血液透析患者的感染 整群随机试验。主要结果：金黄色葡萄球菌 ARBSI。次要结果：其他金黄色葡萄球菌。 CDC 国家医疗安全网络 (ARBSI) 定义的透析相关感染 由金黄色葡萄球菌以外的病原体引起，由所有病原体引起的所有透析相关感染， 目标 2：评估患者对鼻用聚维酮的满意度。 碘去定植，评估其在患者激活中的作用，并评估其障碍和促进因素 通过患者调查来实施目标 3：检查医护人员的满意度。 实施经鼻聚维酮碘去殖民化并评估其障碍和促进因素 通过定性访谈和实地考察进行研究设计：我们的目标是进行随机研究。 隶属于 5 个不同地理位置的医疗保健机构的 16 个血液透析单位之间的阶梯式楔形研究 中心评估鼻用聚维酮碘是否会降低金黄色葡萄球菌 ARBSI 的发生率 这些血液透析单位代表了农村和内城区的患者。 接受长期护理（AHRQ 优先人群）。我们将对所有患者进行调查并进行定性访谈。 医护人员评估这种干预措施的可接受性和可行性，以及障碍和 我们将测试患者鼻子中的金黄色葡萄球菌定植情况，以确定实施方案的实施人员。 鼻腔聚维酮碘是否会减少金黄色葡萄球菌的定植和金黄色葡萄球菌的传播。 将参与这项研究（爱荷华大学、伊利诺伊大学、宾夕法尼亚大学、 华盛顿大学、埃默里医疗保健公司）有着良好的合作历史。 将帮助 AHRQ 实现其“为对抗流动医疗中的抗生素耐药性提供证据”的目标 环境”，并帮助实现预防医疗相关感染的国家行动计划 建议血液透析中心致力于提高 ARBSI 率。