Chicago Prevention and Intervention Epicenter (Chicago PIE)

芝加哥预防和干预中心（芝加哥 PIE）

• 批准号: 8153615
• 负责人: Robert Alan Weinstein
• 金额: $ 40.06万
• 依托单位: HEKTOEN INSTITUTE FOR MEDICAL RESEARCH
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-03-01 至 2016-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8153615
• 关键词: Chicago; Prevention; Intervention; Epicenter; PIE

DESCRIPTION (provided by applicant): Healthcare-acquired infections (HAIs) are a major source of patient suffering and societal cost. Despite improved use of the most essential HAI control measure, hand hygiene by healthcare workers, adherence still lags and additional measures are needed. Three groups of interventions, comprising 6 studies, are proposed. First, multi-drug resistant organisms (MDROs) - methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant gram-negative bacilli - and Clostridium difficile-associated infections (CDIs) are increasing causes of HAIs. MDROs often ping-pong between hospitals and long-term care; this highlights the importance of a regional, rather than the traditional institution-based, approach to control. The Chicago Prevention and Intervention Epicenter proposes T0/1/2/3 regional interventions in acute and long-term care facilities that will include enhanced surveillance and communication and patient cleansing with chlorhexidine to decrease MDRO risk in Chicago. Successful projects can inform MDRO control in other geographic areas. CDIs result in part from the effect of antibiotics on intestinal microbes. Probiotics, mixtures of natural gut- stabilizing bacteria, given to patients receiving antibiotic therapy have the potential to reduce risk of CDI. A T0/1/2 demonstration project of a novel probiotic that has shown promise for preventing CDIs is proposed. Second, device-related infections are addressed. Catheter-related bloodstream infections (CLABSIs) have declined due to wide application of interventions recommended in 2002 by CDC. Now, it may be possible to eliminate CLABSIs by controlling the major remaining infection source-extrinsic contamination of catheter hubs and fluid pathways. A T0/1/2 ICU and lab study of aggressive asepsis of catheter hubs is proposed. Catheter-associated urinary tract infection (CAUTI), although of lower morbidity, is a major MDRO reservoir and source of spread from hospitals into long-term care. A CAUTI technical innovation that has many early adopters despite absence of well-demonstrated efficacy is the handheld bladder scanner. These devices are expensive but provide the opportunity to determine bladder volume non-invasively. A T0/2 prospective controlled trial of bladder scanners for infection control is proposed. Third, we are facing MDROs with no new drugs. A T1/2 intervention to provide more rational antimicrobial use in ICUs, hot spots of resistance, is proposed. Educational activities that have been successful in other venues will be compared with the value of a biologic marker of bacterial infection - procalcitonin - for directing antimicrobial therapy. The impact on ICU infection and prescribing characteristics of doctors will be assessed. To further assess the interventions, costs of averted outcomes and of the interventions will be compared. OPRIONAL OBEJCTIVE SCORE: 2

描述（由申请人提供）：医疗保健获得性感染 (HAI) 是患者痛苦和社会成本的主要来源。尽管医护人员改善了最重要的医院感染控制措施（即手部卫生）的使用，但依从性仍然滞后，需要采取其他措施。提出了三组干预措施，包括 6 项研究。首先，多重耐药菌（MDRO）——耐甲氧西林金黄色葡萄球菌（MRSA）和耐碳青霉烯类革兰氏阴性杆菌——以及艰难梭菌相关感染（CDI）正在增加导致医院感染的原因。 MDRO 经常在医院和长期护理之间来回切换；这凸显了区域控制方法而不是传统的基于机构的方法的重要性。芝加哥预防和干预中心提议对急症和长期护理机构进行 T0/1/2/3 区域干预，其中包括加强监测和沟通以及使用氯己定对患者进行清洁，以降低芝加哥的 MDRO 风险。成功的项目可以为其他地理区域的 MDRO 控制提供信息。 CDI 部分是由抗生素对肠道微生物的影响引起的。益生菌是天然肠道稳定细菌的混合物，给予接受抗生素治疗的患者有可能降低 CDI 风险。提出了一种新型益生菌的 T0/1/2 示范项目，该项目已显示出预防 CDI 的前景。其次，解决与设备相关的感染。由于 CDC 2002 年建议的干预措施的广泛应用，导管相关血流感染 (CLABSI) 有所下降。现在，通过控制导管毂和流体通道的主要剩余感染源——外源性污染，或许可以消除 CLABSI。提议对导管毂进行积极无菌的 T0/1/2 ICU 和实验室研究。导管相关性尿路感染 (CAUTI) 虽然发病率较低，但却是 MDRO 的主要储存库，也是从医院传播到长期护理的来源。 CAUTI 的一项技术创新是手持式膀胱扫描仪，尽管其功效尚未得到充分证明，但已有许多早期采用者。这些设备价格昂贵，但提供了非侵入性确定膀胱容量的机会。建议进行膀胱扫描仪用于感染控制的 T0/2 前瞻性对照试验。第三，我们面临着没有新药的多重耐药菌。提出了 T1/2 干预措施，以便在 ICU（耐药热点）中提供更合理的抗菌药物使用。在其他场所取得成功的教育活动将与细菌感染的生物标记物（降钙素原）的价值进行比较，以指导抗菌治疗。将评估对 ICU 感染和医生处方特征的影响。为了进一步评估干预措施，将比较避免结果和干预措施的成本。 可选目标得分：2