Preventing Nosocomial Respiratory Infections: Patient Safety in the ICU

预防院内呼吸道感染：ICU 中的患者安全

基本信息

批准号：
8477238
负责人：
ELIZABETH Lee DAUGHERTY
金额：
$ 14.18万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-08-01 至 2015-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8477238
关键词：
Address Adherence Aerosols Affect American Attention Attitude Behavior Behavioral Belief Calculi Caring Cessation of life Climate Clinical Clinical Investigator Clinical Research Clinical Trials Commit Coupled Critical Care Critical Illness Data Day Care Devices Disease Outbreaks Epidemic Equipment Evaluation Family Focus Groups Fright Goals Guidelines Hand Handwashing Health Personnel Health system Healthcare Hospitals Hygiene Individual Infection Infection Control Influenza Influenza A Virus, H1N1 Subtype Institute of Medicine (U.S.)Intensive Care Units Intention Intervention Interview Knowledge Lung Masks Measures Mediating Medical Errors Medicine Mentors Modeling Morbidity - disease rate Motivation Nosocomial Infections Organism Outcome Participant Patient Self-Report Patients Pilot Projects Play Prevalence Prevent viral transmission Prevention Procedures Protocols documentation Provider Psychiatry Psychologist Public Health Qualitative Methods Questionnaires Readiness Reporting Research Resources Respiratory Tract Infections Risk Role Safety Severe Acute Respiratory Syndrome Site Structure Testing Training Universities Vancomycin resistant enterococcus Variant Viral Virus Work Workload age group authority career career development efficacy testing empowered expectation experience health care delivery improved influenzavirus injured instructor instrument killings member methicillin resistant Staphylococcus aureus mortality multi-component intervention nosocomial infection control novel pathogen patient safety prevent professor programs protective behavior public health relevance respiratory respiratory infection virus respiratory virus response risk perception routine care socioeconomics transmission process

项目摘要

DESCRIPTION (provided by applicant): In 1999, the Institute of Medicine released its report, "To Err is Human," which estimated that medical errors cause 44,000 to 98,000 deaths annually in the U.S. Healthcare associated infections (HAIs) play a major part in the complications associated with healthcare delivery, with over 2 million infections occurring annually. Much research in control of nosocomial infections and promotion of patient safety has focused on device-related infections. However, recent concerns about respiratory virus epidemics have focused attention on the problem of nosocomial spread of respiratory viruses. Preventing transmission of viral respiratory infections in the intensive care unit (ICU) is essential to promoting patient and provider safety during routine care of patients with such infections and during epidemics. Personal protective equipment (PPE) use decreases nosocomial transmission of epidemiologically important organisms and both organizational and individual healthcare worker (HCW) factors are thought to influence worker self-protective behaviors. However, research examining behavioral strategies to limit HAIs has found strikingly low HCW adherence, and little research has evaluated how both organizational factors and individual HCW factors influence adherence with respiratory precautions to prevent nosocomial respiratory virus infections. Further, patient and family attitudes and behaviors may also play an important role in HCW adherence, but the influence of patient knowledge and attitudes on HCW adherence with PPE has not been investigated. Elizabeth Lee Daugherty, MD, MPH, Instructor of Medicine, in the Pulmonary and Critical Care Division of Johns Hopkins University, has developed this proposal as a collaborative effort among key experts to fill this critical knowledge gap. This proposal will also serve as a key stepping stone toward Dr. Daugherty's goal of becoming an independent clinical investigator and nationally recognized leader in infection control and patient safety, focused on individual and organizational barriers that mediate PPE adherence, HAI rates, and clinical outcomes. As she seeks to achieve her goal, Dr. Daugherty will draw on key intellectual resources by working with Dr. Cynthia Rand, a renowned behavioral psychologist, Dr. Trish Perl, an expert in hospital infection control, and Dr. Peter Pronovost, a recognized authority in patient safety, among others. Dr. Daugherty will engage in a multi-faceted career development program while completing the research outlined in this proposal, under the guidance of her primary mentor, Dr. Rand, Professor of Medicine, Psychiatry, and Public Health at Johns Hopkins. This program will include three main components: 1) one-on- one research mentoring, 2) didactic training in clinical investigation, and 3) career development mentoring, in addition to the successful implementation and conduct of the proposed clinical research plan. All of the members of Dr. Daugherty's mentoring team are fully committed to providing the resources and support that she needs to build on an already productive early career and continue her transition into the fully independent clinical investigator that she hopes to become. The proposal outlined here will provide an essential venue through which to make this expectation a reality. The overall aims of this proposal are to assess the relationship between ICU organizational factors, individual HCW factors, and PPE adherence. We will also develop a novel pilot intervention to improve PPE adherence, which incorporates strategies both to decrease organizational and individual HCW adherence barriers and to empower patients and families to encourage PPE use. Our long term goal is to develop effective, reproducible strategies to lower ICU HAI rates, improve patient safety, and inform HCW and hospital preparedness for response to novel respiratory pathogens, such as SARS or 2009 H1N1 influenza. In specific aim 1, we will assess the association between ICU organizational factors and individual HCW factors on self-reported PPE adherence and directly observed PPE use across a range of ICUs. In specific aim 2, we will evaluate patient and provider barriers to and facilitators of PPE adherence for the prevention of healthcare-associated respiratory virus infections using qualitative methods, and in specific aim 3, we will develop and evaluate the impact of a novel pilot PPE adherence intervention. HAIs are a critical patient safety issue and are associated with significant morbidity and mortality. Little research has examined the influence of individual and organizational barriers to PPE use for control of nosocomial respiratory virus infections. Understanding the factors that influence HCW use of PPE is essential to promoting patient and worker safety during routine care of patients with respiratory infections and also as a model for developing protocols to protect patients and workers during respiratory virus epidemics.

描述（由申请人提供）：1999 年，医学研究所发布了其报告《人都会犯错》，该报告估计医疗错误每年导致美国 44,000 至 98,000 人死亡。与医疗服务相关的并发症，每年发生超过 200 万例感染。许多控制医院感染和促进患者安全的研究都集中在与设备相关的感染上。然而，最近对呼吸道病毒流行的担忧将人们的注意力集中到了呼吸道病毒的院内传播问题上。预防重症监护病房 (ICU) 中病毒性呼吸道感染的传播对于在此类感染患者的常规护理期间和流行期间提高患者和提供者的安全至关重要。个人防护装备 (PPE) 的使用可减少流行病学重要生物体的医院传播，组织和个人医护人员 (HCW) 因素被认为会影响工作人员的自我保护行为。然而，对限制医院感染的行为策略的研究发现，医护人员的依从性极低，而且很少有研究评估组织因素和医护人员个人因素如何影响呼吸道预防措施的依从性，以预防院内呼吸道病毒感染。此外，患者和家人的态度和行为也可能对医护人员的依从性发挥重要作用，但患者知识和态度对医护人员依从个人防护装备的影响尚未得到调查。约翰·霍普金斯大学肺科和重症监护科的医学博士、公共卫生硕士、医学讲师 Elizabeth Lee Daugherty 制定了这一提案，作为主要专家之间的合作努力，以填补这一关键的知识空白。该提案也将成为 Daugherty 博士实现成为独立临床研究者和感染控制和患者安全领域全国公认的领导者的目标的关键垫脚石，重点关注影响个人防护用品依从性、医院感染率和临床结果的个人和组织障碍。在寻求实现目标的过程中，Daugherty 博士将与著名行为心理学家 Cynthia Rand 博士、医院感染控制专家 Trish Perl 博士以及公认的专家 Peter Pronovost 博士合作，利用重要的智力资源。其中包括患者安全方面的权威。多尔蒂博士将在她的主要导师、约翰·霍普金斯大学医学、精神病学和公共卫生教授兰德博士的指导下，参与多方面的职业发展计划，同时完成本提案中概述的研究。该计划将包括三个主要组成部分：1）一对一的研究指导，2）临床研究的教学培训，3）职业发展指导，以及拟议的临床研究计划的成功实施和实施。 Daugherty 博士的指导团队的所有成员都完全致力于为她提供所需的资源和支持，以帮助她在已经富有成效的早期职业生涯的基础上继续发展，并继续向她希望成为的完全独立的临床研究者过渡。这里概述的提案将为实现这一期望提供一个重要的场所。该提案的总体目标是评估 ICU 组织因素、医护人员个人因素和个人防护装备依从性之间的关系。我们还将开发一种新颖的试点干预措施，以提高个人防护用品的依从性，其中包括减少组织和个人医护人员依从性障碍并赋予患者和家庭鼓励使用个人防护用品的策略。我们的长期目标是制定有效、可重复的策略，以降低 ICU HAI 率、提高患者安全，并告知医护人员和医院做好应对新型呼吸道病原体（例如 SARS 或 2009 H1N1 流感）的准备。在具体目标 1 中，我们将评估 ICU 组织因素和个人 HCW 因素与自我报告的 PPE 依从性和直接观察到的一系列 ICU 中 PPE 使用情况之间的关联。在具体目标 2 中，我们将使用定性方法评估患者和提供者坚持个人防护装备的障碍和促进因素，以预防医疗相关呼吸道病毒感染；在具体目标 3 中，我们将开发并评估新型试点个人防护装备的影响依从性干预。 HAI 是一个关键的患者安全问题，并与显着的发病率和死亡率相关。很少有研究探讨个人和组织障碍对使用个人防护装备控制院内呼吸道病毒感染的影响。了解影响医护人员使用个人防护装备的因素对于在呼吸道感染患者的常规护理过程中促进患者和工作人员的安全至关重要，也可以作为制定呼吸道病毒流行期间保护患者和工作人员的方案的模型。