Patient Movement and Impact on Multidrug-Resistant Organism (MDRO) Transmission

患者移动及其对多重耐药菌 (MDRO) 传播的影响

• 批准号: 9890591
• 负责人: Lona Mody
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9890591
• 关键词: Acute; Aging; Aging; Antibiotic Resistance; Antibiotic Resistance; Area; Area; Bacillus; Bacillus; Biopsy; Biopsy; CLC Gene; CLC Gene; Caregivers; Caregivers; Caring; Caring; Clinic; Clinic; Clinical; Clinical; Clinical Data; Clinical Data; Clinical Microbiology; Clinical Microbiology; Communicable Diseases; Communicable Diseases; Day Surgery; Day Surgery; Development; Development; Diagnostic; Diagnostic; Dialysis procedure; Dialysis procedure; Discipline of Nuclear Medicine; Discipline of Nuclear Medicine; Discipline of Nursing; Discipline of Nursing; Distant; Distant; Ecology; Ecology; Education; Education; Elderly; Elderly; Environment; Environment; Environmental Pollution; Environmental Pollution; Epidemiology; Epidemiology; Evaluation; Evaluation; Family; Family; Fingerprint; Fingerprint; Focus Groups; Focus Groups; Future; Future; Genomics; Genomics; Goals; Goals; Hand; Hand; Health; Health; Health Professional; Health Professional; Health Service Area; Health Service Area; Health behavior; Health behavior; Healthcare Systems; Healthcare Systems; Hospital Nursing; Hospital Nursing; Hospitals; Hospitals; Hygiene; Hygiene; Individual; Individual; Infection; Infection; Infection prevention; Infection prevention; Infusion procedures; Infusion procedures; Institution; Institution; Intensive Care Units; Intensive Care Units; Intervention; Intervention; Knowledge; Knowledge; Leadership; Leadership; Medical; Medical; Methods; Methods; Microbiology; Microbiology; Molecular; Molecular; Molecular Epidemiology; Molecular Epidemiology; Movement; Movement; Nursing Homes; Nursing Homes; Occupational Therapy; Occupational Therapy; Operative Surgical Procedures; Operative Surgical Procedures; Organism; Organism; Outcome; Outcome; Participant; Participant; Patients; Patients; Patients' Rooms; Patients' Rooms; Pattern; Pattern; Physical therapy; Physical therapy; Population; Population; Positioning Attribute; Positioning Attribute; Pre-Post Tests; Pre-Post Tests; Prevalence; Prevalence; Prevention; Prevention; Prevention education; Prevention education; Prevention strategy; Prevention strategy; Procedures; Procedures; Prospective cohort study; Prospective cohort study; Provider; Provider; Qualitative Research; Qualitative Research; Quality of life; Quality of life; Radiology Specialty; Radiology Specialty; Recreation; Recreation; Rehabilitation therapy; Rehabilitation therapy; Research Design; Research Design; Role; Role; Safety; Safety; Saints; Saints; Science; Science; Services; Services; Spinal Cord; Spinal Cord; Staphylococcus aureus infection; Staphylococcus aureus infection; Surface; Surface; Time; Time; United States Department of Veterans Affairs; Vancomycin resistant enterococcus; Vancomycin resistant enterococcus; Veterans; Veterans; Visit; Visit; acute care; community living; community living; comorbidity; comorbidity; design; design; disability; disability; genomic data; genomic data; genomic epidemiology; genomic epidemiology; high risk; high risk; improved; improved; indexing; indexing; innovation; innovation; intervention mapping; medical appointment; medical appointment; methicillin resistant Staphylococcus aureus; methicillin resistant Staphylococcus aureus; multi-component intervention; multi-component intervention; multi-drug resistant pathogen; multi-drug resistant pathogen; multidisciplinary; multidisciplinary; nursing home length of stay; nursing home length of stay; patient oriented research; patient oriented research; prevent; prevent; statistics; statistics; success; success; therapy design; therapy design; therapy development; therapy development; translational study; translational study; transmission process; transmission process; ward; ward

Multidrug-resistant organisms (MDROs) are endemic in both acute care and nursing homes (NHs). However, predictors for new MDRO acquisition in older adults and transmission to healthcare professionals (HCPs) and the environment, particularly outside of patient rooms, remain unclear. This is relevant in today’s contemporary healthcare systems with patient movement outside the rooms for medical diagnostics and treatment- such as rehabilitation including physical and occupational therapy, procedures such as biopsies, services such as dialysis, infusion clinics and recreational activities- presenting a tremendous potential for transmission of organisms With this project and a focus on high-risk NH Veterans, our aims are to first characterize the changing epidemiology of MDROs at 3 VA NHs with the explicit goal of developing a ‘Patient Movement Index’ depicting the role of out-of-room visits for medical appointments and recreation in MDRO transmission across the institution. Using molecular and genomic methods, we will develop an understanding of the impact of MDRO transmission, predominant strains circulating in the NHs and other patient use areas. Using an ‘Intervention Mapping Framework’ we will next develop and pilot an integrated multi-modal intervention involving Veterans, their families, HCP as well as leadership to reduce transmission and infections. We anticipate this intervention to include: 1) Veterans’ and caregivers’ hand hygiene and infection prevention education; 2) provider education on MDRO prevention strategies and environmental cleaning; and 3) leadership involvement including infection prevention team, VA NH leadership, and managers of common use areas frequented by our participants. Patterns of patient movements outside their rooms as well as the molecular and genomic data obtained in Specific Aim 1 will be critical in informing our intervention. Our proposed translational study is innovative and timely as we plan to develop a new index that will characterize the amount of time Veterans spend outside their immediate environment in a colonized state and define a “fingerprint” of Veteran-caregiver-environment contamination. These studies will open a new line of inquiry allowing us to design future projects in order to characterize patient movement and transmission in other service areas such as hospitals and specialized units. We expect our results to have widespread application within and outside the VA, enhance Veterans’ quality of life by improving their hygiene practices and preventing infections, and help understand MDRO transmission within an evolving healthcare system. Our multidisciplinary team with expertise in aging, epidemiology including molecular epidemiology, microbiology, infectious diseases, health outcomes, nursing and patient oriented research is uniquely positioned to achieve our goals and advance the field.

多重耐药菌 (MDRO) 在急症护理和疗养院 (NH) 中普遍存在。 老年人中新的 MDRO 感染和传播给医疗保健专业人员 (HCP) 的预测因素以及 环境，特别是病房外的环境，在当今仍不明确。 现代医疗保健系统，患者可以在房间外移动进行医疗诊断和 治疗——例如康复，包括物理和职业治疗、活检等程序， 透析、输液诊所和娱乐活动等服务——呈现出巨大的潜力 生物体的传播 通过这个项目并重点关注高风险的新罕布什尔州退伍军人，我们的目标是首先描述不断变化的特征 3 个 VA NH 的 MDRO 流行病学，明确目标是制定“患者流动指数”来描述 就诊和娱乐的室外就诊在 MDRO 跨区域传播中的作用 使用分子和基因组方法，我们将了解 MDRO 的影响。 传播、在 NH 和其他患者使用区域传播的主要菌株。 映射框架”我们接下来将开发和试点综合多模式干预措施，涉及 退伍军人、他们的家人、医护人员以及领导层将减少传播和感染。 干预措施包括：1) 退伍军人和护理人员的手部卫生和感染预防教育；2) 提供者有关 MDRO 预防策略和环境清洁的教育；以及 3) 领导力 参与包括感染预防团队、VA NH 领导层和公共使用区域的管理者 我们的参与者经常在房间外移动的模式以及分子和 在特定目标 1 中获得的基因组数据对于为我们的干预提供信息至关重要。 我们提出的转化研究是创新且及时的，因为我们计划开发一个新的指数，该指数将 描述退伍军人在殖民州的直接环境之外度过的时间，以及 定义退伍军人护理人员环境污染的“指纹”，这些研究将开辟一条新的路线。 调查使我们能够设计未来的项目，以便描述患者运动和传播的特征 我们希望我们的成果能够广泛应用于其他服务领域，例如医院和专业单位。 退伍军人管理局内外的应用，通过改善退伍军人的卫生习惯来提高他们的生活质量 预防感染，并帮助了解 MDRO 在不断发展的医疗系统中的传播。 我们的多学科团队拥有衰老、流行病学（包括分子流行病学）方面的专业知识， 微生物学、传染病、健康结果、护理和以患者为导向的研究是独一无二的 定位于实现我们的目标并推进该领域。