Pathway from Functional Disability to Antimicrobial Resistance in Nursing Homes

疗养院从功能障碍到抗菌素耐药性的途径

基本信息

批准号：
9058926
负责人：
Lona Mody
金额：
$ 37.32万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-06-15 至 2018-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9058926
关键词：
Activities of Daily Living Antibiotic-resistant organism Antimicrobial Resistance Area Bathing Caregivers Categories Chlorhexidine Clinical Control Groups Cross-Sectional Studies Data Diarrhea Disabled Persons Discipline of Nursing Dose Education Effectiveness Elderly Elements Environment Environmental Pollution Epidemiologic Studies Family Feedback Hand Health Health Care Costs Health Personnel Hospitals Hygiene Impairment Infection Control Infection Control Practitioners Infection prevention Intervention Lead Leadership Modeling Molecular Molecular Profiling Nursing Homes Organism Pathway interactions Pattern Prevalence Prevention program Prevention strategy Prospective Studies Protocols documentation Quality of life Randomized Recreation Rehabilitation therapy Research Research Design Resources Risk Risk Factors Role Stratification Surface Testing Time Work base caregiver interventions cost shifting design disability disability burden environmental intervention functional disability group intervention high risk implantable device innovation microbial multi-component intervention prevent primary outcome programs prospective response translational study transmission process

项目摘要

DESCRIPTION (provided by applicant): Antimicrobial-resistant organisms (AROs) are endemic in nursing homes (NH) with prevalence rates surpassing those in hospitals. The basic question of interaction between a disabled host, institutional environment, and caregiver contact in ARO acquisition (and transmission) remains unanswered. We hypothesize that specific activities of daily living (ADL) disability patterns in NH residents will predict acquisition risk or new AROs. We will examine whether disability and risk of acquisition are proportional to healthcare worker contact time and contact intensity. Our proposed Specific Aims are: Aim 1: Develop and examine a risk-stratification model utilizing resident-, HCW-, and environmental-level factors to identify three categories of NH residents: (1) never acquire an ARO; (2) intermittently acquire an ARO; and (3) newly acquire an ARO and remain persistently colonized. Resident-level factors include incremental levels and specific patterns of ADL impairment, presence of wounds, and use of indwelling devices. HCW factors include contact time and intensity, as well as varying levels of nursing resource utilization. The environment factors include presence of AROs on inanimate objects in resident rooms, common areas, and rehabilitation rooms. We will also establish a "molecular fingerprint" between the strains of AROs colonizing functionally-impaired residents and those isolated from their environment and the hands of caregivers. Using this risk-stratification model, we will establish the optimal ARO prevention strategy in highest-risk functionally-disabled NH residents. Aim 2: Design and evaluate the effectiveness of a multi-component intervention to reduce new acquisition of AROs in the highest-risk functionally-disabled NH residents. This intervention will incorporate resident level, environmental, and caregiver-based strategies. The proposed translational study is innovative and timely because it will develop a risk-stratification model to identify functionally-disabled NH residents who are most likely, if colonized, to transmit AROs; define a molecular "fingerprint" of resident-caregiver-environment ARO contamination; and design and implement a multi-component comprehensive intervention targeting high-risk functionally-disabled residents. The impact of this research will be an effective, efficient, and infection prevention program for NHs to limit ARO acquisition and more importantly transmission. We expect our results to have widespread application in NHs, enhance residents' quality of life, reduce hospital transfers, reduce healthcare costs and shift the evolving paradigm of infection control and prevention in NHs.

描述（由申请人提供）：耐药菌（ARO）在疗养院（NH）中普遍存在，其患病率超过了医院。 ARO 获取（和传播）中残疾宿主、机构环境和护理人员接触之间相互作用的基本问题仍未得到解答。我们假设新罕布什尔州居民的特定日常生活活动 (ADL) 残疾模式将预测获得风险或新的 ARO。我们将检查残疾和感染风险是否与医护人员的接触时间和接触强度成正比。我们提出的具体目标是：目标 1：利用居民、医护人员和环境因素制定并检查风险分层模型，以确定三类 NH 居民：(1) 从未获得 ARO； (2)间歇性获取ARO； (3) 新获得 ARO 并保持持续殖民状态。住院医师层面的因素包括 ADL 损伤的增量水平和具体模式、伤口的存在以及留置装置的使用。医护人员因素包括接触时间和强度，以及不同水平的护理资源利用。环境因素包括居住房间、公共区域和康复室的无生命物体上存在 ARO。我们还将在功能受损居民的 ARO 菌株与从其环境和护理人员手中分离的 ARO 菌株之间建立“分子指纹”。利用这种风险分层模型，我们将为最高风险的功能障碍 NH 居民制定最佳 ARO 预防策略。目标 2：设计并评估多成分干预措施的有效性，以减少最高风险的功能障碍 NH 居民新获得 ARO。这项干预措施将纳入居民基于水平、环境和护理人员的策略。拟议的转化研究具有创新性和及时性，因为它将开发一个风险分层模型来识别功能残疾的新罕布什尔州居民，这些居民如果被定殖，最有可能传播 ARO；定义居民护理人员环境 ARO 污染的分子“指纹”；设计并实施针对高风险功能障碍居民的多组成部分综合干预措施。这项研究的影响将为 NH 提供有效、高效的感染预防计划，以限制 ARO 的获取，更重要的是限制传播。我们期望我们的研究结果能够在NHs中得到广泛应用，提高居民的生活质量，减少医院转诊，降低医疗成本，并改变NHs感染控制和预防不断发展的范式。