Combating Antimicrobial Resistance through Rapid Implementation of Available Guidelines and Evidence (CARRIAGE)

通过快速实施现有指南和证据来对抗抗菌素耐药性 (CARRIAGE)

• 批准号: 10187395
• 负责人: CHARLESNIKA T EVANS
• 金额: --
• 依托单位: VA SALT LAKE CITY HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-10-01 至 2025-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10187395
• 关键词: 2019-nCoV; Address; Adoption; Advisory Committees; Antibiotic Resistance; Antibiotics; Antimicrobial Resistance; Area; Behavior; COVID-19; COVID-19 pandemic; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Characteristics; Clinical; Collaborations; Communicable Diseases; Country; Data; Data Collection; Data Set; Development; Development Plans; Disease; Disease Resistance; Disinfection; Education; Emerging Communicable Diseases; Engineering; Ensure; Evaluation; Event; Evidence based practice; Exhibits; Feedback; Focus Groups; Future; Generations; Goals; Guidelines; Health; Health care facility; Healthcare; Healthcare Systems; ImProv; Individual; Infection; Infection Control; Infection prevention; Infrastructure; Integrated Health Care Systems; Intervention; Interview; Investments; Leadership; Mentors; Methods; Mission; Modeling; Modernization; Morbidity - disease rate; Organism; Outcome; Patient Care; Performance; Phase; Policies; Positioning Attribute; Prevention; Process; Provider; Public Health; Quality of Care; Recording of previous events; Records; Reporting; Research; Research Personnel; Resistance; Safety; Scientist; Secondary to; Series; Services; Site; Surveys; System; Testing; Time; Touch sensation; Training; Treatment Failure; Uncertainty; United States; Veterans; Work; antimicrobial; carbapenem resistance; career; career development; cost; design; drug resistant pathogen; effectiveness evaluation; emerging pathogen; experience; health care quality; health care settings; healthcare-associated infections; implementation science; implementation strategy; improved; innovation; interest; mortality; multi-drug resistant pathogen; novel; pandemic disease; pathogen; patient safety; prevent; programs; resilience; response; routine care; success; theories; transmission process; ultraviolet; uptake

Background: Under-investments in antimicrobial discovery, antimicrobial stewardship, and infection control have reached crisis proportions. While these under-investments have been laid bare by SARS-CoV-2, antimi- crobial-resistant infections—a more silent killer—are accelerating with three million illnesses, 48,000 deaths and $35 billion in excess costs annually in the US, secondary to treatment failure and associated higher morbidity and mortality. The ongoing pandemic of COVID-19, the disease caused by SARS-CoV-2, has also revealed much about the limits of our public health infrastructure and the need to rapidly engage partners, dis- seminate best practices, and adapt to changing conditions during times of widespread uncertainty. Our national, integrated healthcare system for Veterans offers unique opportunities to significantly alter the course of events and improve the outlook for our future through novel implementation and quality improvement efforts. Objectives: The goal of this QUERI program is to continue the successes of its predecessor by addressing the growing concern of antimicrobial resistance and other emerging infectious threats through strategies that train, communicate, and coordinate front-line staff, operational leaders, and field experts. In doing so, we will address the priority goals of our VA operational partners, increase the impact of VA research findings through bi-directional partnerships and rigorous evaluation, and promote VA as a high reliability organization through innovative implementation science. Three projects designed to implement key evidence-based practices in the areas of infection prevention, biosurveillance, and antimicrobial stewardship will target the behaviors and processes that facilitate the spread of antibiotic-resistant and other emerging pathogens, including (1) improv- ing patient safety through overcoming barriers to Ultraviolet-C (UVC) no-touch room disinfection; (2) improving implementation of strategies to prevent the spread of carbapenem-resistant organisms (CROs); and (3) estimating the impact of two different electronic audit and feedback strategies on antimicrobial prescribing practices. These efforts will be supplemented with time-sensitive rapid response projects guided by our operational partners to assist their work with front-line providers across the country. We will also train a new generation of VA implementation scientists through our mentoring core, led by investigators committed to developing junior implementation researchers committed to careers improving the quality, safety, and value of Veteran health care. Methods: The program will employ complementary implementation strategies and theories guided by an Implementation Core consisting of a team of notable VA implementation scientists with proven track records in designing and executing programs to control antimicrobial resistance and prevent the spread of pathogens. We will follow the principles of High Reliability Organizations to deliver reliable performance, consistent safety, and exceptional quality, using approaches that are aligned with the three phases of the QUERI Implementation Roadmap (pre-implementation, implementation, and sustainment). Specific implementation strategies will include blended (internal and external) facilitation, audit and feedback, and provider and staff education and activation. Work system barriers and facilitators will be assessed using the Systems Engineering Initiative for Patient Safety (SEIPS) model, which will help identify factors that influence the processes of care and inform data collection methods that will include the use of national VA datasets, direct observation, and primary data (i.e., surveys, interviews, and focus groups). Finally, our Mentoring Core will utilize the Matrix Mentoring Model as a framework to provide each trainee with a team of mentors, each contributing unique expertise. Trainees will follow a personalized career development plan, and will have opportunities to participate in rapid response projects to gain experience interfacing with VA operational partners.

背景：抗菌药物发现、抗菌药物管理和感染控制方面的投资不足 虽然 SARS-CoV-2 暴露了这些投资不足的情况，但抗病毒药物 耐微生物感染——一种更无声的杀手——正在加速发展，导致 300 万人患病，48,000 人死亡 美国每年因治疗失败和相关更高的费用而产生 350 亿美元的超额费用 由 SARS-CoV-2 引起的疾病 COVID-19 的持续流行也增加了发病率和死亡率。 揭示了我们公共卫生基础设施的局限性以及迅速与合作伙伴合作的必要性， 提出最佳实践，并在普遍不确定的时期适应不断变化的条件。 为退伍军人提供的国家综合医疗保健系统提供了显着改变课程的独特机会 通过新颖的实施和质量改进工作来改善我们的未来前景。 目标：该 QUERI 计划的目标是通过解决以下问题来延续其前身的成功： 通过培训战略，人们越来越关注抗菌素耐药性和其他新出现的感染威胁， 沟通并协调一线员工、运营领导者和现场专家。 解决我们 VA 运营合作伙伴的优先目标，通过以下方式提高 VA 研究结果的影响力： 双向合作伙伴关系和严格的评估，并通过以下方式促进 VA 成为高可靠性组织 创新实施科学。旨在实施关键循证实践的三个项目。 感染预防、生物监测和抗菌药物管理领域将针对行为和 促进抗生素耐药性和其他新出现的病原体传播的过程，包括（1）改进 (2) 通过克服紫外线-C (UVC) 非接触式房间消毒的障碍，提高患者安全； 实施防止碳青霉烯类耐药生物（CRO）传播的战略；以及（3） 估计两种不同的电子审核和反馈策略对抗菌药物处方的影响 这些努力将得到我们指导下的时间敏感的快速反应项目的补充。 我们还将培训新的运营合作伙伴，以协助他们与全国各地的一线供应商合作。 通过我们的指导核心培养 VA 实施科学家，由致力于以下方面的研究人员领导 培养致力于提高质量、安全性和价值的初级实施研究人员 退伍军人保健。 方法：该计划将采用互补的实施策略和理论，以 实施核心由著名的 VA 实施科学家团队组成，他们在 设计和执行计划以控制抗菌素耐药性并防止病原体传播。 将遵循高可靠性组织的原则，提供可靠的性能、一致的安全性和 卓越的品质，使用与 QUERI 实施的三个阶段相一致的方法 路线图（实施前、实施和维持）。 包括混合（内部和外部）促进、审计和反馈，以及提供者和员工的教育和 将使用系统工程计划来评估工作系统的障碍和促进因素。 患者安全 (SEIPS) 模型，这将有助于识别影响护理过程的因素并告知 数据收集方法包括使用国家 VA 数据集、直接观察和原始数据 （即调查、访谈和焦点小组）。最后，我们的指导核心将利用矩阵指导模型。 作为一个框架，为每个学员提供一个导师团队，每个学员都贡献独特的专业知识。 将遵循个性化的职业发展规划，并有机会参与快速反应 项目以获得与 VA 运营合作伙伴对接的经验。