Johns Hopkins Prevention Epicenter: Transdisciplinary Research Approaches to Prevent Healthcare Associated Infections and Antibiotic Resistance (TRAP HAI & AR)

约翰霍普金斯大学预防中心：预防医疗相关感染和抗生素耐药性的跨学科研究方法（TRAP HAI

• 批准号: 10402755
• 负责人: Sara Elizabeth Cosgrove
• 金额: $ 182.48万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10402755
• 关键词: Johns; Hopkins; Prevention; Epicenter; Transdisciplinary

PROJECT SUMMARY/ABSTRACT The purpose of this proposal is to translate basic, epidemiologic, and technologic discoveries into new strategies to prevent healthcare-associated infections and antibiotic resistance and to improve how antibiotics and diagnostic tests are used across all healthcare settings. This work includes six Core Projects and three Optional Collaborative Projects. The Core Projects include: (1) using a human factors engineering approach to improve environmental cleaning in diverse long-term care settings; (2) developing and testing a clinician- informed, electronic antibiotic-associated adverse event harm score for adults and children using data from the electronic health record (EHR) with the goal of changing antibiotic prescribing behaviors in the hospital; (3) developing a measure to detect episodes of organisms transmission from patients sequentially occupying the same hospital room using data from the EHR and piloting its use as an indicator for improved room cleaning; (4) characterizing the molecular epidemiology of extended spectrum β-lactamase-producing Enterobacterales, predicting what patients are colonized with them, and determining the role of infection control lapses and antibiotic exposure in their transmission; (5) characterizing the nasal microbiota of neonates that develop Staphylococcus aureus bacteremia to understand how to prevent this deadly infection; and (6) developing an algorithm using EHR data to identify rapidly healthcare workers and patients who have been exposed to an index patient with a transmissible infectious disease with the goal of quickly mitigating the risk of secondary exposures. The Optional Collaborative Projects include: (1) developing a benchmark for blood culture and blood culture positivity rates and a consensus definition of blood culture inappropriateness and using these results to implement and evaluate an evidence-based algorithm to improve blood culture practices in a multi- institution cohort of adult medicine patients; (2) characterizing the risk for and microbiology and geographical patterns of central line-associated bloodstream infections that are acquired outside of the hospital (e.g., at home, in long-term care facilities, at dialysis) and pilot a prevention toolkit to reduce the risk of infection for patients requiring a central catheter upon hospital discharge, and (3) determining how postnatal age impacts the association between birthweight and bacteremia rates in the neonatal intensive care unit (NICU) in order to develop a practical approach for reporting NICU-onset bacteremia rates that adjusts for birthweight and postnatal age. This proposal demonstrates capacity to integrate expertise in healthcare epidemiology and antibiotic stewardship with other disciplines—human factors engineering, data science, machine learning, microbiology, mathematical modeling, microbiome science, and implementation science—with the goal of identifying novel approaches to prevent healthcare associated infections and antibiotic resistance and that can inform CDC guidance and be applied across multiple settings to reduce harm to patients and healthcare workers.

项目摘要/摘要 该建议的目的是将基本，流行病学和技术发现转化为新 防止医疗保健相关感染和抗生素耐药性并改善抗生素的策略 并在所有医疗机构中使用诊断测试。这项工作包括六个核心项目和三个 可选协作项目。核心项目包括：（1）使用人为因素工程方法 改善潜水员长期护理环境中的环境清洁； （2）开发和测试临床 知情的，电子抗生素相关的广告事件事件事件危害成人和儿童使用来自 电子健康记录（EHR）的目的是改变医院的抗生素处方行为； （3） 制定一种检测生物体传播的措施，依次占据 同一病房使用来自EHR的数据并试用其用作改进房间清洁的指标； （4）表征扩展光谱β-内酰胺酶产生的肠杆菌的分子流行病学， 预测患者与他们一起定殖的内容，并确定感染控制失误的作用 传播中的抗生素暴露； （5）表征发展的新生儿的鼻菌群 金黄色葡萄球菌细菌血症了解如何预防这种致命感染； （6）开发一个 使用EHR数据来识别暴露于 索引患者患有可传染的传染病，目的是迅速减轻继发性风险 暴露。可选协作项目包括：（1）为血液培养和 血液培养阳性率和血液培养不符合性的共识定义，并使用这些定义 实施和评估基于证据的算法的结果，以改善多种多样的血液培养实践 成人医学患者的机构队列； （2）表征与微生物学和地理学的风险 在医院外获得的中央线相关血流感染的模式（例如 家庭，在透析中的长期护理设施中），并试行预防工具包，以降低感染风险 出院时需要中央导管的患者，以及（3）确定产后年龄如何影响 新生儿重症监护病房（NICU）的出生体重和细菌率之间的关联是为了 开发一种实际方法来报告NICU-菌率，以适应出生体重和 产后年龄。该提案表明能力将医疗保健流行病学专业知识整合到 与其他学科的抗生素管理 - 人类因素工程，数据科学，机器学习， 微生物学，数学建模，微生物组科学和实施科学，其目的是 识别新的方法来防止医疗保健相关的感染和抗生素耐药性，并且可以 通知CDC指导并在多种环境中应用以减少对患者和医疗保健的伤害 工人。