Effect of Expanding Barrier Precautions for Reducing Clostridium difficile Acquisition in VA.

扩大屏障预防措施对减少 VA 中艰难梭菌感染的影响。

• 批准号: 10641758
• 负责人: NASIA SAFDAR
• 金额: --
• 依托单位: WM S. MIDDLETON MEMORIAL VETERANS HOSP
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10641758
• 关键词: Admission activity; Affect; American; Antibiotic-resistant organism; Antibiotics; Antimicrobial Resistance; Antisepsis; Biological; Caring; Cessation of life; Clostridium difficile; Clothing; Cluster randomized trial; Colon; Communicable Diseases; Communities; Containment; Data; Decontamination; Diagnostic tests; Diarrhea; Disease; Disease Outbreaks; Disinfection; Environment; Environmental Pollution; Equipment; Exposure to; Goals; Hand; Health; Health Personnel; Health care facility; Healthcare; Hospital Units; Hospitalization; Hospitals; Hygiene; Incidence; Infection; Infection Control; Infection prevention; Inpatients; Institutional Review Boards; Interruption; Intervention; Laboratory Technicians; Length of Stay; Measures; Medical; Methods; Microbiology; Monitor; Morbidity - disease rate; Nurses; Organism; Patients; Patients' Rooms; Perception; Perforation; Prevention; Prevention Measures; Provider; Pseudomembranous Colitis; Radiology Specialty; Randomized; Recommendation; Reproduction spores; Research; Research Assistant; Research Training; Resistance; Resources; Risk Factors; Secure; Site; Societies; Surface; Testing; Time; Toxic Megacolon; United States; Veterans; Work; comorbidity; cost; diarrheal disease; effectiveness evaluation; evidence based guidelines; experience; health care settings; healthcare-associated infections; human old age (65+); improved; infection rate; infection risk; methicillin resistant Staphylococcus aureus; modifiable risk; mortality; multi-drug resistant pathogen; new epidemic; pathogen; patient safety; prevent; programs; public health priorities; recruit; respiratory; screening; standard care; standard of care; transmission process

Background: Each year approximately 1.7 million occur in the United States causing significant morbidity and nearly 100,000 deaths. Clostridium difficile infection (CDI) has become the most common healthcare- associated infection (HAI) in U.S. hospitals causing half a million infections and 30,000 deaths. CDI ranges from asymptomatic colonization, mild to severe diarrhea, pseudomembranous colitis, toxic megacolon, colonic perforation, and death. Risk factors for CDI include older age, comorbidity, hospitalization, exposure to others with CDI, and antibiotic use. The increasing incidence of C. difficile and emergence of new epidemic strain has resulted in outbreaks in healthcare settings. Prevention of healthcare-onset (HO) CDI has quickly become a priority for most hospitals. Hospital prevention measures are limited to modifiable risk factors (i.e., prudent antibiotic use and limiting exposure to C. difficile). Hospital exposure to C. difficile can occur directly (i.e., hands or clothing of healthcare workers) or indirectly (i.e., environmental surfaces or shared equipment) so infection prevention measures focus on healthcare worker hand hygiene, healthcare worker barrier precautions (i.e., use of gowns and gloves) and cleaning and disinfection of the hospital environment and reusable medical equipment. However, these interventions are limited to symptomatic patients who test positive for CDI. Asymptomatic patients serve as a reservoir for cross contamination, but microbiological screening for asymptomatic carriage of C. difficile is not routinely performed in healthcare. Gloving for all patient contacts may interrupt transmission from asymptomatic patients colonized with C. difficile. Objectives: The overall purpose of the proposed study is to determine the effectiveness of healthcare worker use of gloves for all patient contact for reducing acquisition of C. difficile and hospital-onset CDI in inpatient hospital units. The main objective of the study is to compare the effects of universal gloving for all patient contact to the current standard of care (i.e., glove and gown only for known CDI cases). The specific aims are 1) Compare the effects of universal gloving for all patient contact to the current standard of care on C. difficile acquisition rates in hospitalized patients; 2) Compare the effects of universal gloving compared to standard of care gloving on CDI rates, other healthcare-associated infections, 30-day mortality and unit length of stay; 3) Evaluate intervention fidelity, the cost and stakeholder experiences. Methods: The study will be a cluster randomized trial (CRT) in ten inpatient VA hospital units. In the pre- intervention period we will conduct preparatory work including recruiting hospitals, training research assistants, securing IRB approval, identifying current practices, finalizing monitoring and observation plans and measuring baseline C. difficile acquisition rates. This will be followed by an intervention period executing the CRT in which hospital units will be randomized either to implement barrier precautions for all patient contacts or continue standard care (i.e., barrier precautions for patients with known CDI). The intervention will consist of all healthcare workers (nurses, providers, respiratory therapist, radiology and laboratory technicians, etc.) utilizing gloves for all patient contacts in the units that are randomized to receive the intervention. The non-intervention units will follow standard of care which consists of healthcare workers following barrier precautions (i.e., gloves and gowns) only for patients with known CDI and other antibiotic-resistant organisms (e.g., MRSA). The unit of analysis is the ICU, since data are collected at the level of the unit. Monthly data will be collected from all participating sites including C. difficile acquisition and infection rates, mortality, length of stay, barrier precaution compliance and end-user perceptions. Impact: The anticipated impact on Veterans’ healthcare is primarily the reduction of C. difficile acquisition and subsequent infection and its associated morbidity, mortality and costs. If found to be effective, the results will change the paradigm for CDI prevention in healthcare settings.

背景：每年大约有170万次发生在美国，导致大量发病率和 近100,000人死亡。艰难梭菌感染（CDI）已成为最常见的医疗保健 美国医院的相关感染（HAI），导致50万感染和30,000例死亡。 CDI范围 从不对称定殖，轻度至重度腹泻，假膜结肠炎，有毒的巨型巨型，结肠 穿孔和死亡。 CDI的危险因素包括年龄较大，合并症，住院，接触其他 使用CDI和抗生素使用。艰难梭菌的发生率的增加和新的流行病的出现已有 导致医疗机构爆发。预防医疗保健发表（HO）CDI迅速成为 大多数医院的优先事项。医院预防措施仅限于可修改的危险因素（即审慎 抗生素使用和限制艰难梭菌的暴露）。可以直接发生医院暴露于艰难梭菌（即 医护人员的手或衣服）或间接（即环境表面或共享设备） 感染预防措施的重点是医疗保健工人手卫生，医疗工人的障碍预防措施 （即，使用礼服和手套）以及对医院环境的清洁和消毒和可重复使用的医疗 设备。但是，这些干预措施仅限于对CDI呈阳性的有症状患者。 非对称患者是交叉污染的储层，但微生物筛查的 艰难梭菌的无症状载体在医疗保健中并未常规执行。手套供所有患者接触 可能会中断用艰难梭菌定殖的不对称患者的传播。 目标：拟议研究的总体目的是确定医疗工作者的有效性 使用手套用于所有患者接触以减少艰难梭菌和住院治疗中的医院CDI的获取 医院单位。该研究的主要目的是比较通用手套对所有患者的影响 接触当前的护理标准（即仅用于已知CDI病例的手套和礼服）。具体目的是 1）将通用手套对所有患者接触的影响与当前护理标准对艰难梭菌的影响进行比较 住院患者的收购率； 2）比较通用手套的效果与标准 照顾CDI率，其他医疗保健相关感染，30天死亡率和单位住院时间； 3） 评估干预保真度，成本和利益相关者的经验。 方法：该研究将是十个住院VA医院单位的簇随机试验（CRT）。在前 干预期我们将进行准备工作，包括招聘医院，培训研究助理， 确保IRB批准，确定当前实践，确定监视和观察计划并进行衡量 基线艰难梭菌采集率。随后将执行CRT的干预期 医院单位将被随机分配以实施所有患者联系人的障碍预防措施，或继续 标准护理（即已知CDI患者的屏障预防措施）。干预将由所有干预组成 使用医护人员（护士，提供者，呼吸治疗师，放射学和实验室技术人员等） 所有患者联系人的手套是随机分配干预措施的单位的手套。非干预 单位将遵循护理标准，该标准包括遵循障碍预防措施的医护人员（即手套） 和礼服）仅适用于已知CDI和其他抗生素耐药性生物（例如MRSA）的患者。单位 分析是ICU，因为数据是在单元级别收集的。每月数据将从所有人收集 参与地点，包括艰难梭菌获取和感染率，死亡率，住院时间，障碍 预防遵从性和最终用户的看法。 影响：对退伍军人医疗保健的预期影响是减少艰难梭菌的主要收购和 随后的感染及其相关的发病率，死亡率和成本。如果发现有效，结果将 更改医疗保健环境中CDI预防的范例。