Infection Prevention and Antimicrobial Stewardship: Minding the Gaps: The Iowa Prevention Epicenter

感染预防和抗菌药物管理：弥补差距：爱荷华州预防中心

• 批准号: 10653046
• 负责人: Loreen A Herwaldt
• 金额: $ 148.09万
• 依托单位: UNIVERSITY OF IOWA
• 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/10653046
• 关键词: Infection; Prevention; Antimicrobial; Stewardship; Minding

ABSTRACT We designed this proposal to address multiple CDC Epicenters' research priorities: preventing healthcare personnel (HCP) contamination, understanding and decreasing transmission of epidemiologically important pathogens including emerging respiratory viruses such as COVID-19, extending antimicrobial stewardship (AS), decreasing antimicrobial resistant infections, exploring sepsis epidemiology and prevention, quantifying and decreasing environmental contamination, implementing a decolonization program to obtain source control and decrease surgical site infections (SSI), applying innovative research methodology, and training the next generation of healthcare epidemiologists. Our proposed projects range from translational stage T0 to T2 and involve academic medical centers, a VA Medical Center, acute care hospitals, quick/urgent care centers (UCC), surgical patients, patients discharged from hospitals, and healthcare personnel (HCP) exposed to viral respiratory pathogens. Our long-term objectives are to: 1) improve the integration of infection prevention measures into HCP's patient care processes, 2) improve personal protective equipment (PPE) design and use to decrease HCP contamination and transmission, 3) improve surveillance for healthcare-associated infections (HAI), 4) identify practical ways to decrease spread of viral pathogens, 4) improve antibiotic use and decrease antimicrobial resistance, and 5) prevent hospital-onset sepsis (HOS) and HAI, including SSI. Core Project (CP) I uses methods from human factors engineering, ethnography, industrial hygiene, environmental microbiology, and computer visioning to improve PPE design, decrease HCP self-contamination, improve integration of PPE use and hand hygiene during patient care, and decrease bacterial and viral environmental contamination. CP II employs novel software via cellphones to expand surveillance for SSI and C. difficile infections after discharge and to monitor HCP exposed to respiratory viruses for signs or symptoms of infection. CP III and the Medium Optional Collaborative Project (OCP) address neglected opportunities for AS--UCC and patients at hospital discharge--by creating and testing novel AS metrics to decrease antibiotic prescriptions for acute respiratory tract infections in UCC (CP III) and by conducting a cluster-randomized trial of post-prescription audit-and-review to reduce unnecessary antibiotic use after discharge (Medium OCP). CP IV mines large administrative data sets and analyzes data from individual medical records to define the epidemiology of HOS, validate CDC's acute sepsis event algorithm for HOS, and identify remediable HOS risk factors that could be targets for preventive measures. The Large OCP will conduct a stepped wedge trial of a simple, inexpensive intervention—2 doses of intranasal povidone iodine—to prevent SSI in patients with high- energy lower extremity fractures, who are a high-risk population with few available preventive measures. The Small OCP seeks to improve antibiograms and, therefore, antibiotic use by including geospatial information in antibiograms. This information should provide clinicians with information more specific to their patients.

抽象的 我们设计此提案是为了解决多个 CDC Epicenters 的研究重点：预防医疗保健 人员（HCP）污染、了解和减少流行病学重要的传播 包括新出现的呼吸道病毒（例如 COVID-19）在内的病原体，扩大抗菌药物管理范围 （AS），减少抗生素耐药性感染，探索脓毒症流行病学和预防，量化 减少环境污染，实施非殖民化计划以获得源头控制 并减少手术部位感染（SSI），应用创新的研究方法，并培训下一代 我们提出的项目范围从 T0 到 T2 阶段以及 涉及学术医疗中心、退伍军人管理局医疗中心、急症护理医院、快速/紧急护理中心 (UCC)、手术患者、出院患者以及接触病毒的医护人员 (HCP) 我们的长期目标是：1）提高感染预防的一体化程度。 HCP 患者护理流程的措施，2) 改进个人防护装备 (PPE) 的设计和使用 减少 HCP 污染和传播，3) 改善对医疗保健相关感染的监测 (HAI)，4) 确定减少病毒病原体传播的实用方法，4) 改善抗生素的使用并减少 抗菌素耐药性，5) 预防院内败血症 (HOS) 和 HAI，包括 SSI 核心项目。 (CP) 我使用人因工程、人种学、工业卫生、环境 微生物学和计算机视觉来改进 PPE 设计、减少 HCP 自身污染、改善 在患者护理过程中整合个人防护装备的使用和手部卫生，并减少细菌和病毒环境 CP II 通过手机采用新颖的软件来扩大对 SSI 和艰难梭菌的监测。 出院后感染，并监测接触呼吸道病毒的医护人员是否有以下症状或体征 CP III 和中等可选合作项目 (OCP) 解决了被忽视的机会。 AS——UCC 和出院患者——通过创建和测试新的 AS 指标来减少抗生素的使用 治疗 UCC 急性呼吸道感染 (CP III) 的处方并进行整群随机试验 处方后审核和审查，以减少出院后不必要的抗生素使用（中 OCP）。 IV 挖掘大型管理数据集和个人医疗记录中的嵌套数据来定义 HOS 的流行病学，验证 CDC 针对 HOS 的急性脓毒症事件算法，并确定可补救的 HOS 风险 大型 OCP 将对可能成为预防措施目标的因素进行阶梯式楔形试验。 简单、廉价的干预措施（2 剂鼻内聚维酮碘）可预防高危患者的 SSI 能量下肢骨折，他们是高危人群，可用的预防措施很少。 Small OCP 致力于通过将地理空间信息纳入抗生素谱中来改善抗生素谱，从而改善抗生素的使用。 该信息应提供针对患者的更具体的信息。