The Surface of Hospitals Intensive Environmental Load Disinfection (SHIELD) Study

医院表面强化环境负荷消毒 (SHIELD) 研究

• 批准号: 10013217
• 负责人: BRAD J SPELLBERG
• 金额: $ 30.87万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2021-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10013217
• 关键词: Surface; Hospitals; Intensive; Environmental; Load

SUMMARY/ABSTRACT Finding novel strategies to reduce healthcare-associated infections (HAIs), and Clostridium difficile infections (CDI) specifically, is a primary focus of the US DHHS and AHRQ. Improved terminal cleaning of hospital rooms is a critical imperative to interrupting transmission of HAIs. Unfortunately, the quality of terminal room cleaning achieved with standard hospital protocols is highly variable and inadequate. More reliable, intense disinfection has great potential to improve standard terminal room cleaning as a method to reduce HAIs. HyperDRYMist is a novel disinfectant device that creates a submicron, liquid particle mist of an EPA- approved, sporicidal, hydrogen peroxide-based, silver ion-impregnated disinfectant, which is dispersed across all air-exposed surfaces. After an EPA-compliant dwell period, the mist settles and the air in the room clears below EPA standards for particle safety, leaving all impacted surfaces dry to the touch. The entire process takes 20-30 minutes. In contrast, hydrogen-peroxide vapor technology, in which the active agent is in gaseous form and is not a liquid particulate mist, requires 2-3 hours to safely turn around a room. No patient or staff safety concerns of the misting process were identified despite months of use at multiple hospitals. Most importantly, in a 6 month, pilot, cross-over study, use of HyperDRYMist reduced the incidence of CDI from 4.2% to 0.6%; after cessation, CDI rates rose back up to 4.7% (prelim data). Thus HyperDRYMist has strong preliminary evidence. We propose to conduct a multi-centered trial to: 1. Define the impact of HyperDRYMist on HAI rates. Los Angeles County+University of Southern California, Harbor-UCLA, and Olive View Medical Centers are public hospitals in LA that provide care for AHRQ priority populations. A 12 month lead-in period will be used to establish baseline HAI rates and study infrastructure, and to ship, test, prepare, deploy and train personnel on the equipment. During the 24-month, prospective, active-controlled intervention, single occupancy rooms in the hospitals will undergo normal terminal cleaning by EVS with (intervention) vs. without (control) the HyperDRYMist device. After the intervention, the relative change from baseline in the rate of facility-onset, CDC-defined CDI between intervention and control rooms will be the primary outcome measure; secondary outcome measures will evaluate other forms of MDRO infection; a direct medical cost-benefit analysis will also be conducted. 2. Define the impact of HyperDRYMist on microbiome ecology and densities in key areas of hospital rooms. Microbial ecology on high touch surfaces in hospital rooms will be compared between interventional vs. control rooms to determine the impact of HyperDRYMist disinfection. This study will determine the potential for a novel method to routinely, more effectively disinfect many more surfaces in a hospital room than is achieved with standard cleaning. The availability of a simple, effective, terminal room-cleaning technology that reduces HAIs will tremendously benefit US healthcare.

摘要/摘要 寻找减少医疗相关感染 (HAI) 和艰难梭菌感染的新策略 具体来说，（CDI）是美国 DHHS 和 AHRQ 的主要关注点。改善医院终端清洁 房间是中断 HAI 传播的关键。遗憾的是航站楼房间质量 采用标准医院方案实现的清洁变化很大且不充分。更可靠、更强烈 作为减少医院感染的一种方法，消毒在改善标准终端房间清洁方面具有巨大潜力。 HyperDRYMist 是一种新型消毒设备，可产生 EPA- 的亚微米液体颗粒雾 经批准的、杀孢子的、基于过氧化氢的、银离子浸渍的消毒剂，分散在 所有暴露在空气中的表面。经过符合 EPA 规定的停留时间后，雾气沉淀，房间内的空气变得清澈 低于 EPA 颗粒安全标准，使所有受影响的表面摸起来干燥。整个过程 需要 20-30 分钟。相比之下，过氧化氢蒸气技术中的活性剂呈气态 形成且不是液体颗粒雾，需要 2-3 小时才能安全地绕房间一周。 尽管在医院使用了数月，但并未发现患者或工作人员对雾化过程存在安全顾虑。 多家医院。最重要的是，在为期 6 个月的试点交叉研究中，使用 HyperDRYMist 减少了 CDI 发生率从 4.2% 降至 0.6%；停止后，CDI 利率回升至 4.7%（初步数据）。因此 HyperDRYMist 拥有强有力的初步证据。我们建议进行多中心试验： 1. 定义 HyperDRYMist 对 HAI 率的影响。洛杉矶县+南方大学 加利福尼亚州、Harbor-UCLA 和 Olive View 医疗中心是洛杉矶的公立医院，为以下患者提供医疗服务： AHRQ 优先人群。将使用 12 个月的导入期来建立基线 HAI 率和 研究基础设施，并运送、测试、准备、部署和培训设备人员。期间 将在医院的单人病房内进行为期 24 个月的前瞻性主动控制干预 使用（干预）与不使用（控制）HyperDRYMist 设备时通过 EVS 进行的正常终端清洁。后 干预措施、设施发病率相对于基线的相对变化、CDC 定义的 CDI 干预和控制室将是主要结果衡量标准；次要结果措施将 评估其他形式的多重耐药菌感染；还将进行直接的医疗成本效益分析。 2. 定义 HyperDRYMist 对医院关键区域微生物组生态和密度的影响 房间。将比较医院病房高接触表面的微生物生态学 介入室与控制室的比较，以确定 HyperDRYMist 消毒的影响。 这项研究将确定一种新方法的潜力，以常规、更有效地消毒许多 医院病房中的表面比标准清洁所达到的表面更多。一个简单的可用性， 减少 HAI 的有效终端房间清洁技术将极大地有利于美国的医疗保健。

项目成果

Introducing antimicrobial stewardship to the outpatient clinics of a suburban academic health system.

• DOI: 10.1017/ash.2021.228
• 发表时间: 2022
• 期刊: Antimicrobial stewardship & healthcare epidemiology : ASHE
• 作者: Nielsen, Travis B;Santarossa, Maressa;Probst, Beatrice;Labuszewski, Laurie;Lopez, Jenna;Barsanti-Sekhar, Mary;Albarillo, Fritzie
• 通讯作者: Albarillo, Fritzie