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 寻找减少医疗保健相关感染（HAI）和艰难梭菌感染的新型策略 （CDI）具体而言，是美国DHHS和AHRQ的主要重点。改进的医院终端清洁 房间是中断Hais传播的至关重要的。不幸的是，终端房间的质量 通过标准医院协议实现的清洁是高度可变且不足的。更可靠，强烈 消毒具有改善标准终端房间清洁作为减少HAI的方法的巨大潜力。 HyperDrymist是一种新型的消毒装置，可创建EPA-的亚微米，液态粒子雾 经过批准的，孢子性的，基于过氧化氢的，银离子浸渍的消毒剂，分散在 所有空气曝光的表面。经过符合EPA的居中，雾气沉降，房间中的空气清除 低于EPA的颗粒安全标准，使所有受影响的表面都干燥。整个过程 需要20-30分钟。相比之下，活性剂处于气态中 形式，不是液体颗粒雾，需要2-3小时才能安全地旋转房间。 尽管使用了几个月的使用 多家医院。最重要的是，在6个月的飞行员，跨界研究中，使用超级精神降低了 CDI的发生率从4​​.2％至0.6％；停止后，CDI速率上升到4.7％（PRELIM数据）。因此 超级敏制主义者有强有力的初步证据。我们建议进行以下多中心试验： 1。定义超级精神者对HAI速率的影响。洛杉矶县+南部大学 加利福尼亚州，港口 - 乌克拉郡和橄榄景医疗中心是洛杉矶的公立医院，可为 AHRQ优先人群。将使用12个月的提前期来建立基线HAI率和 研究基础设施，并在设备上运送，测试，准备，部署和培训人员。在 24个月，预期的，主动控制的干预措施，医院的单人居住室将接受 通过（干预）与没有（控制）超晶装置的电动汽车进行正常终端清洁。后 干预措施，在设施发作速率，CDC定义的CDI的基线的相对变化 干预室和控制室将是主要的结果指标；次要结果措施将 评估其他形式的MDRO感染；还将进行直接的医疗成本效益分析。 2。定义高剂学对医院关键领域微生物组生态和密度的影响 房间。将比较医院室高触摸表面的微生物生态学 介入与控制室，以确定超级消毒的影响。 这项研究将确定一种新型方法常规，更有效地消毒的潜力 与标准清洁相比​​，病房中的表面要多。简单的可用性 减少HAI的有效，终端清洁技术将极大地使美国医疗保健受益。

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