The purpose of this career development proposal is to obtain the necessary resources and protected time to develop the skills needed to be an independent, patient-oriented researcher in the field of healthcare epidemiology. I intend to focus my research on developing and testing interventions to decrease nosocomial infections. To accomplish this goal, I will obtain a Masters Degree in Public Health, taking courses in epidemiology, ethics, statistical analysis, and outcomes research. In addition, I have chosen a mentor, Dr. Victoria Fraser, an expert in the field of nosocomial infection outcomes and prevention, and a faculty advisory committee to facilitate my research and career development. The classes and mentorship will also allow me to successfully carry out my proposed research project - the development and evaluation of a multicenter intervention to reduce the rate of catheter-associated bloodstream infections. The use of central venous catheters places individuals at risk for catheter-associated bloodstream infections. Catheter-associated bloodstream infections result in increased hospital stays and cost of care. Evidence-based guidelines exist which recommend specific practices to reduce the risk of catheter-associated infections, including the use of maximal barrier precautions to insert central venous catheters and aseptic technique when caring for catheters. It is unknown to what extent these evidence-based guidelines for the use of central venous catheter have been adopted into clinical practice. A few small studies have shown that focused interventions based on these guidelines are successful in reducing the incidence of catheter-associated bloodstream infections. However, these studies have been limited to single sites, with varying levels of physician and nursing participation.
Specific Aim 1 of this proposal will determine the current practices and policies regarding the insertion and care of central venous catheters in intensive care units at seven medical centers, as compared to the best practices and evidence-based guidelines reported in the literature.
Specific Aim 2 will calculate the effect, at intensive care units in seven hospitals, of implementing an evidence-based intervention designed to modify processes of central venous catheter insertion and care on the incidence of catheter-associated bloodstream infections.
Specific Aim 3 will assess the effect that the intervention will have on antibiotic utilization and blood culture contamination rates. I will build on the experience outlined in this proposal to establish myself an independent investigator in healthcare epidemiology, studying nosocomial infections and developing interventions to prevent them. ? ?
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