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. ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23AI050585-03
Application #
6886320
Study Section
Microbiology and Infectious Diseases B Subcommittee (MID)
Program Officer
Korpela, Jukka K
Project Start
2003-05-01
Project End
2008-04-30
Budget Start
2005-05-01
Budget End
2006-04-30
Support Year
3
Fiscal Year
2005
Total Cost
$118,783
Indirect Cost
Name
Washington University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
068552207
City
Saint Louis
State
MO
Country
United States
Zip Code
63130
Bhavan, Kavita P; Marschall, Jonas; Olsen, Margaret A et al. (2010) The epidemiology of hematogenous vertebral osteomyelitis: a cohort study in a tertiary care hospital. BMC Infect Dis 10:158
Marschall, Jonas; Tibbetts, Robert J; Dunne Jr, W Michael et al. (2009) Presence of the KPC carbapenemase gene in Enterobacteriaceae causing bacteremia and its correlation with in vitro carbapenem susceptibility. J Clin Microbiol 47:239-41
Apisarnthanarak, Anucha; Phattanakeitchai, Piphob; Warren, David K et al. (2008) Impact of knowledge and positive attitudes about avian influenza (H5N1 virus infection) on infection control and influenza vaccination practices of Thai healthcare workers. Infect Control Hosp Epidemiol 29:472-4
Marschall, Jonas; Agniel, Denis; Fraser, Victoria J et al. (2008) Gram-negative bacteraemia in non-ICU patients: factors associated with inadequate antibiotic therapy and impact on outcomes. J Antimicrob Chemother 61:1376-83
Marshall, Caroline; Black, Jim (2007) Education-based intervention to prevent catheter-associated bloodstream infection. Infect Control Hosp Epidemiol 28:370;author reply 370-1
Schuerer, Douglas J E; Zack, Jeanne E; Thomas, James et al. (2007) Effect of chlorhexidine/silver sulfadiazine-impregnated central venous catheters in an intensive care unit with a low blood stream infection rate after implementation of an educational program: a before-after trial. Surg Infect (Larchmt) 8:445-54
Warren, David K; Guth, Rebecca M; Coopersmith, Craig M et al. (2007) Impact of a methicillin-resistant Staphylococcus aureus active surveillance program on contact precaution utilization in a surgical intensive care unit. Crit Care Med 35:430-4
Marschall, Jonas; Leone, Carole; Jones, Marilyn et al. (2007) Catheter-associated bloodstream infections in general medical patients outside the intensive care unit: a surveillance study. Infect Control Hosp Epidemiol 28:905-9
Jones, Jeffrey C; Rogers, Theodore J; Brookmeyer, Peter et al. (2007) Mupirocin resistance in patients colonized with methicillin-resistant Staphylococcus aureus in a surgical intensive care unit. Clin Infect Dis 45:541-7
Apisarnthanarak, Anucha; Rutjanawech, Sasinuj; Wichansawakun, Sanit et al. (2007) Initial inappropriate urinary catheters use in a tertiary-care center: incidence, risk factors, and outcomes. Am J Infect Control 35:594-9

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