The RFA that this grant is responding to requests the development of novel methods for controlling the transmission of antimicrobial resistant pathogens, the study of the cost-effectiveness of the methods and the advancement in understanding how antimicrobial resistant pathogens are most commonly transmitted. To fully respond to the objectives of the RFA, we plan on studying the following. Hypothesis 1: Targeted active surveillance of patients indicated to be at high risk for colonization by MRSA upon hospital admission to a non-intensive care unit (ICU) and subsequent isolation of colonized patients will reduce MRSA bacteremia rates and be cost-effective to acute-care hospitals. Hypothesis 2: Mandatory universal glove and gown wearing by healthcare workers during all patient contact within the ICU setting will reduce MRSA, VRE, and imipenem-resistant Pseudomonas aeruginosa transmission, and be cost-effective. Hypothesis 3: Among long-term care residents with a recent history of MRSA colonization, residents who have 1) uncontrolled secretions (e.g. stool incontinence or heavy respiratory secretions) or 2) stage 3 or higher pressure ulcers or 3) high level of dependence for their activities of daily living (ADLs) will transmit MRSA more frequently.
Aim 1 : Assess the cost-effectiveness of hospital-wide targeted active surveillance using a removed-treatment interrupted time-series quasi-experimental design.
Aim 2 : Assess the cost-effectiveness of universal glove and gown wearing in a medical-intensive care unit and a surgical intensive care unit using an untreated control group interrupted time-series quasi-experimental design.
Aim 3 : Identify factors that are associated with transmission of MRSA to other long-term care residents in a prospective cohort study. The significance of aim 1 is that no studies have assessed the effectiveness and cost-effectiveness of active surveillance programs outside ICU populations. The significance of aim 2 is that despite numerous interventions in ICU populations aimed at decreasing patient-to-patient transmission of antimicrobial resistant pathogens, rates continue to increase.
Aim 2 will study the cost-effectiveness of a novel intervention namely universal glove and gown wearing.
Aim 3 will advance our understanding of how MRSA is most commonly transmitted among long-term care residents. In this grant, we have assembled a team with expertise in antibiotic resistance, molecular epidemiology, cost-effectiveness, mathematical modeling and quasi- experimental study design that will be able to scientifically study important infection control interventions and advance our understanding of how antimicrobial resistant bacterial pathogens are most commonly transmitted between human hosts. ? ? ?
