Duke University Prevention Epicenter
First Funded: 2011
Overview: Researchers from Duke University School of Medicine and the University of North Carolina at Chapel Hill School of Medicine are collaborating to investigate novel strategies for prevention of healthcare-associated infections. The team of researchers combines several unique resources and research expertise. In particular, the Epicenter brings significant expertise in infection control in community hospitals through the Duke Infection Control Outreach Network (DICON), a network of over 40 community hospital in the southeastern US. Currently, data from this unique resource include over 16 million patient days. Other areas of expertise in the Epicenter include hospital epidemiology, infection control, multidrug resistant organisms, disinfection and sterilization, and transmission of organisms from the environment. Finally, the Epicenter includes significant laboratory infrastructure and capabilities through three microbiology and molecular laboratories.
Research Study Areas:Among several other projects, researchers from the Epicenter are currently investigating on novel strategies for enhanced terminal room disinfection, the clinical and molecular epidemiology of multidrug resistant organisms in community hospitals, the epidemiology and prevention of healthcare-associated infections in community hospitals, novel methods and definitions for surveillance of healthcare-associated infections, and a quality improvement collaborative to improve outcomes of critically ill patients. Additional information about the Duke Epicenter and research projects within DICON can be found at http://dicon.medicine.duke.edu/research.
Research Projects Led by Duke University Prevention Epicenter:
The Epicenter is currently involved in a multicenter cluster-randomized trial with 2x2 factorial crossover design study of enhanced methods for terminal disinfection entitled The Benefits of Enhanced Terminal Room (BETR) Disinfection Study. This study involves nine hospitals, including two tertiary care centers, 6 community hospitals, and a VAMC. Each hospital will randomly undergo four strategies for terminal room disinfection over a 28 month period, including cleaning with 1) quaternary ammonium alone, 2) quaternary ammonium followed by a UV-C light emitting device, 3) bleach alone, and 4) bleach followed by a UV-C light emitting device. The primary outcome of the study is clinical incidence of MRSA, VRE, multidrug-resistant Acinetobacter, and Clostridium difficile.
- As part of the CDC's Prevention Epicenter Programs, DICON researchers are participating with collaborators from other Epicenters to evaluate a new "streamlined" VAP definition (sVAP). This large multicenter study involves two major components. First, data are being collected from > 30 ICUs to compare incidence of the new definition compared with the incidence of the standard, NHSN definition for VAP. Second, a multicenter quality improvement project is being kicked-off to implement a combined spontaneous awakening trial (SAT) and spontaneous breathing trial (SBT) protocol.
- The Benefits of Universal Gowns and Gloves (BUGG) study is a cluster-randomized, multicenter study to determine if the use of universal gowns and gloves can decrease acquisition of MRSA and VRE among ICU patients. This study is funded by the AHRQ and involves 20 ICUs across the country. DICON researchers are overseeing the participation of medical/surgical ICUs from 2 DICON hospitals - Durham Regional Hospital (Durham, NC) and Duke Raleigh Hospital (Raleigh, NC).
- Bacteremia and sepsis are leading causes of death among hospitalized patients. Appropriate antibiotic therapy is paramount for patients with these infections. Unfortunately, many patients with bacteremia and sepsis do not receive the therapy they need. This problem is not well understood, in particular, among patients admitted to community hospitals. As a result, DICON researchers are performing a retrospective cohort analysis of more than 2,000 patients with bacteremia admitted to 10 DICON hospitals from 2003 through 2006 to determine specific risk factors and characteristics associated with receipt of inappropriate therapy. Findings from this study will be used to develop interventions to improve care for patients admitted to community hospitals with this devastating infection.
- Bacteria with multidrug resistance due to extended spectrum beta-lactamases (ESBLs) cause devastating infections. Worldwide, the incidence of ESBL-producing bacteria is on the rise. In 2009, DICON researchers published a report that confirmed that this same increase was indeed occurring in community hospitals in NC. As a result of these initial findings, DICON researchers are currently completing a prospective, multicenter cohort study to investigate the clinical-molecular epidemiology of this emerging problem.
- Beginning in 2012, DICON researchers will begin enrolling patients admitted to a local community hospital with multidrug-resistant infections into a prospective registry for further research. This registry and bio-repository will be used to determine the clinical and molecular epidemiology of MRSA, VRE, ESBL, and C. difficile among patients admitted to a community hospital as compared to patients admitted to a tertiary
Daniel J. Sexton, MD
Director of Duke Infection Control Outreach Network - DICON
Principal Investigator- Duke University Prevention Epicenter
Duke University School of Medicine