This is the competitiverenewalapplicationfor the CDC "Epi-Centersfor Preventionof Healthcare- AssociatedInfections"grant fromWashingtonUniversitySchoolof Medicine(WUSM) &BJCHealthcare. We have been a CDC Epi-Centerfor the past 8 years.BJCis an integratedhealthcaredeliverysystemwith 12 hospitalsin Missouri&Illinoisincluding2 "US News &World Report" top 10 hospitals(BarnesJewish Hospital&St. LouisChildrensHospital),3 large communityhospitals,3 smallsuburbanhospitals,4 small ruralhospitals, 6 longtermcare facilities,a dialysisnetwork&an ambulatorysurgery center.The infection controlprogramsof all BJCfacilitiesareintegratedwithcommonpolicies&procedures,surveillance, electronic data repositories&, expertpharmacy&microbiologyinformaticssystems.WUSM &BJC havea longhistorystudyingriskfactors,outcomes,&costsof healthcareassociatedinfections&theyhave developed&implementedmultiplesuccessfulinterventionstoreduceinfectionsindiversehealthcare settings.We proposeto continuetowork collaborativelywithCDC &otherEpi-Centersto performresearch todecreasethe riskof healthcareacquiredinfections,antibioticresistance,&otheradverseevents. Our Specific Aims are to: 1) Evaluatethe effectivenessof 0.125% chlorhexidinebodywashestoreducemethicillin-resistant Staphylococcus aureus (MRSA) in 2 ICUsperforming activesurveillance for MRSA; 2) Determine the efficacy of academic detailing by a antimicrobial stewardship team to improve antimicrobial use &evaluate a computerized expert system to improve antibiotic use in4 ICUs; 3) Evaluate the accuracy &efficiency of 2 C. difficile-associated disease (CDAD)surveillance methods, ICD-9 codes &electronic microbiology reports, &compare CDAD rates by these methods with traditional infection control surveillance in 4 hospitals; 4) Use real time electronically collected data including type, dose, &timing of surgical prophylactic antibiotics, blood glucose, ICD-9 codes, microbiology &antibiotic data at 3 hospitals to determine compliance v,ith recommendationsfor surgical antibiotic prophylaxis &the effect of noncompliance on surgical site infection (SSI) rates, the incidence of hyperglycemia&its effect on SSI rates, &the accuracy of electronic surveillancecompared to traditional infection control surveillance;and Identify specific including timing failing hospital by performinga prospective case controlstudy of medication use in fallers &non fallers, to guide development 5o)f interventions to dmecerdeiacasetiothnes risk of falltihnegirindhoosesp, irtoaulitze,d&patientsa.ssociated with inthe PFERFO._J,',A,N_SEITE(S) (organ_.a'Jon,citys.tate) Washington University 680 South Euclid Avenue St. Louis, MO 63110 PHS 3.=$(Rev. (3C_'04) Page 2 FormPage 2 P_="_E'_I'_mat!esSgator,'ProgramDirector(Last, First, Middle): Fraser, Victoria J. I__'-'YPERSO,%.%ELSee L,'_tru_Jens.Use continuabbn pages as needed to provide the requiredinformation in the format shown below. S_ _%_ PrL",,_'--;Ia,,!west_g3torL.ist another key personnelin alphabeticalorder, last namefirst. N_e eRA CommonsUser Name Organization Roleon Project Fraser, V_ctoriaJ VICKYFRASER WashingtonUniversity PI Babcock, Hilary HILBABCOCK WashingtonUniversity Investigator Camins, Bernard BCAMINS WashingtonUniversity Investigator Coopersmith,Craig COOPERSMITHC WashingtonUniversity Investigator Dubberke, Eric R ERIKDUBBERKE WashingtonUniversity Investigator Elvrard,Alexis ALEXlSELWARD Washington University Investigator Kollef, Marin Washington University Investigator McDonald, Jay Washington University Investigator OIsen, Margaret OLSENM Washington University Investigator Warren, David K DAVIDWARREN Washington University Co-PI Woeltje, Keith KEITHWOELTJE Washington University Investigator OTHER SlG.%".rC'-Ai NT CO,NTRIBUTORS P_a.,":'_. Organization Roleon Project Hollenbeak, Christopher PennsylvaniaState University Collaborator Murphy,Denise BJC Healthcare Collaborator Human Embryonic Stem Cells [] No [] Yes If theprop<:_edprojectinvolveshumanembryonicstem cells,list below the registrationnumberofthespecificcellline{s)from the followinglist: h,,'_:llstemcetls nih aov/reoistry/index asp. Use continuationpages as needed. If,as'3e'_'._. c_-"='_be re,'erencedat this;lb'nein. cludea statementhatonefromtheReqistr]/willbeused. CeTIUne Disclosure Permission Statement. Ap_lic._bTteo SBIPJSTrR Only, See instructions.[] Yes [] No PHS 3-=-3(Re,,,.0_3,"_4) Page 3 Form Page 2-continued Numbetrhefoflowingpagesconsecutivetlhyroughout theapplicationD.onotusesuffixesuchas4a.4b. P._.._,._!Invest_jator/ProgramDirector (Last, First, Middle): Fraser, Victoria J Tr,e r.a.,"=ecf t._.eprLn_palinvestigatorlprogram director must be provided at the top of each pnnted pageand each continuation page. RESEARCH GRANT TABLE OF CONTENTS Page Numbers Face Page ....:............................................................................................................................................. 1 Description,