Duke University-University of North Carolina Prevention Epicenter

Overview

The Duke-UNC Prevention Epicenter identifies potential strategies to decrease healthcare-associated infections (HAIs) and prevent antimicrobial resistance (AR) emergence, transmission and acquisition.

The Epicenter has expertise in infection control and antimicrobial stewardship in community hospitals via two successful programs:

• Duke Infection Control Outreach Network (DICON).

• Duke Antimicrobial Stewardship Outreach Network (DASON).

These networks include 65 and 35 community hospitals respectively in six southeastern states. The Epicenter also has significant laboratory infrastructure support and capabilities for molecular studies through the Disinfection, Resistance and Transmission Epidemiology (DiRTE) laboratory.

Investigators are experts in hospital epidemiology, infection control, antimicrobial stewardship (AS), epidemiologic studies of multidrug-resistant organisms, disinfection and sterilization.

Core research study areas

Core projects include six unique studies that address four specific lines of investigation:

• Environmental disinfection.
• Antimicrobial stewardship (AS).
• Diagnostic stewardship.
• Community-acquired Clostridioides difficile (C. diff) infection (CA-CDI).

These studies involve patients in the community and those admitted to local and academic hospitals. These objectives will be achieved by using the strengths of an innovative and previously successful collaboration between investigators in the Duke Center for Antimicrobial Stewardship and Infection Prevention and the University of North Carolina at Chapel Hill. This collaboration uses the institutions' expertise in environmental disinfection, infection prevention, epidemiology, surveillance, AS, AR and emerging infections, and access to large and unique research networks and infrastructure.

These studies:

• Assess new strategies to reduce environmental contamination with pathogens related to hospital sinks and plumbing using:
  • Pall filters and drain covers.
  • Engineered plasmids.

• Identify and evaluate innovative AS interventions and metrics to decrease AR and patient harm:
  • At transitions of care (e.g., discharge) in community hospitals.
    
  • Related to post-operative antibiotics.

• Develop and validate reflex urine culture criteria to improve use of urine cultures.
• Review and confirm the contribution of environmental sources on acquisition and occurrence of CA-CDI.

Core research study areas include:

• Preventing pathogen transmission from the hospital environment.
• Assessing new strategies to prevent sink contamination with epidemiologically important germs.
• Evaluating a new intervention (i.e., plasmids) to eliminate sink P-trap (plumbing system) contamination.
• Preventing AR and adverse drug events through AS.
• Evaluating strategies to ensure necessity for post-discharge antibiotics.
• Preventing adverse events from unnecessary or misinterpreted diagnostic tests.
• Evaluating parameters for improved use of reflex urine culture.
• Preventing C. diff infections.
• Identifying C. diff in environmental settings outside the hospital.

Multicenter collaborative research projects

• Evaluate strategies to decrease transmission of pathogens from patients, environment and healthcare workers.
• Determine feasibility and value of robust antibiotic use risk-adjustment in AS program assessments.
• Understanding the surgical wound microbiome.

Principal investigator

Deverick J. Anderson, MD, MPH