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Diekema DJ, Nori P, Stevens MP, Smith MW, Coffey KC, Morgan DJ. Are Contact Precautions "Essential" for the Prevention of Healthcare-associated Methicillin-Resistant Staphylococcus aureus? Clin Infect Dis 2024; 78:1289-1294. [PMID: 37738565 DOI: 10.1093/cid/ciad571] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/01/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023] Open
Abstract
The recently updated Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, and the Association of Professionals in Infection Control practice recommendations for methicillin-resistant Staphylococcus aureus (MRSA) prevention in acute care facilities list contact precautions (CPs) for patients known to be infected or colonized with MRSA as an "essential practice," meaning that it should be adopted in all acute care facilities. We argue that existing evidence on benefits and harms associated with CP do not justify this recommendation. There are no controlled trials that support broad use of CP for MRSA prevention. Data from hospitals that have discontinued CP for MRSA have found no impact on MRSA acquisition or infection. The burden and harms of CP remain concerning, including the environmental impact of increased gown and glove use. We suggest that CP be included among other "additional approaches" to MRSA prevention that can be implemented under specific circumstances (eg outbreaks, evidence of ongoing transmission despite application of essential practices).
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Affiliation(s)
- Daniel J Diekema
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Department of Medicine, Maine Medical Center, Portland, Maine, USA
| | - Priya Nori
- Department of Medicine, Division of Infectious Diseases, Montefiore Health System, Albert Einstein College of Medicine, Bronx, NewYork, USA
| | - Michael P Stevens
- Department of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Matthew W Smith
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
| | - K C Coffey
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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2
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Hansen SGK, Klein K, Nymark A, Andersen L, Gradel KO, Lis-Toender J, Oestergaard C, Chen M, Datcu R, Skov MN, Holm A, Rosenvinge FS. Vancomycin-resistant Enterococcus faecium: impact of ending screening and isolation in a Danish University hospital. J Hosp Infect 2024; 146:82-92. [PMID: 38360093 DOI: 10.1016/j.jhin.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/11/2024] [Accepted: 01/27/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Substantial resources are used in hospitals worldwide to counteract the ever-increasing incidence of vancomycin-resistant and vancomycin-variable Enterococcus faecium (VREfm and VVEfm), but it is important to balance patient safety, infection prevention, and hospital costs. AIM To investigate the impact of ending VREfm/VVEfm screening and isolation at Odense University Hospital (OUH), Denmark, on patient and clinical characteristics, risk of bacteraemia, and mortality of VREfm/VVEfm disease at OUH. The burden of VREfm/VVEfm bacteraemia at OUH and the three collaborative hospitals in the Region of Southern Denmark (RSD) was also investigated. METHODS A retrospective cohort study was conducted including first-time VREfm/VVEfm clinical isolates (index isolates) detected at OUH and collaborative hospitals in the period 2015-2022. The intervention period with screening and isolation was from 2015 to 2021, and the post-intervention period was 2022. Information about clinical isolates was retrieved from microbiological databases. Patient data were obtained from hospital records. FINDINGS At OUH, 436 patients were included in the study, with 285 in the intervention period and 151 in the post-intervention period. Ending screening and isolation was followed by an increased number of index isolates. Besides a change in van genes, only minor non-significant changes were detected in all the other investigated parameters. Mortality within 30 days did not reflect the VREfm/VVEfm-attributable deaths, and in only four cases was VREfm/VVEfm infection the likely cause of death. CONCLUSION Despite an increasing number of index isolates, nothing in the short follow-up period supported a reintroduction of screening and isolation.
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Affiliation(s)
- S G K Hansen
- Department of Clinical Microbiology and Infection Control, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - K Klein
- Department of Clinical Microbiology and Infection Control, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - A Nymark
- Department of Clinical Microbiology and Infection Control, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - L Andersen
- Department of Clinical Microbiology and Infection Control, Odense University Hospital, Odense, Denmark
| | - K O Gradel
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J Lis-Toender
- Department of Clinical Microbiology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - C Oestergaard
- Department of Clinical Microbiology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - M Chen
- Department of Clinical Microbiology, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - R Datcu
- Department of Clinical Microbiology, Esbjerg and Grindsted Hospital, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - M N Skov
- Department of Clinical Microbiology and Infection Control, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - A Holm
- Department of Clinical Microbiology and Infection Control, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - F S Rosenvinge
- Department of Clinical Microbiology and Infection Control, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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3
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Scruggs-Wodkowski E, Greene MT, Saint S, Fowler KE, Linder KA, Krein SL. Comparing practices to prevent infectious diseases transmission among Veterans Affairs and Nonveterans Affairs hospitals: Results from a national survey in the United States. Am J Infect Control 2024; 52:495-497. [PMID: 37944756 DOI: 10.1016/j.ajic.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/27/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
Our national cross-sectional survey of United States hospitals found greater implementation of contact precautions for multidrug-resistant organisms and a higher percentage reporting the use of supplemental no-touch disinfection devices among Veterans Affairs (VA) versus non-VA hospitals. Nationally coordinated infection prevention initiatives within the VA could account for these practice differences.
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Affiliation(s)
- Elizabeth Scruggs-Wodkowski
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, MI; Center for Clinical Management Research, VA/UM Patient Safety Enhancement Program, Ann Arbor, MI; Department of Internal Medicine, Infectious Diseases Section, LTC Charles S Kettles VA Medical Center, Ann Arbor, MI.
| | - M Todd Greene
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, MI; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Center for Clinical Management Research, VA/UM Patient Safety Enhancement Program, Ann Arbor, MI
| | - Sanjay Saint
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, MI; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Center for Clinical Management Research, VA/UM Patient Safety Enhancement Program, Ann Arbor, MI
| | - Karen E Fowler
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, MI; Center for Clinical Management Research, VA/UM Patient Safety Enhancement Program, Ann Arbor, MI
| | - Kathleen A Linder
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, MI; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Center for Clinical Management Research, VA/UM Patient Safety Enhancement Program, Ann Arbor, MI; Department of Internal Medicine, Infectious Diseases Section, LTC Charles S Kettles VA Medical Center, Ann Arbor, MI
| | - Sarah L Krein
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, MI; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Center for Clinical Management Research, VA/UM Patient Safety Enhancement Program, Ann Arbor, MI
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4
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Kelly G, Hudson M, Apple B, Bundage D, Lembcke B, Lasco T, Al Mohajer M. Discontinuation of contact precautions in patients with hospital-acquired MRSA and VRE infections during the COVID-19 pandemic: A multi-center experience. J Infect Prev 2024; 25:33-37. [PMID: 38362111 PMCID: PMC10866122 DOI: 10.1177/17571774231208312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 10/02/2023] [Indexed: 02/17/2024] Open
Abstract
Variations in the literature support the benefit of contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) infections in the hospital setting. During personal protective equipment shortages throughout the COVID-19 pandemic, contact precautions were discontinued for MRSA and VRE-infected patients. Rates of hospital-acquired MRSA and VRE infections were compared before and after this intervention, along with hand hygiene proportions. Contact precaution discontinuation did not lead to an increase in hospital-acquired MRSA or VRE infections.
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Affiliation(s)
- Gillean Kelly
- Department of Medicine, Baylor College of Medicine School of Medicine, Houston, TX, USA
| | - Marisa Hudson
- Department of Medicine, Baylor College of Medicine School of Medicine, Houston, TX, USA
| | - Bridget Apple
- St Luke’s Health Sugar Land Hospital, Sugar Land, TX, USA
| | | | | | - Todd Lasco
- Baylor St Luke’s Medical Center, Houston, TX, USA
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Mayar Al Mohajer
- Department of Medicine, Baylor College of Medicine School of Medicine, Houston, TX, USA
- Baylor St Luke’s Medical Center, Houston, TX, USA
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5
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Most ZM, Phillips B, Sebert ME. Discontinuation of Contact Precautions for Methicillin-resistant Staphylococcus aureus in a Pediatric Healthcare System. J Pediatric Infect Dis Soc 2024; 13:123-128. [PMID: 38170639 DOI: 10.1093/jpids/piae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/02/2024] [Indexed: 01/05/2024]
Abstract
BACKGROUND Many hospitals caring for adult patients have discontinued the requirement for contact precautions (CP) for patients with methicillin-resistant Staphylococcus aureus (MRSA) infection or colonization without reported negative effects. It is not clear whether this experience can be extrapolated to pediatric facilities. METHODS CP for MRSA were discontinued in all locations except the neonatal intensive care unit at a 3-hospital pediatric healthcare system in September 2019. All hospitalized patients underwent surveillance for LabID healthcare facility-onset MRSA infections. Analysis was done using interrupted time series (ITS) from September 2017 through August 2023 and aggregate before-and-after rate ratios. RESULTS There were 234 incident healthcare facility-onset MRSA infections during 766 020 patient days of surveillance. After discontinuation of CP for MRSA there was no change in the ITS slope (0.06, 95% CI: -0.35 to 0.47, P = .78) or intercept (0.21, 95% CI: -0.36 to 0.78, P = .47) of the LabID healthcare facility-onset MRSA infection incidence density rate. Additionally, there was no change in the aggregate incidence density rate of these MRSA LabID events (aggregate rate ratio = 0.98, 95% CI: 0.74 to 1.28). MRSA nasal colonization among patients being screened before cardiac surgery did not change (aggregate rate ratio = 0.94, 95% CI: 0.60 to 1.48). The prevalence rate of contact isolation days decreased by 14.0%. CONCLUSIONS Discontinuation of CP for pediatric patients with MRSA was not associated with increased MRSA infection over 4 years. Our experience supports considering discontinuation of CP for MRSA in similar pediatric healthcare settings in the context of good adherence to horizontal infection prevention measures.
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Affiliation(s)
- Zachary M Most
- Division of Infectious Disease, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Infection Prevention and Control Department, Children's Health System of Texas, Children's Medical Center Dallas, Dallas, Texas, USA
| | - Bethany Phillips
- Infection Prevention and Control Department, Children's Health System of Texas, Children's Medical Center Dallas, Dallas, Texas, USA
| | - Michael E Sebert
- Division of Infectious Disease, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Infection Prevention and Control Department, Children's Health System of Texas, Children's Medical Center Dallas, Dallas, Texas, USA
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6
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Brust KB, Kobayashi T, Diekema DJ. Asymptomatic Testing of Hospital Admissions for SARS-CoV-2: Is it OK to Stop? Clin Infect Dis 2024; 78:356-360. [PMID: 37463415 DOI: 10.1093/cid/ciad423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/28/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023] Open
Abstract
Universal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing of all persons admitted to acute care hospitals has become common practice. We describe why 1 hospital discontinued this practice after weighing potential benefits against known harms. Considerations around the benefits shifted as we saw a decline in SARS-CoV-2 community transmission and coronavirus disease 2019 (COVID-19) severity of illness, increased availability of vaccines and treatments, and better understood the many other transmission pathways in the healthcare environment. Considerations around harms included the additional strain on laboratory and infection prevention resources, and several unintended adverse consequences of admission screening for patients, including unnecessary isolation, antiviral treatments, and delays in care delivery. Poor test performance for detection of infectiousness also played a significant role in determining to stop universal screening. No increase in hospital-onset COVID-19 has been documented since discontinuation of admission testing. We continue to apply other established layers of prevention while monitoring for any change in incidence of within-facility transmission of SARS-CoV-2.
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Affiliation(s)
- Karen B Brust
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Takaaki Kobayashi
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Daniel J Diekema
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Department of Medicine, Maine Medical Center, Portland, Maine, USA
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7
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Hagiya H, Otsuka F. Increased evidence for no benefit of contact precautions in preventing extended-spectrum β-lactamases-producing Enterobacteriaceae: Systematic scoping review. Am J Infect Control 2023; 51:1056-1062. [PMID: 36736903 DOI: 10.1016/j.ajic.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Extended-spectrum β-lactamases-producing Enterobacteriaceae (ESBL-E) is a critical antimicrobial resistance pathogen, to which we need to pay the greatest attention. This study was aimed at uncovering the present evidence for the preventive effectiveness of contact precautions for patients colonized or infected with ESBL-E. METHODS According to the Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews, we searched MEDLINE for articles with relevant keywords from the beginning of 2010 to October 18, 2022. RESULTS Of the 355 articles found, 9, including 8 observational studies and 1 randomized controlled trial, were selected. Safety of discontinuing contact precautions was evaluated mainly in acute-care and long-term care hospitals. Consistently, all authors concluded that contact precautions can be safely discontinued in patients colonized or infected with ESBL-E. CONCLUSION The clinical impact of discontinuing contact precautions for patients with ESBL-E is minimal and can be safely withdrawn at acute, noncritical, adult care wards. Relevant data from pediatric and geriatric wards, as well as intensive care units, were insufficient and should be investigated in future research.
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Affiliation(s)
- Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 7008558, Japan.
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 7008558, Japan
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8
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Pfister TR, Chow B, Shen Y, Ellison J, Bush K. The associated impact of standardized admission screening on vancomycin-resistant Enterococci bloodstream infections. Infect Control Hosp Epidemiol 2023; 44:1289-1293. [PMID: 36200345 DOI: 10.1017/ice.2022.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To determine whether discontinuing active screening for vancomycin-resistant Enterococcus (VRE) in Alberta, Canada, acute-care facilities had an associated impact on the rate of rise of hospital-acquired (HA) VRE bloodstream infection (VRE-BSI). SETTING Acute-care facilities in Alberta, Canada. PATIENTS All patients who were admitted to Alberta Health Services or Covenant Health acute-care facilities between January 1, 2013, and March 31, 2020, and who met the definition for hospital-acquired VRE-BSI were included in the analyses. METHODS An intervention time-series Poisson regression was used to determine the slope change in VRE incidence between the pre- and postintervention (screening) periods. The patient population was separated into 3 cohorts: group 1 (low risk, VRE screening stopped), group 2 (high risk, VRE screening stopped), and group 3 (high risk, VRE screening continued). For all groups, a level- and slope-change model was used. RESULTS We did not find a statistically significant difference in the slope change or rate of rise in VRE-BSI before and after the intervention, with incidence rate ratio (IRRs) of 1.015 (95% confidence interval [CI], 0.982-1.049), 1.025 (95% CI, 0.967-1.086), and 0.989 (95% CI, 0.924-1.059) for groups 1, 2 and 3, respectively. CONCLUSIONS In Alberta, the rate of HA VRE-BSI has remained consistent, and our findings indicate that there has been no increase in the rate of rise of HA VRE-BSI in sites or units that discontinued screening for VRE, regardless of patient risk group.
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Affiliation(s)
- Ted R Pfister
- Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - Blanda Chow
- Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - Ye Shen
- Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - Jennifer Ellison
- Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - Kathryn Bush
- Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
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9
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Popovich KJ, Aureden K, Ham DC, Harris AD, Hessels AJ, Huang SS, Maragakis LL, Milstone AM, Moody J, Yokoe D, Calfee DP. SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2023; 44:1039-1067. [PMID: 37381690 PMCID: PMC10369222 DOI: 10.1017/ice.2023.102] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 06/29/2023]
Abstract
Previously published guidelines have provided comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing efforts to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and infection. This document updates the "Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in Acute Care Hospitals" published in 2014.1 This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
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Affiliation(s)
- Kyle J. Popovich
- Department of Internal Medicine, RUSH Medical College, Chicago, Illinois
| | - Kathy Aureden
- Infection Prevention, Advocate Aurora Health, Downers Grove, Illinois
| | - D. Cal Ham
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anthony D. Harris
- Health Care Outcomes Research, University of Maryland School of Medicine, Baltimore, Maryland
| | - Amanda J. Hessels
- Columbia School of Nursing, New York, New York
- Hackensack Meridian Health, Edison, New Jersey
| | - Susan S. Huang
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
| | - Lisa L. Maragakis
- Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Aaron M. Milstone
- Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julia Moody
- Infection Prevention, HCA Healthcare, Nashville, Tennessee
| | - Deborah Yokoe
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California
- Transplant Infectious Diseases, UCSF Medical Center, San Francisco, California
| | - David P. Calfee
- Department of Medicine, Weill Cornell Medicine, New York, New York
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
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Kakimoto K, Nishiki S, Kaga Y, Harada T, Kawahara R, Takahashi H, Ueda E, Koshimo N, Ito H, Matsui T, Oishi K, Yamagishi T. Effectiveness of patient and staff cohorting to reduce the risk of vancomycin-resistant enterococcus (VRE) acquisition: a retrospective cohort study during a VRE outbreak in Japan. J Hosp Infect 2023; 134:35-42. [PMID: 36669647 DOI: 10.1016/j.jhin.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/18/2022] [Accepted: 11/26/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Patient and staff cohorting is part of a bundle approach in the response to multi-drug-resistant organisms, but its effectiveness is not fully clarified. This study compared the risks of acquiring vancomycin-resistant Enterococcus faecium (VREfm) at a hospital during a VREfm outbreak based on contact characteristics in order to better understand the effectiveness of cohorting. METHODS Exposure came from contact with patients with VREfm (infectors), including existing patients with VREfm and patients who acquired VREfm during the study period. Contact was defined as length of contact time, degree of sharing space, and care by the same nurses as those caring for infectors between January and March 2018. The outcome was VREfm acquisition as determined through monthly stool or rectal screening cultures. Incidence rates were calculated based on contact patterns, and incidence rate ratios (IRRs) were compared. FINDINGS Among 272 inpatients (4038 patient-days), 43 patients acquired VREfm with the same or similar pulsotype. Incidence rates were 8.45 per 1000 patient-days when susceptible inpatients were on the same ward as an infector but cared for by different nurses (reference), 16.96 when susceptible inpatients were on the same ward as an infector and cared for by the same nurses [IRR 2.01, 95% confidence interval (CI) 0.62-10.28], and 52.91 when susceptible inpatients shared a room with an infector (IRR 6.26, 95% CI 1.61-35.40). CONCLUSION Compared with susceptible inpatients in a different room from infectors and not being cared for by the same nurses, the risk of VREfm acquisition could be six times higher for susceptible inpatients who are in the same room as infectors, and could be double for susceptible inpatients cared for by the same nurses as infectors.
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Affiliation(s)
- K Kakimoto
- Field Epidemiology Training Programme, National Institute of Infectious Diseases, Tokyo, Japan; Osaka Field Epidemiologic Investigation Team, Division of Public Health, Osaka Institute of Public Health, Osaka, Japan
| | - S Nishiki
- Field Epidemiology Training Programme, National Institute of Infectious Diseases, Tokyo, Japan; Centre for Field Epidemiology Intelligence, Research and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Y Kaga
- Field Epidemiology Training Programme, National Institute of Infectious Diseases, Tokyo, Japan; Inba Public Health Centre, Chiba, Japan
| | - T Harada
- Division of Microbiology, Osaka Institute of Public Health, Osaka, Japan
| | - R Kawahara
- Division of Microbiology, Osaka Institute of Public Health, Osaka, Japan
| | - H Takahashi
- Infection Control Team, Nagayama Hospital, Osaka, Japan
| | - E Ueda
- Izumisano Public Health Centre, Osaka, Japan
| | - N Koshimo
- Izumisano Public Health Centre, Osaka, Japan
| | - H Ito
- Izumisano Public Health Centre, Osaka, Japan
| | - T Matsui
- Centre for Field Epidemiology Intelligence, Research and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - K Oishi
- Centre for Field Epidemiology Intelligence, Research and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan; Toyama Institute of Health, Toyama, Japan
| | - T Yamagishi
- Antimicrobial Resistance Research Centre, National Institute of Infectious Diseases, Tokyo, Japan.
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Garcia R, Barnes S, Boukidjian R, Goss LK, Spencer M, Septimus EJ, Wright MO, Munro S, Reese SM, Fakih MG, Edmiston CE, Levesque M. Recommendations for change in infection prevention programs and practice. Am J Infect Control 2022; 50:1281-1295. [PMID: 35525498 PMCID: PMC9065600 DOI: 10.1016/j.ajic.2022.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 01/25/2023]
Abstract
Fifty years of evolution in infection prevention and control programs have involved significant accomplishments related to clinical practices, methodologies, and technology. However, regulatory mandates, and resource and research limitations, coupled with emerging infection threats such as the COVID-19 pandemic, present considerable challenges for infection preventionists. This article provides guidance and recommendations in 14 key areas. These interventions should be considered for implementation by United States health care facilities in the near future.
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Affiliation(s)
- Robert Garcia
- Department of Healthcare Epidemiology, State University of New York at Stony Brook, Stony Brook, NY.
| | - Sue Barnes
- Infection Preventionist (Retired), San Mateo, CA
| | | | - Linda Kaye Goss
- Department of Infection Prevention, The Queen's Health System, Honolulu, HI
| | | | - Edward J Septimus
- Department of Population Medicine, Harvard Medical School, Boston, MA
| | | | - Shannon Munro
- Department of Veterans Affairs Medical Center, Research and Development, Salem, VA
| | - Sara M Reese
- Quality and Patient Safety Department, SCL Health System Broomfield, CO
| | - Mohamad G Fakih
- Clinical & Network Services, Ascension Healthcare and Wayne State University School of Medicine, Grosse Pointe Woods, MI
| | | | - Martin Levesque
- System Infection Prevention and Control, Henry Ford Health, Detroit, MI
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12
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Martin EM, Colaianne B, Bridge C, Bilderback A, Tanner C, Wagester S, Yassin M, Pontzer R, Snyder GM. Discontinuing MRSA and VRE contact precautions: Defining hospital characteristics and infection prevention practices predicting safe de-escalation. Infect Control Hosp Epidemiol 2022; 43:1595-1602. [PMID: 34847970 DOI: 10.1017/ice.2021.457] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To define conditions in which contact precautions can be safely discontinued for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). DESIGN Interrupted time series. SETTING 15 acute-care hospitals. PARTICIPANTS Inpatients. INTERVENTION Contact precautions for endemic MRSA and VRE were discontinued in 12 intervention hospitals and continued at 3 nonintervention hospitals. Rates of MRSA and VRE healthcare-associated infections (HAIs) were collected for 12 months before and after. Trends in HAI rates were analyzed using Poisson regression. To predict conditions when contact precautions may be safely discontinued, selected baseline hospital characteristics and infection prevention practices were correlated with HAI rate changes, stratified by hospital. RESULTS Aggregated HAI rates from intervention hospitals before and after discontinuation of contact precautions were 0.14 and 0.15 MRSA HAI per 1,000 patient days (P = .74), 0.05 and 0.05 VRE HAI per 1,000 patient days (P = .96), and 0.04 and 0.04 MRSA laboratory-identified (LabID) events per 100 admissions (P = .57). No statistically significant rate changes occurred between intervention and non-intervention hospitals. All successful hospitals had low baseline MRSA and VRE HAI rates and high hand hygiene adherence. We observed no correlations between rate changes after discontinuation and the assessed hospital characteristics and infection prevention factors, but the rate improved with higher proportion of semiprivate rooms (P = .04). CONCLUSIONS Discontinuing contact precautions for MRSA/VRE did not result in increased HAI rates, suggesting that contact precautions can be safely removed from diverse hospitals, including community hospitals and those with lower proportions of private rooms. Good hand hygiene and low baseline HAI rates may be conditions permissive of safe removal of contact precautions.
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Affiliation(s)
- Elise M Martin
- Department of Infection Prevention and Control, UPMC Presbyterian, Pittsburgh, Pennsylvania
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | | | - Colleen Tanner
- Department of Quality, UPMC Passavant, Pittsburgh, Pennsylvania
| | | | - Mohamed Yassin
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Infection Prevention and Control, UPMC Mercy, Pittsburgh, Pennsylvania
| | - Raymond Pontzer
- Department of Infection Prevention and Control, UPMC St. Margaret, Pittsburgh, Pennsylvania
| | - Graham M Snyder
- Department of Infection Prevention and Control, UPMC Presbyterian, Pittsburgh, Pennsylvania
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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13
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Bouchand C, Andréo A, Le Gallou F, Corvec S, Bourigault C, Lepelletier D. Retrospective analysis of a large single cohort of Enterobacteriaceae producing extended-spectrum B-lactamase (E-ESBL) patients: incidence, microbiology, and mortality. Eur J Clin Microbiol Infect Dis 2022; 41:1237-1243. [PMID: 36056207 DOI: 10.1007/s10096-022-04489-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
Abstract
We conducted a retrospective study from 2005 to 2019 to describe the epidemiology and mortality of enterobacterial producing extended-spectrum β-lactamase (E-ESBL) infections in our university hospital over a 17-year period of time. Clinical and microbiological data were extracted from different software used for continuous surveillance. Stool samples from systematic screening for E-ESBL colonization were excluded from the study. The incidence rate of infected patient was calculated by E-ESBL species and by year. A comparison of mortality rate in patients with bloodstream infections versus other types of infections was conducted using a Kaplan-Meier method survival curves. A log rank test (with a risk of 5%) was carried out. A total of 3324 patients with E-ESBL infection were included with an increased incidence density per 1000 days of hospitalization from 0.03 in 2005 to 0.47 in 2019. Escherichia coli was the most frequently isolated pathogen (64%). Global mortality rate was significantly higher with E. coli than with Klebsiella spp. and Enterobacter spp. (p < 0.001). Mortality was higher in patients with E-ESBL bloodstream infection than in patients with other type of E-ESBL infection (p < 0.001). Our study showed a significant increase of the E-ESBL incidence density over a 17-year period survey with a higher mortality in patients with E-ESBL bacteremia. This highlights the need to continue efforts to control the spread of these multi-resistant bacteria in our institution.
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Affiliation(s)
- Camille Bouchand
- Hospital Hygiene Department, Nantes University Hospital, 5, rue du Prof. Yves Boquien, R44093, Nantes, France
| | - Anaïs Andréo
- Hospital Hygiene Department, Nantes University Hospital, 5, rue du Prof. Yves Boquien, R44093, Nantes, France
| | - Florence Le Gallou
- Hospital Hygiene Department, Nantes University Hospital, 5, rue du Prof. Yves Boquien, R44093, Nantes, France
| | - Stéphane Corvec
- Laboratory of Bacteriology, Nantes University Hospital, R44093, Nantes, France
| | - Céline Bourigault
- Hospital Hygiene Department, Nantes University Hospital, 5, rue du Prof. Yves Boquien, R44093, Nantes, France
| | - Didier Lepelletier
- Hospital Hygiene Department, Nantes University Hospital, 5, rue du Prof. Yves Boquien, R44093, Nantes, France. .,IIcimed 1155 Laboratory, Institut de Recherche en Santé 2, Nantes Université, R44035, Nantes, France.
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14
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Büchler AC, Ragozzino S, Wicki M, Spaniol V, Jäger S, Seth-Smith HMB, Goldenberger D, Hinic V, Egli A, Frei R, Widmer AF. Patients exposed to vancomycin-resistant enterococci during in-hospital outbreaks in a low endemic setting: a proposal for risk-based screening. Antimicrob Resist Infect Control 2022; 11:60. [PMID: 35418099 PMCID: PMC9008949 DOI: 10.1186/s13756-022-01089-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background The optimal extent of screening of contact patients (CoPat) after exposure to patients infected or colonized with vancomycin-resistant enterococci (VRE) remains controversial. Methods We retrospectively developed a new risk stratification for screening patients exposed to VRE, based on data from three outbreaks—two with Enterococcus faecium vanB and one with Enterococcus faecium vanA involving 1096 CoPat—in a low endemic setting. We classified them into four risk groups: three on environmental exposure, one by healthcare exposure: high (sharing the same room/bathroom with a VRE-colonized patient), medium (hospitalization in the same room after a VRE-colonized patient’s discharge until terminal disinfection including ultraviolet C (UVc)-disinfection), low (hospitalized in the same room within three weeks before the VRE-colonized patient), and “staff” (screening of patients having the same medical care team). Results VRE-transmission occurred in 7.9% in the high-risk group compared to 0.6% and 0% in the medium and low risk groups. There was a significant trend to higher rates of transmission by risk level of exposure (p < 0.001). In the “staff” group, VRE transmission rate was 2.3%. Conclusion Based on this stratification, we recommend to focus screening of exposed CoPat on the high-risk and “staff” group, saving resources and costs, but larger studies will allow to further improve the yield of VRE screening in the outbreak setting.
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Affiliation(s)
- Andrea C Büchler
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Silvio Ragozzino
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Melanie Wicki
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Violeta Spaniol
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Sammy Jäger
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Helena M B Seth-Smith
- Clinical Bacteriology and Mycology, University Hospital Basel, University of Basel, Basel, Switzerland.,Applied Microbiology Research Laboratory, University of Basel, Basel, Switzerland
| | - Daniel Goldenberger
- Clinical Bacteriology and Mycology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Vladimira Hinic
- Clinical Bacteriology and Mycology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Adrian Egli
- Clinical Bacteriology and Mycology, University Hospital Basel, University of Basel, Basel, Switzerland.,Applied Microbiology Research Laboratory, University of Basel, Basel, Switzerland
| | - Reno Frei
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Andreas F Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
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15
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AlMohanna Z, Snavely AC, Viviano JP, Bischoff WE. Long-term impact of contact precautions cessation for Methicillin-Resistant Staphylococcus Aureus (MRSA). Am J Infect Control 2022; 50:336-341. [PMID: 34793891 DOI: 10.1016/j.ajic.2021.10.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Methicillin-Resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated infections (HAI). Contact isolation has been traditionally implemented to stop transmission but its impact is increasingly questioned. METHODS A single center, retrospective, nonrandomized, observational, quasi-experimental study compared MRSA HAI rates between pre-/postdiscontinuation of MRSA contact isolation in a tertiary university hospital over 68 months. Data on primary outcomes, Central line-associated bloodstream infections and MRSA LabID bacteremia events, were analyzed by interrupted time series design using segmented Poisson regression modeling. As secondary outcomes catheter-associated urinary tract infections , ventilator-associated pneumonia , surgical site infections and hospital-associated pneumonia were compared using Fisher's exact tests. Current savings due to discontinuation were calculated based on gown use. RESULTS Two hundred and ninty-five patients developed 399 HAIs. Infection rates between pre- and postinterventions were as follows: Central line-associated bloodstream infections: (0.02% vs 0.02%; P-value = .64), MRSA LabID events: (0.01% vs 0.02%; P-value = .32), hospital-associated pneumonia: (0.01% vs 0.01%; P-value = .64), catheter-associated urinary tract infections: (0% vs 0.01%; P-value = .56), ventilator-associated pneumonia: (0.01% vs 0.01%; P-value = .32), surgical site infections (0.55% vs 0.15%; P-value = .03). Savings amount to $139,228 annually. CONCLUSIONS Discontinuing CP did not negatively impact endemic MRSA HAI rates between pre-postdiscontinuation periods and saved costs for isolation materials.
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Affiliation(s)
- Zainab AlMohanna
- Infection Prevention and Health System Epidemiology, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Anna C Snavely
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - James P Viviano
- Infection Prevention and Health System Epidemiology, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Werner E Bischoff
- Infection Prevention and Health System Epidemiology, Atrium Health Wake Forest Baptist, Winston-Salem, NC.
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16
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Wong VWY, Huang Y, Wei WI, Wong SYS, Kwok KO. Approaches to multidrug-resistant organism prevention and control in long-term care facilities for older people: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2022; 11:7. [PMID: 35033198 PMCID: PMC8761316 DOI: 10.1186/s13756-021-01044-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/23/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Despite clear evidence of benefits in acute-care hospitals, controversy over the effectiveness of IPC measures for MDROs is perceptible and evidence-based practice has not been established. OBJECTIVE To investigate the effects of IPC interventions on MDRO colonization and infections in LTCFs. DATA SOURCES Ovid MEDLINE, EMBASE, and CINAHL from inception to September 2020. ELIGIBILITY CRITERIA Original and peer-reviewed articles examining the post-intervention effects on MDRO colonization and infections in LTCFs. INTERVENTIONS (i) Horizontal interventions: administrative engagement, barrier precautions, education, environmental cleaning, hand hygiene, performance improvement, and source control; and (ii) vertical intervention: active surveillance plus decolonization. STUDY APPRAISAL AND SYNTHESIS We employed a random-effects meta-analysis to estimate the pooled risk ratios (pRRs) for methicillin-resistant Staphylococcus aureus (MRSA) colonization by intervention duration; and conducted subgroup analyses on different intervention components. Study quality was assessed using Cochrane risk of bias tools. RESULTS Of 3877 studies identified, 19 were eligible for inclusion (eight randomized controlled trials (RCTs)). Studies reported outcomes associated with MRSA (15 studies), vancomycin-resistant Enterococci (VRE) (four studies), Clostridium difficile (two studies), and Gram-negative bacteria (GNB) (two studies). Eleven studies were included in the meta-analysis. The pRRs were close to unity regardless of intervention duration (long: RR 0.81 [95% CI 0.60-1.10]; medium: RR 0.81 [95% CI 0.25-2.68]; short: RR 0.95 [95% CI 0.53-1.69]). Vertical interventions in studies with a small sample size showed significant reductions in MRSA colonization while horizontal interventions did not. All studies involving active administrative engagement reported reductions. The risk of bias was high in all but two studies. CONCLUSIONS Our meta-analysis did not show any beneficial effects from IPC interventions on MRSA reductions in LTCFs. Our findings highlight that the effectiveness of interventions in these facilities is likely conditional on resource availability-particularly decolonization and barrier precautions, due to their potential adverse events and uncertain effectiveness. Hence, administrative engagement is crucial for all effective IPC programmes. LTCFs should consider a pragmatic approach to reinforce standard precautions as routine practice and implement barrier precautions and decolonization to outbreak responses only.
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Affiliation(s)
- Valerie Wing Yu Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 419, 4/F, JC School of Public Health and Primary Care Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong Special Administrative Region, China
| | - Ying Huang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 419, 4/F, JC School of Public Health and Primary Care Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong Special Administrative Region, China
| | - Wan In Wei
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 419, 4/F, JC School of Public Health and Primary Care Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong Special Administrative Region, China
| | - Samuel Yeung Shan Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 419, 4/F, JC School of Public Health and Primary Care Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong Special Administrative Region, China
| | - Kin On Kwok
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 419, 4/F, JC School of Public Health and Primary Care Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong Special Administrative Region, China.
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region, China.
- Shenzhen Research Institute of The Chinese University of Hong Kong, Shenzhen, China.
- Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region, China.
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17
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Biehl LM, Higgins PG, Stemler J, Gilles M, Peter S, Dörfel D, Vogel W, Kern WV, Gölz H, Bertz H, Rohde H, Klupp EM, Schafhausen P, Salmanton-García J, Stecher M, Wille J, Liss B, Xanthopoulou K, Zweigner J, Seifert H, Vehreschild MJGT. Impact of single-room contact precautions on acquisition and transmission of vancomycin-resistant enterococci on haematological and oncological wards, multicentre cohort-study, Germany, January-December 2016. Euro Surveill 2022; 27:2001876. [PMID: 35027104 PMCID: PMC8759111 DOI: 10.2807/1560-7917.es.2022.27.2.2001876] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 08/18/2021] [Indexed: 06/14/2023] Open
Abstract
BackgroundEvidence supporting the effectiveness of single-room contact precautions (SCP) in preventing in-hospital acquisition of vancomycin-resistant enterococci (haVRE) is limited.AimWe assessed the impact of SCP on haVRE and their transmission.MethodsWe conducted a prospective, multicentre cohort study in German haematological/oncological departments during 2016. Two sites performed SCP for VRE patients and two did not (NCP). We defined a 5% haVRE-risk difference as non-inferiority margin, screened patients for VRE, and characterised isolates by whole genome sequencing and core genome MLST (cgMLST). Potential confounders were assessed by competing risk regression analysis.ResultsWe included 1,397 patients at NCP and 1,531 patients at SCP sites. Not performing SCP was associated with a significantly higher proportion of haVRE; 12.2% (170/1,397) patients at NCP and 7.4% (113/1,531) patients at SCP sites (relative risk (RR) 1.74; 95% confidence interval (CI): 1.35-2.23). The difference (4.8%) was below the non-inferiority margin. Competing risk regression analysis indicated a stronger impact of antimicrobial exposure (subdistribution hazard ratio (SHR) 7.46; 95% CI: 4.59-12.12) and underlying disease (SHR for acute leukaemia 2.34; 95% CI: 1.46-3.75) on haVRE than NCP (SHR 1.60; 95% CI: 1.14-2.25). Based on cgMLST and patient movement data, we observed 131 patient-to-patient VRE transmissions at NCP and 85 at SCP sites (RR 1.76; 95% CI: 1.33-2.34).ConclusionsWe show a positive impact of SCP on haVRE in a high-risk population, although the observed difference was below the pre-specified non-inferiority margin. Importantly, other factors including antimicrobial exposure seem to be more influential.
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Affiliation(s)
- Lena M Biehl
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- German Centre for Infection Research, partner site Bonn-Cologne, Germany
| | - Paul G Higgins
- German Centre for Infection Research, partner site Bonn-Cologne, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Jannik Stemler
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- German Centre for Infection Research, partner site Bonn-Cologne, Germany
| | - Meyke Gilles
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Silke Peter
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
- German Centre for Infection Research, partner site Tübingen, Germany
| | - Daniela Dörfel
- Department of Haematology, Oncology and Immunology, Siloah hospital, Hannover, Germany
| | - Wichard Vogel
- Department of Oncology, Haematology, Immunology and Rheumatology, Internal Medicine II, University Hospital Tübingen, Tübingen, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, University Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hanna Gölz
- Institute for Medical Microbiology and Hygiene, University Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hartmut Bertz
- Department of Haematology, Oncology and Stem Cell Transplantation, University Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Holger Rohde
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf, Germany
- German Centre for Infection Research, partner site Hamburg-Lübeck-Borstel, Germany
| | - Eva-Maria Klupp
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf, Germany
| | - Philippe Schafhausen
- Department of Oncology and Haematology, Hubertus Wald Tumorzentrum/University Cancer Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jon Salmanton-García
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Melanie Stecher
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- German Centre for Infection Research, partner site Bonn-Cologne, Germany
| | - Julia Wille
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Blasius Liss
- Department I of Internal Medicine, Helios University Hospital Wuppertal, Wuppertal, Germany
- Department of Internal medicine I, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Kyriaki Xanthopoulou
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Janine Zweigner
- Department of Hospital Hygiene and Infection Control, University Hospital of Cologne, Cologne, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Harald Seifert
- German Centre for Infection Research, partner site Bonn-Cologne, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Maria J G T Vehreschild
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
- German Centre for Infection Research, partner site Bonn-Cologne, Germany
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18
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Joshi S, Shallal A, Zervos M. Vancomycin-Resistant Enterococci: Epidemiology, Infection Prevention, and Control. Infect Dis Clin North Am 2021; 35:953-968. [PMID: 34752227 DOI: 10.1016/j.idc.2021.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Vancomycin-resistant enterococcus (VRE) is a pathogen of growing concern due to increasing development of antibiotic resistance, increasing length of hospitalizations and excess mortality. The utility of some infection control practices are debatable, as newer developments in infection prevention strategies continued to be discovered. This article summarizes the significance of VRE and VRE transmission, along with highlighting key changes in infection control practices within the past 5 years.
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Affiliation(s)
- Seema Joshi
- Division of Infectious Diseases, Henry Ford Hospital, CFP-3, 2799 W Grand Boulevard, Detroit, MI, USA.
| | - Anita Shallal
- Division of Infectious Diseases, Henry Ford Hospital, CFP-3, 2799 W Grand Boulevard, Detroit, MI, USA
| | - Marcus Zervos
- Wayne State University, CFP-3, 2799 W Grand Boulevard, Detroit, MI, USA
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19
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Larrosa MN, Almirante B. Isolation strategy for controlling the spread of multidrug-resistant organisms: Is this still an essential option in hospitals? ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2021; 39:425-428. [PMID: 34736746 PMCID: PMC8560164 DOI: 10.1016/j.eimce.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/24/2022]
Affiliation(s)
- María Nieves Larrosa
- Microbiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Spanish Network of Investigation in Infectious Diseases (RD16/0016/0003), Spain.
| | - Benito Almirante
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Spanish Network of Investigation in Infectious Diseases (RD16/0016/0003), Spain
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20
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McFarlane AC, Kabbani D, Bakal JA, Smith SW. Clinical impact of vancomycin-resistant enterococci colonization in nonliver solid organ transplantation and its implications for infection control strategies: A single-center, 10-year retrospective study. Transpl Infect Dis 2021; 23:e13747. [PMID: 34674357 DOI: 10.1111/tid.13747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/30/2021] [Accepted: 10/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Vancomycin-resistant enterococci (VRE) colonization in nonliver solid organ transplantation (SOT) is poorly defined. Infection control management of these patients is influenced by the association of VRE with adverse outcomes in liver transplantation. This study examines the frequency and clinical impact of VRE colonization specifically on nonliver SOT patients and discusses implications for nosocomial VRE control. METHODS We retrospectively reviewed all nonliver SOT patients at a single transplant center from 2005 to 2015. We determined colonization rates in the peritransplant period and the rate of VRE infections. The association between VRE colonization with 90-day mortality and other clinical outcomes was examined. RESULTS There were 1786 nonliver SOTs from 2005 to 2015, with 81 (4.6%) colonized with VRE in the peritransplantation period. The colonization prevalence varied by organ type: 45 of 423 lung (10.6%), 12 of 352 heart (3.4%), one of 18 heart-lung (5.6%), 20 of 884 kidney (2.3%), three of 63 kidney-pancreas (4.8%), zero of 11 pancreas, zero of five small bowel, and zero of 11 multivisceral. Peritransplant VRE colonization was not associated with 90-day mortality odds ratio = 2.35 (95% CI = 0.53, 10.29) and adjusted odds ratio = 1.52 (95% CI = 0.34, 6.88). In the multivariable logistic regression, there was no association with mortality at 1 year or 5 years, hospital length of stay, rehospitalization, or days alive out of hospital. There were 14 inpatient VRE infections up to 1 year after transplantation. CONCLUSION Nonliver SOT patients have lower rates of VRE colonization than liver SOT, and colonization was not associated with increased adverse clinical outcomes. Although infection control strategies for VRE in hospital remain controversial, nonliver SOT should be considered among typical hospitalized patients when designing strategies for prevention.
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Affiliation(s)
- Alexandra C McFarlane
- Department of Medicine, Division of Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Dima Kabbani
- Department of Medicine, Division of Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey A Bakal
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada.,Alberta SPOR SUPPORT Unit Data Platform, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie W Smith
- Department of Medicine, Division of Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
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21
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Büchler AC, Dangel M, Frei R, Jäger S, Roth JA, Seth-Smith HMB, Egli A, Widmer AF. Does high adherence to contact precautions lead to low in-hospital transmission of multi-drug-resistant micro-organisms in the endemic setting? J Hosp Infect 2021; 116:53-59. [PMID: 34252477 DOI: 10.1016/j.jhin.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Conflicting results have been published on the impact of contact precautions (CPs) on reduction of transmission of multi-drug-resistant micro-organisms (MDROs) in the endemic setting. Ambiguous definitions coupled with low adherence partly explain these differences. AIM We prospectively monitored the level of adherence to CPs and aimed to relate it to in-hospital transmission of MDROs. METHODS Between January 2016 and March 2018, all patients under CPs underwent continuous monitoring of adherence to CPs by routine on-site visits on days 0, 3 and 7 after initiating CPs using a standardized checklist. The protocol included 10 interventions that were routinely checked such as CP sign at the door as well as wearing of gowns and gloves upon entry to the patient room. Patients requiring CPs were defined as colonized or infected with MDROs (meticillin-resistant Staphylococcus aureus (MRSA), non-Escherichia coli extended-spectrum beta lactamase (ESBL) Enterobacterales, vancomycin-resistant enterococci (VRE) and carbapenem-resistant Gram-negative micro-organisms (CRGN)) as well as patients infected with respiratory viruses, norovirus, scabies and hypervirulent strains of Clostridioides difficile. FINDINGS Overall, data from 13,756 CP records from 1378 visits of 812 patients were analysed. Adherence varied between 93% and 100% for each intervention, except for "separate space for contaminated material" with an adherence of 5.3-6.1%. The incidence of in-hospital transmission during the study period was extremely low for MRSA, VRE, non-E.coli ESBL Enterobacterales and CRGN with 0.00-0.064 cases/1000 patient days. CONCLUSION High adherence coupled with continuous monitoring of CPs correlated with a very low in-hospital transmission rate. These results indicate that CPs are highly effective if routine monitoring of adherence is implemented.
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Affiliation(s)
- A C Büchler
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - M Dangel
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - R Frei
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - S Jäger
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - J A Roth
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - H M B Seth-Smith
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - A Egli
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - A F Widmer
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
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22
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Larrosa MN, Almirante B. Isolation strategy for controlling the spread of multidrug-resistant organisms: Is this still an essential option in hospitals? Enferm Infecc Microbiol Clin 2021; 39:S0213-005X(21)00188-9. [PMID: 34154857 PMCID: PMC8213526 DOI: 10.1016/j.eimc.2021.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/02/2022]
Affiliation(s)
- María Nieves Larrosa
- Microbiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Spanish Network of Investigation in Infectious Diseases (RD16/0016/0003), Spain.
| | - Benito Almirante
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Spanish Network of Investigation in Infectious Diseases (RD16/0016/0003), Spain
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23
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Kleyman R, Cupril-Nilson S, Robinson K, Thakore S, Haq F, Chen L, Oyesanmi O, Browning K, Pino J, Mhaskar R. Does the removal of contact precautions for MRSA and VRE infected patients change health care-associated infection rate?: A systematic review and meta-analysis. Am J Infect Control 2021; 49:784-791. [PMID: 33276000 DOI: 10.1016/j.ajic.2020.11.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Update existing meta-analysis to analyze if discontinuation of contact precautions (CPs) for Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin resistant Enterococcus (VRE) colonization or infection affects hospital-associated MRSA or VRE infection rates. METHODS We conducted a systematic review of 17 studies evaluating discontinuation of CPs for MRSA and VRE. Random-effects and fixed-effects models were used to determine the pooled risk ratios (RR) of preincidence hospital-associated infection rate to postincidence rate. Subgroup analysis was used to assess sources of heterogeneity. RESULTS No significant difference between rates of hospital-associated MRSA infection before and after stopping the CPs was observed (RR, 0.84; 95% confidence internal [CI], 0.71-1.01; P = .06). An inverse association was observed between discontinuation of CPs and rates of hospital-associated VRE infection (RR, 0.82; 95% CI, 0.72-0.94; P = .005). A subgroup analysis of 6 studies that used chlorhexidine, showed no difference between rates of hospital-associated MRSA infection with discontinuation of CPs (RR, 0.83; 95% CI, 0.69-1.00; P = .05). In 5 studies that did not use chlorhexidine, there was no difference between rates of hospital-associated MRSA infection with discontinuation of CPs (RR, 1.02; 95% CI, 0.55-1.88; P= .95). CONCLUSIONS There was no significant difference in rates of hospital-associated MRSA infection before and after removing CPs. Additionally, there were decreased rates of hospital-associated VRE infection following stoppage of CPs.
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Affiliation(s)
- Robert Kleyman
- Regional Medical Center Bayonet Point, Graduate Medical Education, HCA West Division, Hudson, FL.
| | - Sophia Cupril-Nilson
- Regional Medical Center Bayonet Point, Graduate Medical Education, HCA West Division, Hudson, FL
| | - Kent Robinson
- Regional Medical Center Bayonet Point, Graduate Medical Education, HCA West Division, Hudson, FL
| | - Shaival Thakore
- Regional Medical Center Bayonet Point, Graduate Medical Education, HCA West Division, Hudson, FL
| | - Furqan Haq
- Regional Medical Center Bayonet Point, HCA West Division, Hudson, FL
| | - Liwei Chen
- University of South Florida, Morsani College of Medicine, Tampa, FL
| | | | - Kimberly Browning
- Regional Medical Center Bayonet Point, HCA West Division, Hudson, FL
| | - Joseph Pino
- Regional Medical Center Bayonet Point, HCA West Division, Hudson, FL
| | - Rahul Mhaskar
- University of South Florida, Morsani College of Medicine, Tampa, FL
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24
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Vazquez-Rosas GJ, Merida-Vieyra J, Aparicio-Ozores G, Lara-Hernandez A, De Colsa A, Aquino-Andrade A. Molecular Characterization of Staphylococcus aureus Obtained from Blood Cultures of Paediatric Patients Treated in a Tertiary Care Hospital in Mexico. Infect Drug Resist 2021; 14:1545-1556. [PMID: 33911882 PMCID: PMC8071697 DOI: 10.2147/idr.s302416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/05/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose Staphylococcus aureus is one of the main causative agents of hospital-acquired (HA) infections. In Mexico, information about the characteristics of clinical S. aureus isolates is limited. Our aim was to characterize S. aureus strains obtained from blood cultures of paediatric patients treated in a tertiary care hospital. Materials and Methods We analysed 249 S. aureus isolates over the period from 2006 to 2019, and their resistance profiles were determined. The isolates were classified into methicillin-resistant S. aureus (MRSA) or methicillin-sensitive S. aureus (MSSA). Staphylococcal cassettes chromosome mec (SCCmec) were detected. Virulence genes (cna, clfA, clfB, eta, etb, fnbA, fnbB, hla, pvl, sec, and tsst) were amplified, and their clonal relationships were established by pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST) and clonal complex (CC) typing. We reviewed one hundred medical files to collect clinical information. Results Thirty-eight percent of the isolates were MRSA and showed an expanded profile of resistance to other non-beta-lactam antibiotics, while MSSA strains presented a reduced resistance profile. SCCmec-II was the most frequent element (86.3%). Eight virulence factors were detected in MSSA and six in MRSA. The pvl gene was detected in four MRSA-SCCmec-IV isolates (P≤0.0001). MRSA isolates were distributed among 14 clones and were classified into 15 sequence types (ST); the most frequent was ST1011 (17%). The most common CC in MRSA was CC5 (69%, P≤0.0001), and in MSSA, it was CC30 (30%, P≤0.0001). Eighty-seven percent of MRSA isolates were HA-MRSA, and 13% were community-acquired MRSA (CA-MRSA). Of 21 HA-MRSA isolates, 17 had SCCmec-II, while two CA-MRSA isolates had SCCmec-IV. Of MSSA isolates, 77% were derived from HA infections and 23% from CA infections. Conclusion MSSA isolates had more virulence factors. MRSA isolates were resistant to more non-beta-lactam antibiotics, and those with SCCmec-IV expressed a greater variety of virulence factors. Most S. aureus isolates belonged to CC5.
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Affiliation(s)
- Guillermo Jose Vazquez-Rosas
- Molecular Microbiology Laboratory, Instituto Nacional de Pediatria, Mexico City, Mexico.,Medical Bacteriology Laboratory, Instituto Politecnico Nacional, Mexico City, Mexico
| | - Jocelin Merida-Vieyra
- Molecular Microbiology Laboratory, Instituto Nacional de Pediatria, Mexico City, Mexico
| | | | | | - Agustin De Colsa
- Molecular Microbiology Laboratory, Instituto Nacional de Pediatria, Mexico City, Mexico.,Department of Paediatric Infectious Diseases, Instituto Nacional de Pediatria, Mexico City, Mexico
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25
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Goto M, Harris AD, Perencevich EN. Contact Precautions and Methicillin-Resistant Staphylococcus aureus-Modeling Our Way to Safety. JAMA Netw Open 2021; 4:e211574. [PMID: 33720366 DOI: 10.1001/jamanetworkopen.2021.1574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michihiko Goto
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Anthony D Harris
- Division of Genomic Epidemiology and Clinical Outcomes, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Eli N Perencevich
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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26
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Hebden J, Pogorzelska-Maziarz M. Journal club: Stopping the routine use of contact precautions for management of MRSA and VRE at three academic medical centers: An interrupted time series analysis. Am J Infect Control 2020; 48:1562-1563. [PMID: 33220894 DOI: 10.1016/j.ajic.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Joan Hebden
- IPC Consulting Group LLC, Baltimore, MD; Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD.
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27
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Abstract
Purpose of review There is a continuing debate regarding contact precaution (CP) usage for endemic multidrug-resistant organisms (MDROs). In this review, we examine current recommendations for CP and highlight differences in CP use between endemic and non-endemic MDROs. Recent findings The discontinuation of CP had no effect on the incidence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci. The evidence regarding CP for extended-spectrum beta-lactamase producing Enterobacteriaceae is inconclusive, highlighting the need for more research to determine best infection control strategies. Carbapenem-resistant Enterobacteriaceae maintains a sporadic pattern in the USA, supporting current recommendations to use CP for colonized and infected patients. MDR Acinetobacter baumannii (MDR-AB) is extremely virulent and responsible for outbreaks in healthcare settings, emphasizing the need for CP use with MDR-AB infected patients. Candida auris (C. auris) is often misdiagnosed; it is resistant to UV light and quaternary ammonium low-level disinfection. Because little is known about the transmission of C. auris, significant caution and CP use are necessitated. There is little research on vancomycin-resistant S. aureus (VRSA) control strategies due to its rarity; thus, CP is strongly recommended. Summary Contact precautions are frequently part of a bundled infection control approach that involves meticulous hand hygiene, patient decolonization, chlorhexidine gluconate bathing, and reducing the use of invasive devices. Healthcare facilities should continue to utilize CP for non-endemic MDROs and the presence of endemic MDROs; however, CP may not add benefit to the current infection prevention bundle approach.
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28
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Cotoia A, Spadaro S, Gambetti G, Koulenti D, Cinnella G. Pathogenesis-Targeted Preventive Strategies for Multidrug Resistant Ventilator-Associated Pneumonia: A Narrative Review. Microorganisms 2020; 8:microorganisms8060821. [PMID: 32486132 PMCID: PMC7356213 DOI: 10.3390/microorganisms8060821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/20/2020] [Accepted: 05/28/2020] [Indexed: 11/18/2022] Open
Abstract
Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in the intensive care unit (ICU), accounting for relevant morbidity and mortality among critically ill patients, especially when caused by multidrug resistant (MDR) organisms. The rising problem of MDR etiologies, which has led to a reduction in treatment options, have increased clinician’s attention to the employment of effective prevention strategies. In this narrative review we summarized the evidence resulting from 27 original articles that were identified through a systematic database search of the last 15 years, focusing on several pathogenesis-targeted strategies which could help preventing MDR-VAP. Oral hygiene with Chlorhexidine (CHX), CHX body washing, selective oral decontamination (SOD) and/or digestive decontamination (SDD), multiple decontamination regimens, probiotics, subglottic secretions drainage (SSD), special cuff material and shape, silver-coated endotracheal tubes (ETTs), universal use of gloves and contact isolation, alcohol-based hand gel, vaporized hydrogen peroxide, and bundles of care have been addressed. The most convincing evidence came from interventions directly addressed against the key factors of MDR-VAP pathogenesis, especially when they are jointly implemented into bundles. Further research, however, is warranted to identify the most effective combination.
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Affiliation(s)
- Antonella Cotoia
- Department of Anesthesia and Intensive Care, University of Foggia, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Viale Pinto 241, 71122 Foggia, Italy; (G.G.); (G.C.)
- Correspondence:
| | - Savino Spadaro
- Department of Morphology, Surgery and Experimental Medicine, Anesthesia and Intensive Care Section, University of Ferrara, Azienda Ospedaliera- Universitaria Sant’Anna, Via Aldo Moro 8, 44124 Ferrara, Italy;
| | - Guido Gambetti
- Department of Anesthesia and Intensive Care, University of Foggia, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Viale Pinto 241, 71122 Foggia, Italy; (G.G.); (G.C.)
| | - Despoina Koulenti
- 2nd Critical Care Department, Attikon University Hospital, 12462 Athens, Greece;
- UQCCR, Faculty of Medicine, The University of Queensland, Brisbane QLD 4029, Australia
| | - Gilda Cinnella
- Department of Anesthesia and Intensive Care, University of Foggia, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Viale Pinto 241, 71122 Foggia, Italy; (G.G.); (G.C.)
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29
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So M. Vancomycin-Resistant Enterococcus in Hematology-Oncology Patients: a Review on Colonization, Screening, Infections, Resistance, and Antimicrobial Stewardship. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2020. [DOI: 10.1007/s40506-020-00227-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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30
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Höring S, Lemmen S. [Management of patients with multidrug-resistant bacteria after hospital discharge]. MMW Fortschr Med 2020; 162:56-60. [PMID: 32248468 DOI: 10.1007/s15006-020-0343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Steffen Höring
- Zentralbereich für Krankenhaushygiene und Infektiologie (ZfKI), Zentrum für Infektiologie (DGI), Universitätsklinikum Aachen, Pauwelsstr. 30, D-52074, Aachen, Deutschland.
| | - Sebastian Lemmen
- Leiter des Zentralbereichs für Krankenhaushygiene und Infektiologie (ZfKI), Zentrum für Infektiologie (DGI), Universitätsklinikum Aachen, Deutschland
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31
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Carey D, Price K, Neal S, Compton C, Ash C, Bryan N, Kaplan P, McMullen K. The impact of discontinuing contact precautions for multidrug resistant organisms at a less than 400-bed level II teaching hospital and a community hospital: A 3-month pilot study. Am J Infect Control 2020; 48:333-336. [PMID: 31519476 DOI: 10.1016/j.ajic.2019.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND The impact of discontinuing contact precautions (CPs) for patients with select multidrug-resistant organisms on bacteremia infection rates was evaluated in this quality improvement project. METHODS The removal of use of CPs, with increased focus on standard precautions, for all patients with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) colonization/infection was piloted via a quality improvement project over a 3-month period. RESULTS CP was discontinued in December 2018. Comparing 3 months pre- and postchange, the overall incidence density rate decreased for hospital-onset (HO) laboratory-identified (LabID) MRSA bacteremia (0.07 vs 0.02; P = .52), whereas HO LabID VRE bacteremia rates remained the same (0.00 vs 0.00). Overall estimated financial savings, including personal protective equipment ($15,375) and staff time ($17,165), was $32,540 for the project period, with annualized estimated savings of $130,160. CONCLUSIONS In this pilot study evaluating the discontinuance of CPs, there was no evidence of an increase in HO MRSA or VRE LabID bacteremia incidence density rates. This practice change may be safely implemented at similar health care facilities.
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Affiliation(s)
- Darlene Carey
- Infection Prevention and Control, Gwinnett Medical Center, Lawrenceville, GA.
| | - Kaleb Price
- Infection Prevention and Control, Gwinnett Medical Center, Lawrenceville, GA
| | - Shylanda Neal
- Infection Prevention and Control, Gwinnett Medical Center, Lawrenceville, GA
| | - Cinnamon Compton
- Infection Prevention and Control, Gwinnett Medical Center, Lawrenceville, GA
| | - Charles Ash
- Infection Prevention and Control, Gwinnett Medical Center, Lawrenceville, GA
| | - Nicole Bryan
- Infection Prevention and Control, Gwinnett Medical Center, Lawrenceville, GA
| | - Peter Kaplan
- Infection Prevention and Control, Gwinnett Medical Center, Lawrenceville, GA
| | - Kathleen McMullen
- Infection Prevention, Occupational Health and Wound Care, Christian Hospital and Northwest Healthcare, St. Louis, MO
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Contact isolation versus standard precautions to decrease acquisition of extended-spectrum β-lactamase-producing Enterobacterales in non-critical care wards: a cluster-randomised crossover trial. THE LANCET. INFECTIOUS DISEASES 2020; 20:575-584. [PMID: 32087113 DOI: 10.1016/s1473-3099(19)30626-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 09/02/2019] [Accepted: 10/25/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The effectiveness of contact isolation for decreasing the spread of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) has been questioned. The aim of this study was to establish the benefits of contact isolation over standard precautions for reducing the incidence density of ESBL-E colonisation and infection in adult medical and surgical wards with an active surveillance culture programme. METHODS We did a cluster-randomised crossover trial in adult wards in four European university hospitals. Medical, surgical, or combined medical-surgical wards without critical care were randomised to continue standard precautions alone or implement contact isolation alongside standard precautions for 12 months, followed by a 1 month washout period and 12 months of the alternate strategy. Randomisation was done via a computer-generated sequence, with a block size of two consecutive wards. Only laboratory technicians and data analysts were masked to allocation. Patients were screened for ESBL-E carriage within 3 days of admission, once a week thereafter, and on discharge. The primary outcome was the incidence density of ESBL-E, defined as the acquisition rate per 1000 patient-days at risk at the ward level and assessed in the per-protocol population, which included all patients screened at least twice with a length of stay of more than 1 week for each intervention period. No specific safety measures were assessed given the minimal risk of adverse events. The trial is registered, ISRCTN57648070. FINDINGS We enrolled 20 wards from four hospitals in Germany (eight wards), the Netherlands (four wards), Spain (four wards), and Switzerland (four wards). Between Jan 6, 2014, and Aug 31, 2016, 38 357 patients were admitted to these wards. Among 15 184 patients with a length of stay of more than 1 week, 11 368 patients (75%) were screened at least twice. The incidence density of ward-acquired ESBL-E was 6·0 events per 1000 patient-days at risk (95% CI 5·4-6·7) during periods of contact isolation and 6·1 (5·5-6·7) during periods of standard precautions (p=0·9710). Multivariable analysis adjusted for length of stay, percentage of patients screened, and prevalence in first screening cultures yielded an incidence rate ratio of 0·99 (95% CI 0·80-1·22; p=0·9177) for care under contact isolation compared with standard precautions. INTERPRETATION Contact isolation showed no benefit when added to standard precautions for controlling the spread of ESBL-E on non-critical care wards with extensive surveillance screening. FUNDING European Commission.
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33
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Patient to healthcare personnel transmission of MRSA in the non-intensive care unit setting. Infect Control Hosp Epidemiol 2020; 41:601-603. [PMID: 32036800 DOI: 10.1017/ice.2020.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The transmission rate of methicillin-resistant Staphylococcus aureus (MRSA) to gloves or gowns of healthcare personnel (HCP) caring for MRSA patients in a non-intensive care unit setting was 5.4%. Contamination rates were higher among HCP performing direct patient care and when patients had detectable MRSA on their body. These findings may inform risk-based contact precautions.
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Comparison of surveillance and clinical cultures to measure the impact of infection control interventions on the incidence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus in the hospital. Infect Control Hosp Epidemiol 2020; 41:161-165. [PMID: 31896372 DOI: 10.1017/ice.2019.322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate whether clinical cultures are an appropriate surrogate for surveillance cultures to measure the effect of interventions on the incidence of MRSA and VRE in the hospital. DESIGN Cross-sectional and quasi-experimental, retrospective analysis. SETTING AND POPULATION Convenience sample of patients admitted between January 1, 2002, and June 31, 2011, to the medical intensive care unit (MICU) and surgical intensive care unit (SICU) of an acute-care hospital in the United States. INTERVENTIONS Asynchronously in the MICU and SICU, we introduced (1) universal glove and gown use, (2) bundled intervention to prevent central-line-associated bloodstream infection, and (3) daily chlorhexidine gluconate bathing. RESULTS We observed a statistically significant correlation between surveillance and clinical culture-based incidence rates of MRSA in the MICU (0.32; P < .001) and the SICU (0.37; P < .001) but not for VRE in either the MICU (0.16, P = .11) or the SICU (0.15; P = .12). For VRE, but not for MRSA, incidence density rates based on surveillance cultures were 2- to 4-fold higher than for clinical cultures. When evaluating the impacts of the interventions, different effect estimates were noted for universal glove and gown use on MRSA acquisition in MICU, and for VRE acquisition in both the MICU and the SICU based on surveillance versus clinical cultures. CONCLUSIONS For multidrug-resistant organism acquisition, surveillance cultures should be used when feasible because clinical cultures may not be an appropriate surrogate. Clinical or surveillance-based end points for infection control interventions should reflect the conceptual model from colonization to infection and where an intervention might have an effect, rather than considering them interchangeable.
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35
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Less contact isolation is more in the ICU: not sure. Intensive Care Med 2019; 46:1735-1738. [DOI: 10.1007/s00134-019-05809-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
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Barcudi D, Sosa EJ, Lamberghini R, Garnero A, Tosoroni D, Decca L, Gonzalez L, Kuyuk MA, Lopez T, Herrero I, Cortes P, Figueroa M, Egea AL, Gagetti P, Fernandez Do Porto DA, Corso A, Turjanski AG, Bocco JL, Sola C. MRSA dynamic circulation between the community and the hospital setting: New insights from a cohort study. J Infect 2019; 80:24-37. [PMID: 31606351 DOI: 10.1016/j.jinf.2019.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/09/2019] [Accepted: 10/03/2019] [Indexed: 12/21/2022]
Abstract
Dissemination of methicillin-resistant-Staphylococcus aureus/(MRSA) is a worldwide concern both in hospitals [healthcare-associated-(HA)-MRSA] and communities [community-associated-(CA)-MRSA]. Knowledge on when and where MRSA colonization is acquired and what clones are involved is necessary, to focus efforts for prevention of hospital-acquired MRSA-infections. METHODS A prospective/longitudinal cohort study was performed in eight Argentina hospitals (Cordoba/ October-December/2014). Surveillance cultures for MRSA (nose-throat-inguinal) were obtained on admission and at discharge. MRSA strains were genetically typed as CA-MRSAG and HA-MRSAG genotypes. RESULTS Overall, 1419 patients were screened and 534 stayed at hospital for ≥3 days. S. aureus admission prevalence was 30.9% and 4.2% for MRSA. Overall MRSA acquisition rate was 2.3/1000 patient-days-at-risk with a MRSA acquisition prevalence of 1.96% (95%CI: 1.0%-3.4%); 3.2% of patients were discharged back to community with MRSA. CA-MRSAG accounted for 84.6% of imported, 100.0% of hospital-acquired and 94% of discharged MRSA strains. Most imported and acquired MRSA strains belonged to two major epidemic CA-MRSA clones spread in Argentina: PFGEtypeI-ST5-IVa-t311-PVL+ and PFGEtypeN/ST30-IVc-t019-PVL+. CONCLUSIONS CA-MRSA clones, particularly ST5-IV-PVL+ and ST30-IV-PVL+, with main reservoir in the community, not only enter but also are truly acquired within hospital, causing healthcare-associated-hospital-onset infections, having a transmission capacity greater or similar than HA-MRSAG. This information is essential to develop appropriate MRSA infection prevention-control programs, considering hospital and community.
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Affiliation(s)
- Danilo Barcudi
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI) CONICET and Universidad Nacional de Córdoba; Departamento de Bioquímica Clínica; Facultad de Ciencias Químicas; Haya de La Torre y Medina Allende, Ciudad Universitaria, X5000-Córdoba, Argentina
| | - Ezequiel J Sosa
- Instituto de Cálculo, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, CONICET, Ciudad Universitaria, Pabellón 2, C1428EHA Ciudad de Buenos Aires, Argentina; Instituto de Química Biológica de La Facultad de Ciencias Exactas y Naturales (IQUIBICEN)-CONICET, Ciudad Universitaria, Pabellón 2, C1428EHA Ciudad de Buenos Aires, Argentina
| | - Ricardo Lamberghini
- Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Bajada Pucará 2025, X5000 Córdoba, Argentina; Hospital Guillermo Rawson, Bajada Pucará 2025, X5000 Córdoba, Argentina
| | - Analía Garnero
- Hospital de Niños de la Santísima Trinidad de Córdoba, Córdoba, Bajada Pucará 787, X5000 ANN, Argentina
| | - Dario Tosoroni
- Facultad de Medicina, Universidad Católica de Córdoba, Jacinto Ríos 555, X5004ASK Córdoba, Argentina
| | - Laura Decca
- Clínica Regional del SUD-Río IV, Av. Italia 1262, X5800 Río Cuarto, Córdoba, Argentina
| | - Liliana Gonzalez
- Hospital Infantil Municipal de Córdoba, Juan Antonio Lavalleja 3050, X5000 Córdoba, Argentina
| | - María A Kuyuk
- Hospital Militar Córdoba, Cruz Roja Argentina 1114, X5000 Córdoba, Argentina
| | - Teresa Lopez
- Hospital Guillermo Rawson, Bajada Pucará 2025, X5000 Córdoba, Argentina
| | - Ivana Herrero
- Hospital de Urgencias, Catamarca 441, X5000 Córdoba, Argentina
| | - Paulo Cortes
- Hospital Pediátrico del Niño Jesús, Av. Castro Barros 650, X5000HTT Córdoba, Argentina
| | - Myrian Figueroa
- Hospital Misericordia, Nuevo Siglo, Belgrano 1502, X5000 Córdoba, Argentina
| | - Ana L Egea
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI) CONICET and Universidad Nacional de Córdoba; Departamento de Bioquímica Clínica; Facultad de Ciencias Químicas; Haya de La Torre y Medina Allende, Ciudad Universitaria, X5000-Córdoba, Argentina
| | - Paula Gagetti
- Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas (INEI)-ANLIS "Dr. Carlos G. Malbrán", Av. Vélez Sarsfield 563, C1282AFF Ciudad Autónoma de Buenos Aires, Argentina
| | - Darío A Fernandez Do Porto
- Instituto de Cálculo, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, CONICET, Ciudad Universitaria, Pabellón 2, C1428EHA Ciudad de Buenos Aires, Argentina; Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, Pabellón 2, C1428EHA Ciudad de Buenos Aires, Argentina
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- The members of the Study Group are listed in the Acknowledgments section, where the participants of each hospital and their affiliations are described
| | - Alejandra Corso
- Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas (INEI)-ANLIS "Dr. Carlos G. Malbrán", Av. Vélez Sarsfield 563, C1282AFF Ciudad Autónoma de Buenos Aires, Argentina
| | - Adrián G Turjanski
- Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, Pabellón 2, C1428EHA Ciudad de Buenos Aires, Argentina
| | - José L Bocco
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI) CONICET and Universidad Nacional de Córdoba; Departamento de Bioquímica Clínica; Facultad de Ciencias Químicas; Haya de La Torre y Medina Allende, Ciudad Universitaria, X5000-Córdoba, Argentina
| | - Claudia Sola
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI) CONICET and Universidad Nacional de Córdoba; Departamento de Bioquímica Clínica; Facultad de Ciencias Químicas; Haya de La Torre y Medina Allende, Ciudad Universitaria, X5000-Córdoba, Argentina.
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Popovich KJ, Davila S, Chopra V, Patel PK, Lassiter S, Olmsted RN, Calfee DP. A Tiered Approach for Preventing Methicillin-Resistant Staphylococcus aureus Infection. Ann Intern Med 2019; 171:S59-S65. [PMID: 31569224 DOI: 10.7326/m18-3468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Shannon Davila
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.D., S.L.)
| | - Vineet Chopra
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (V.C., P.K.P.)
| | - Payal K Patel
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (V.C., P.K.P.)
| | - Shelby Lassiter
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.D., S.L.)
| | - Russell N Olmsted
- Integrated Clinical Services Team, Trinity Health, Livonia, Michigan (R.N.O.)
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Schrank GM, Snyder GM, Davis RB, Branch-Elliman W, Wright SB. The discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: Impact upon patient adverse events and hospital operations. BMJ Qual Saf 2019; 29:1-2. [PMID: 31320496 DOI: 10.1136/bmjqs-2018-008926] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 06/11/2019] [Accepted: 06/29/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Contact precautions for endemic methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) are a resource-intensive intervention to reduce healthcare-associated infections, potentially impeding patient throughput and limiting bed availability to isolate other contagious pathogens. We investigated the impact of the discontinuation of contact precautions (DcCP) for endemic MRSA and VRE on patient outcomes and operations metrics in an acute care setting. METHODS This is a retrospective, quasi-experimental analysis of the 12 months before and after DcCP for MRSA and VRE at an academic medical centre. The frequency for bed closures due to contact isolation was measured, and personal protective equipment (PPE) expenditures and patient satisfaction survey results were compared using the Wilcoxon signed-rank test. Using an interrupted time series design, emergency department (ED) admission wait times and rates of patient falls, pressure ulcers and nosocomial MRSA and VRE clinical isolates were compared using GEEs. RESULTS Prior to DcCP, bed closures for MRSA and/or VRE isolation were associated with estimated lost hospital charges of $9383 per 100 bed days (95% CI: 8447 to 10 318). No change in ED wait times or change in trend was observed following DcCP. There were significant reductions in monthly expenditures on gowns (-61.0%) and gloves (-16.3%). Patient satisfaction survey results remained stable. No significant changes in rates or trends were observed for patient falls or pressure ulcers. Incidence rates of nosocomial MRSA (1.58 (95% CI: 0.82 to 3.04)) and VRE (1.02 (95% CI: 0.82 to 1.27)) did not significantly change. CONCLUSIONS DcCP was associated with an increase in bed availability and revenue recovery, and a reduction in PPE expenditures. Benefits for other hospital operations metrics and patient outcomes were not identified.
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Affiliation(s)
- Gregory M Schrank
- Department of Medicine, Division of Infectious Diseases, University of Maryland Medical Center, Baltimore, Maryland, United States
| | - Graham M Snyder
- Department of Infection Prevention and Control, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Roger B Davis
- Department of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Westyn Branch-Elliman
- Department of Medicine, Section of Infectious Diseases, VA Boston Healthcare System, West Roxbury, Massachusetts, United States.,VA Boston Center for Healthcare Organization and Implementation Research, Boston, Massachusetts, United States.,Harvard Medical School, Boston, Massachusetts, United States
| | - Sharon B Wright
- Harvard Medical School, Boston, Massachusetts, United States.,Division of Infection Control/Hospital Epidemiology, Silverman Institute of Health Care Quality & Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States.,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
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39
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Maragakis LL, Jernigan JA. Things We Do For Good Reasons: Contact Precautions for Multidrug-resistant Organisms, Including MRSA and VRE. J Hosp Med 2019; 14:194-196. [PMID: 30811332 PMCID: PMC10810419 DOI: 10.12788/jhm.3169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/15/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Lisa L Maragakis
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Healthcare Epidemiology and Infection Prevention, Johns Hopkins Health System, Baltimore, Maryland
| | - John A Jernigan
- Division of Healthcare Quality Promotion, The Centers for Disease Control and Prevention, Atlanta, Georgia
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40
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Sreeramoju P. Recent advances in understanding the epidemiology of healthcare-associated infections. F1000Res 2019; 8. [PMID: 30740216 PMCID: PMC6348434 DOI: 10.12688/f1000research.15891.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2019] [Indexed: 11/20/2022] Open
Abstract
Since the 2014 publication of updates to the Society for Healthcare Epidemiology of America (SHEA) compendium of strategies to reduce healthcare-associated infections, there have been several advances in understanding the epidemiology of these diseases. This review article captures many of the key advances but does not include all of them.
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Affiliation(s)
- Pranavi Sreeramoju
- University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
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41
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Kim MH, Lee SG, Kim KS, Heo YJ, Oh JE, Jeong SJ. Environmental disinfection with photocatalyst as an adjunctive measure to control transmission of methicillin-resistant Staphylococcus aureus: a prospective cohort study in a high-incidence setting. BMC Infect Dis 2018; 18:610. [PMID: 30509196 PMCID: PMC6276245 DOI: 10.1186/s12879-018-3555-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background Environmental disinfection with continuously antimicrobial surfaces could offer superior control of surface bioburden. We sought to decide the efficacy of photocatalyst antimicrobial coating in reducing methicillin-resistant Staphylococcus aureus (MRSA) acquisition in high incidence setting. Methods We performed prospective cohort study involving patients hospitalized in medical intensive care unit. A titanium dioxide-based photocatalyst was coated on high touch surfaces and walls. Five months of pre-intervention data were compared with five months of post-intervention data. The incidence rates of multidrug-resistant organism acquisition and the rates of hospital-acquired blood stream infection, pneumonia, urinary tract infection, and Clostridium difficile–associated diseases were compared using Cox proportional hazards regression analysis. Results In total, 621 patients were included. There was significant decrease in MRSA acquisition rate after photocatalyst coating (hazard ratio, 0.37; 95% confidence interval, 0.14–0.99; p = 0.04). However, clinical identification of vancomycin-resistant Enterococcus spp. and multidrug-resistant Acinetobacter baumannii did not decrease significantly. The hazard of contracting hospital-acquired pneumonia during the intervention period compared to baseline period was 0.46 (95% confidence interval, 0.23–0.94; p = 0.03). Conclusions In conclusion, MRSA rate was significantly reduced after photocatalyst coating. We provide evidence that photocatalyst disinfection can be an adjunctive measure to control MRSA acquisition in high-incidence settings. Trial registration ISRCTN Registry (ISRCTN31972004). Registered retrospectively on November 19, 2018. Electronic supplementary material The online version of this article (10.1186/s12879-018-3555-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Min Hyung Kim
- Department of Internal Medicine, Bundang Jesaeng Hospital, 180-2Seohyeon-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-774, South Korea
| | - Seong Gyu Lee
- Department of Laboratory Medicine, Bundang Jesaeng Hospital, 180-2Seohyeon-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-774, South Korea
| | - Ki Sook Kim
- Department of Infection Control Office, Bundang Jesaeng Hospital, 180-2Seohyeon-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-774, South Korea
| | - Yoon Ji Heo
- Department of Infection Control Office, Bundang Jesaeng Hospital, 180-2Seohyeon-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-774, South Korea
| | - Ji Eun Oh
- Department of Nursing, Bundang Jesaeng Hospital, 180-2Seohyeon-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-774, South Korea
| | - Su Jin Jeong
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Hygienemaßnahmen zur Prävention der Infektion durch Enterokokken mit speziellen Antibiotikaresistenzen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:1310-1361. [DOI: 10.1007/s00103-018-2811-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Vehreschild MJGT, Haverkamp M, Biehl LM, Lemmen S, Fätkenheuer G. Vancomycin-resistant enterococci (VRE): a reason to isolate? Infection 2018; 47:7-11. [PMID: 30178076 DOI: 10.1007/s15010-018-1202-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/21/2018] [Indexed: 12/13/2022]
Abstract
In recent years, an increase in invasive VRE infections has been reported worldwide, including Germany. The most common gene encoding resistance to glycopeptides is VanA, but predominant VanB clones are emerging. Although neither the incidence rates nor the exact routes of nosocomial transmission of VRE are well established, screening and strict infection control measures, e.g. single room contact isolation, use of personal protective clothing by hospital staff and intensified surface disinfection for colonized individuals, are implemented in many hospitals. At the same time, the impact of VRE infection on mortality remains unclear, with current evidence being weak and contradictory. In this short review, we aim to give an overview on the current basis of evidence on the clinical effectiveness of infection control measures intended to prevent transmission of VRE and to put these findings into a larger perspective that takes further factors, e.g. VRE-associated mortality and impact on patient care, into account.
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Affiliation(s)
- Maria J G T Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, 50924, Cologne, Germany
- Deutsches Zentrum für Infektionsforschung (DZIF), Standort Bonn-Cologne, Germany
| | - Miriam Haverkamp
- Zentralbereich für Krankenhaushygiene und Infektiologie, Uniklinik Aachen, Aachen, Germany
| | - Lena M Biehl
- Department I of Internal Medicine, University Hospital of Cologne, 50924, Cologne, Germany
- Deutsches Zentrum für Infektionsforschung (DZIF), Standort Bonn-Cologne, Germany
| | - Sebastian Lemmen
- Zentralbereich für Krankenhaushygiene und Infektiologie, Uniklinik Aachen, Aachen, Germany
| | - Gerd Fätkenheuer
- Department I of Internal Medicine, University Hospital of Cologne, 50924, Cologne, Germany.
- Deutsches Zentrum für Infektionsforschung (DZIF), Standort Bonn-Cologne, Germany.
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