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McCarthy S, Motala A, Shekelle PG. Prevention in adults of transmission of infection with multidrug-resistant organisms: an updated systematic review from Making Healthcare Safer IV. BMJ Qual Saf 2024:bmjqs-2024-017545. [PMID: 39326932 DOI: 10.1136/bmjqs-2024-017545] [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: 05/20/2024] [Accepted: 08/31/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND Healthcare-associated infections due to multidrug-resistant organisms (MDROs) remain a high priority patient safety topic, despite broad acceptance as standard-of-care safety practices to prevent central line-associated bloodstream infection, catheter-associated urinary tract infection and ventilator-associated pneumonia. Prior editions of Making Healthcare Safer have mixed certainty evidence for various other patient safety practices. OBJECTIVES As part of Making Healthcare Safer IV, we performed an updated systematic review on the certainty of evidence for the following safety practices at reducing in-facility MDRO infections in adult patients: universal gloving, contact precautions, cohorting, environmental decontamination, patient decolonisation and the adverse effects of isolation. METHODS We searched PubMed and the Cochrane Library 2011-May 2023 for systematic reviews and original research studies, both randomised and observational. Settings were limited to high-income countries. Screening and eligibility were done in duplicate, while data extraction was done by one reviewer and checked by a second reviewer. The synthesis of results is narrative. Certainty of evidence was based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. RESULTS Three systematic reviews and three original research studies provided moderate certainty evidence that patient decolonisation reduced MDRO infections, although restricted to certain populations and organisms. One systematic review provided low certainty evidence that universal gloving was beneficial, again limited to certain populations. One systematic review and two original research studies provided low certainty evidence of benefit for environmental decontamination. One systematic review and one new original study provided low certainty evidence of benefit for cohorting in outbreak settings, and very low certainty evidence of benefit in endemic settings. Six original research studies provide mixed evidence for benefit of contact precautions. There is very low certainty evidence of a signal of increased non-infectious adverse events under patients in contact isolation. CONCLUSION In general, the reviewed patient safety practices reduced MDRO infections, but certainty of evidence was low. PROSPERO REGISTRATION NUMBER CRD42023444973.
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Affiliation(s)
- Sean McCarthy
- Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aneesa Motala
- RAND Corporation, Santa Monica, California, USA
- University of Southern California, Los Angeles, California, USA
| | - Paul G Shekelle
- Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- RAND Corporation, Santa Monica, California, USA
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2
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Wang Z, Wu H, Guo Y, Zhu L, Dai Z, Zhang H, Ma X. Development and validation of a novel prediction model for Carbapenem-resistant organism infection in a large-scale hospitalized patients. Diagn Microbiol Infect Dis 2024; 110:116415. [PMID: 38970947 DOI: 10.1016/j.diagmicrobio.2024.116415] [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: 04/07/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/08/2024]
Abstract
Carbapenem-resistant organism (CRO) are defined as gram-negative bacteria. The lack of safe and effective antibiotics has led to an increase in incidence rate. The purpose of this study is to establish and determine a risk nomogram to predict CRO infection in hospitalized patients. Hospitalized patients' information were collected from the electronic medical record system of hospital between January 2019 and December 2022. Based on the inclusion and exclusion criteria, we identified 131390 inpatients who met the criteria for this study. For the training cohort, the area under the curves (AUC) for predicting the CRO infection was 0.935. For the validation cohort, the AUC for predicting the CRO infection was 0.937. We have developed the first novel nomogram to predict CRO infection in hospitalized patients, which is reliable and high-performance. The nomogram performs well among hospitalized patients and has good predictive ability.
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Affiliation(s)
- Zhiqiang Wang
- Department of Biostatistics, Akeso Biopharma Inc, Shanghai, China
| | - Hao Wu
- Department of Medical Infection Management, Pudong New Area People's Hospital, Shanghai, China
| | - Yunping Guo
- Department of Traditional Chinese Medicine, Pudong New Area People's Hospital, Shanghai, China
| | - Linyin Zhu
- Department of Medical Infection Management, Pudong New Area People's Hospital, Shanghai, China
| | - Zhuangqing Dai
- Department of Medical Infection Management, Pudong New Area People's Hospital, Shanghai, China
| | - Huihui Zhang
- Department of Medical Infection Management, Pudong New Area People's Hospital, Shanghai, China
| | - Xiaoting Ma
- Department of Medical Infection Management, Pudong New Area People's Hospital, Shanghai, China.
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3
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Martínez DA, Cai J, Lin G, Goodman KE, Paul R, Lessler J, Levin SR, Toerper M, Simner PJ, Milstone AM, Klein EY. Modelling interventions and contact networks to reduce the spread of carbapenem-resistant organisms between individuals in the ICU. J Hosp Infect 2023; 136:1-7. [PMID: 36907332 PMCID: PMC10315994 DOI: 10.1016/j.jhin.2023.02.016] [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: 08/22/2022] [Revised: 01/25/2023] [Accepted: 02/03/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Contact precautions are widely used to prevent the transmission of carbapenem-resistant organisms (CROs) in hospital wards. However, evidence for their effectiveness in natural hospital environments is limited. OBJECTIVE To determine which contact precautions, healthcare worker (HCW)-patient interactions, and patient and ward characteristics are associated with greater risk of CRO infection or colonization. DESIGN, SETTING AND PARTICIPANTS CRO clinical and surveillance cultures from two high-acuity wards were assessed through probabilistic modelling to characterize a susceptible patient's risk of CRO infection or colonization during a ward stay. User- and time-stamped electronic health records were used to build HCW-mediated contact networks between patients. Probabilistic models were adjusted for patient (e.g. antibiotic administration) and ward (e.g. hand hygiene compliance, environmental cleaning) characteristics. The effects of risk factors were assessed by adjusted odds ratio (aOR) and 95% Bayesian credible intervals (CrI). EXPOSURES The degree of interaction with CRO-positive patients, stratified by whether CRO-positive patients were on contact precautions. MAIN OUTCOMES AND MEASURES The prevalence of CROs and number of new carriers (i.e. incident CRO aquisition). RESULTS Among 2193 ward visits, 126 (5.8%) patients became colonized or infected with CROs. Susceptible patients had 4.8 daily interactions with CRO-positive individuals on contact precautions (vs 1.9 interactions with those not on contact precautions). The use of contact precautions for CRO-positive patients was associated with a reduced rate (7.4 vs 93.5 per 1000 patient-days at risk) and odds (aOR 0.03, 95% CrI 0.01-0.17) of CRO acquisition among susceptible patients, resulting in an estimated absolute risk reduction of 9.0% (95% CrI 7.6-9.2%). Also, carbapenem administration to susceptible patients was associated with increased odds of CRO acquisition (aOR 2.38, 95% CrI 1.70-3.29). CONCLUSIONS AND RELEVANCE In this population-based cohort study, the use of contact precautions for patients colonized or infected with CROs was associated with lower risk of CRO acquisition among susceptible patients, even after adjusting for antibiotic exposure. Further studies that include organism genotyping are needed to confirm these findings.
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Affiliation(s)
- D A Martínez
- School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile; Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - J Cai
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, USA
| | - G Lin
- Center for Disease Dynamics, Economics and Policy, Washington, DC, USA
| | - K E Goodman
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - R Paul
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - J Lessler
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S R Levin
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - M Toerper
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - P J Simner
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - A M Milstone
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - E Y Klein
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Disease Dynamics, Economics and Policy, Washington, DC, USA; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
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Krishna A, Chopra T. Prevention of Infection due to Clostridium (Clostridioides) difficile. Infect Dis Clin North Am 2021; 35:995-1011. [PMID: 34752229 DOI: 10.1016/j.idc.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Clostridium (Clostridioides) difficile infection (CDI) causes significant morbidity and mortality in the United States every year. Prevention of CDI is difficult because of spore durability and requires implementation of multipronged strategies. Two categories of prevention strategies are infection control and prevention and risk factor reduction. Hand hygiene, contact precautions, patient isolation, and environmental decontamination are cornerstones of infection control and prevention. Risk factor reduction should focus on antibiotic stewardship to reduce unnecessary antibiotic use. If CDI incidence remains higher than the institution's goal despite these measures, then special measures should be considered.
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Affiliation(s)
- Amar Krishna
- Internal Medicine, Norther Light AR Gould Hospital, 140 Academy Street, Presque Isle, ME 04769, USA.
| | - Teena Chopra
- Infectious Diseases, Wayne State University/Detroit Medical Center, UHC-2B, 4201 St Antoine, Detroit, MI 48201, USA
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Kernéis S, Lucet JC, Santoro A, Meschiari M. Individual and collective impact of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae in patients admitted to the ICU. J Antimicrob Chemother 2021; 76:i19-i26. [PMID: 33534878 DOI: 10.1093/jac/dkaa494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
KPC-producing Klebsiella pneumoniae (KPC-Kp) raises major concerns in the context of intensive care, owing to limited treatment options and the ability to cause outbreaks in this specific setting. The objectives of this review are to give an overview of the burden of KPC-Kp in ICU patients and to discuss methodological issues and limitations regarding the quality of data available. Robust and reliable assessment of the KPC-Kp impact in the ICU should take into consideration not only characteristics of the individuals, but also of the health systems including length of stay, costs and hospital organization issues. Estimates of mortality reported in the current literature are weakened by the poor quality of adjustment for age-specific risks, co-morbidities, and appropriateness of therapy. All these confounding factors should be taken into account in models, with consideration of control groups and competing risks that is currently lacking in the published literature. Since development of antibiotic resistance is an unstoppable phenomenon and economic and human resources are facing progressive limitations due to budget constraints, cost-saving strategies targeted to avoid ICU closure, temporary limitation of admissions or delayed hospital discharge are necessary. The early identification of KPC-Kp-colonized patients through active screening strategies is likely to be the cornerstone of such a cost-saving strategy. However, there are still many open issues concerning which of these strategies are the most effective. Owing to extreme heterogeneity and several methodological flaws in current publications, future studies investigating the long-term sequelae and economic impact of KPC-Kp in the ICU are urgently needed.
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Affiliation(s)
- Solen Kernéis
- Université de Paris, INSERM, IAME, F-75018, Paris, France.,Equipe de Prévention du Risque Infectieux, APHP, Hôpital Bichat, F-75018, Paris, France
| | - Jean Christophe Lucet
- Université de Paris, INSERM, IAME, F-75018, Paris, France.,Equipe de Prévention du Risque Infectieux, APHP, Hôpital Bichat, F-75018, Paris, France
| | - Antonella Santoro
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Marianna Meschiari
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
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6
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Granzotto EM, Gouveia AM, Gasparetto J, Dantas LR, Tuon FF. Depression and anxiety in hospitalized patients on contact precautions for multidrug-resistant microorganisms. Infect Dis Health 2020; 25:133-139. [PMID: 32005585 DOI: 10.1016/j.idh.2020.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/19/2019] [Accepted: 01/05/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Contact precautions for patients with multidrug-resistant organisms (MDROs) have been associated with adverse effects. The aim of this study was, therefore, to evaluate the level of anxiety and depression through different standardized scales in patients isolated by MDROs. METHODS This is a case-control study with hospitalized patients on contact precautions for MDROs. A questionnaire survey was conducted to analyse the presence and level of depression and anxiety. A multivariable analysis was performed to define independent questions for anxiety/depression scores to create a short questionnaire facilitating a practical approach to the care of hospitalized patients with MDROs. A receiver operating characteristic (ROC) curve was plotted to determine the diagnostic ability of the simplified score. RESULTS A total of 141 patients were included in the study, among whom 68 were isolated because of MDRO colonization while 73 were not isolated (control-group). Forty-five (31.9%) patients had some degree of anxiety. Patients in MDRO contact isolation had a higher level of anxiety than those who were not isolated (55.9% vs. 9.6%, p < 0.001). The equation obtained by multivariated analysis allowed for the construction of a score with ROC area of 0.949 and a sensitivity of 91.1%. CONCLUSION Contact isolation for MDROs is associated with increased depression and anxiety. A simple anxiety score was developed and should be validated for screening.
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Affiliation(s)
| | - Aline Maciel Gouveia
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba PR, Brazil
| | - Juliano Gasparetto
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba PR, Brazil
| | - Letícia Ramos Dantas
- Laboratory of Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba PR, Brazil
| | - Felipe Francisco Tuon
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba PR, Brazil; Laboratory of Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba PR, Brazil.
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7
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Reddy SC, Valderrama AL, Kuhar DT. Improving the Use of Personal Protective Equipment: Applying Lessons Learned. Clin Infect Dis 2019; 69:S165-S170. [DOI: 10.1093/cid/ciz619] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Unrecognized transmission of pathogens in healthcare settings can lead to colonization and infection of both patients and healthcare personnel. The use of personal protective equipment (PPE) is an important strategy to protect healthcare personnel from contamination and to prevent the spread of pathogens to subsequent patients. However, optimal PPE use is difficult, and healthcare personnel may alter delivery of care because of the PPE. Here, we summarize recent research from the Prevention Epicenters Program on healthcare personnel contamination and improvement of the routine use of PPE as well as Ebola-specific PPE. Future efforts to optimize the use of PPE should include increasing adherence to protocols for PPE use, improving PPE design, and further research into the risks, benefits, and best practices of PPE use.
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Affiliation(s)
- Sujan C Reddy
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy L Valderrama
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David T Kuhar
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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8
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Fehling P, Hasenkamp J, Unkel S, Thalmann I, Hornig S, Trümper L, Scheithauer S. Effect of gloved hand disinfection on hand hygiene before infection-prone procedures on a stem cell ward. J Hosp Infect 2019; 103:321-327. [PMID: 31226271 DOI: 10.1016/j.jhin.2019.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hand hygiene compliance even before infection-prone procedures (indication 2, 'before aseptic tasks', according to the World Health Organization (WHO)) remains disappointing. AIM To improve hand hygiene compliance by implementing gloved hand disinfection as a resource-neutral process optimization strategy. METHODS We performed a three-phase intervention study on a stem cell transplant ward. After baseline evaluation of hand hygiene compliance (phase 1) gloved hand disinfection was allowed (phase 2) and restricted (phase 3) to evaluate and differentiate intervention derived from learning and time effects. The incidence of severe infections as well as of hospital-acquired multidrug-resistant bacteria was recorded by active surveillance. FINDINGS Hand hygiene compliance improved significantly from 50% to 76% (P < 0.001) when gloved hand disinfection was allowed. The biggest increase was for infection-prone procedures (WHO 2) from 31% to 65%; P < 0.001. Severe infections decreased by trend (from 6.0 to 2.5 per 1000 patient-days) whereas transmission of multidrug-resistant organisms was not affected. CONCLUSION Gloved hand disinfection significantly improved compliance with the hand hygiene, especially in activities relevant to infections and infection prevention. Thus, this process optimization may be an additional, easy implementable, resource-neutral tool for a highly vulnerable patient cohort.
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Affiliation(s)
- P Fehling
- Institute of Infection Control and Infectious Diseases, University Medical Center, Georg August University Goettingen, Germany.
| | - J Hasenkamp
- Department of Hematology and Oncology, University Medical Center, Georg August University Goettingen, Germany
| | - S Unkel
- Department of Medical Statistics, University Medical Center, Georg August University Goettingen, Germany
| | - I Thalmann
- Institute of Infection Control and Infectious Diseases, University Medical Center, Georg August University Goettingen, Germany
| | - S Hornig
- Institute of Infection Control and Infectious Diseases, University Medical Center, Georg August University Goettingen, Germany
| | - L Trümper
- Department of Hematology and Oncology, University Medical Center, Georg August University Goettingen, Germany
| | - S Scheithauer
- Institute of Infection Control and Infectious Diseases, University Medical Center, Georg August University Goettingen, Germany
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9
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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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10
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[Critically ill patient isolation: risk or protection?]. J Healthc Qual Res 2018; 33:250-255. [PMID: 30401420 DOI: 10.1016/j.jhqr.2018.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/20/2018] [Accepted: 06/26/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Isolation precautions are an effective measure to prevent the spread of multi-resistant microorganisms (MMR). However, its implementation is complex and can increase some risks to the patient. The aim of this study is to determine whether the implementation of isolation precautions increase the risk of patient safety incidents (PSI) in critically ill patients. MATERIAL AND METHODS A retrospective observational study was conducted involving patients admitted to the ICU of a University Hospital, and that required isolation for more than 48h. Period of study: two years (from 2013/03/01 to 2015/03/31). Data source was the electronic medical record. The tools for evaluation were the Modular Review Form questionnaires (MRF1 and MRF2). An analysis was made of PSI and adverse events (AEs) during periods with and without isolation precautions, including the PSI type, severity, and preventability. RESULTS The study included a total of 76 patients, 74 of whom had at least one PSI. A total of 798 PSI were detected (511 during isolation period), 599 were a No harm incident (NHI) and 199 were adverse AEs. The most frequent PSIs were associated with medication (316) and patient health care (279). Most of them were moderately or highly preventable. The incidence of PSI during periods with and without isolation was 27.3 (SD 33.8) and 29 (39.6) per 100 patient-days, respectively. CONCLUSIONS PSIs in ICU are frequent, and the most of them are preventable. The adoption of isolation precautions does not constitute a risk factor for PSI. Improving patient safety culture is essential for an adequate prevention strategy.
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11
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Noninfectious Hospital Adverse Events Decline After Elimination of Contact Precautions for MRSA and VRE. Infect Control Hosp Epidemiol 2018; 39:788-796. [PMID: 29745356 DOI: 10.1017/ice.2018.93] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVETo evaluate the impact of discontinuing routine contact precautions (CP) for endemic methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) on hospital adverse events.DESIGNRetrospective, nonrandomized, observational, quasi-experimental study.SETTINGAcademic medical center with single-occupancy rooms.PARTICIPANTSInpatients.METHODSWe compared hospital reportable adverse events 1 year before and 1 year after discontinuation of routine CP for endemic MRSA and VRE (preintervention and postintervention periods, respectively). Throughout the preintervention period, daily chlorhexidine gluconate bathing was expanded to nearly all inpatients. Chart reviews were performed to identify which patients and events were associated with CP for MRSA/VRE in the preintervention period as well as the patients that would have met prior criteria for MRSA/VRE CP but were not isolated in the postintervention period. Adverse events during the 2 periods were compared using segmented and mixed-effects Poisson regression models.RESULTSThere were 24,732 admissions in the preintervention period and 25,536 in the postintervention period. Noninfectious adverse events (ie, postoperative respiratory failure, hemorrhage/hematoma, thrombosis, wound dehiscence, pressure ulcers, and falls or trauma) decreased by 19% (12.3 to 10.0 per 1,000 admissions, P=.022) from the preintervention to the postintervention period. There was no significant difference in the rate of infectious adverse events after CP discontinuation (20.7 to 19.4 per 1,000 admissions, P=.33). Patients with MRSA/VRE showed the largest reduction in noninfectious adverse events after CP discontinuation, with a 72% reduction (21.4 to 6.08 per 1,000 MRSA/VRE admissions; P<.001).CONCLUSIONAfter discontinuing routine CP for endemic MRSA/VRE, the rate of noninfectious adverse events declined, especially in patients who no longer required isolation. This suggests that elimination of CP may substantially reduce noninfectious adverse events.Infect Control Hosp Epidemiol 2018;788-796.
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12
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Siegel JD, Guzman-Cottrill JA. Pediatric Healthcare Epidemiology. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2018. [PMCID: PMC7152479 DOI: 10.1016/b978-0-323-40181-4.00002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Lofgren ET. Estimating the impact post randomization changes in staff behavior in infection prevention trials: a mathematical modeling approach. BMC Infect Dis 2017; 17:539. [PMID: 28774285 PMCID: PMC5541411 DOI: 10.1186/s12879-017-2632-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 07/25/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Randomized controlled trials (RCTs) of behavior-based interventions are particularly vulnerable to post-randomization changes between study arms. We assess the impact of such a change in a large, multicenter study of universal contact precautions to prevent infection transmission in intensive care units. METHODS We construct a stochastic mathematical model of methicillin-resistant Staphylococcus aureus (MRSA) acquisition in a simulated 18-bed intensive care unit (ICU). Using parameters from a recent study of contact precautions that reported a post-randomization change in contact rates, with fewer visits observed in the treatment arm, we explore the impact of several possible interpretations of this change on MRSA acquisition rates. RESULTS Scenarios where contact precautions resulted in less patient visitation resulted in a mean decrease in MRSA acquisition rate of 37%, accounting for much of the effect reported in the trial. CONCLUSIONS Behavior changes that impact the contact rate have the potential to drastically alter the results of RCTs in infection control settings. Careful monitoring for these changes, and an assessment of which changes will likely have the greatest impact on the study before the study begins are both recommended.
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Affiliation(s)
- Eric T Lofgren
- Paul G. Allen School for Global Animal Health, Washington State University, 240 SE Ott Road, Room 311, Pullman, WA, 99164-7090, USA. .,Community Health Analytics Initiative, Washington State University, Pullman, WA, USA.
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14
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Harris AD, Morgan DJ, Pineles L, Perencevich EN, Barnes SL. Deconstructing the relative benefits of a universal glove and gown intervention on MRSA acquisition. J Hosp Infect 2017; 96:49-53. [PMID: 28410760 DOI: 10.1016/j.jhin.2017.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/09/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The 20-site Benefits of Universal Glove and Gown (BUGG) study found that wearing gloves and gowns for all patient contacts in the intensive care unit (ICU) reduced acquisition rates of meticillin-resistant Staphylococcus aureus (MRSA). The relative importance of gloves and gowns as a barrier, improved hand hygiene, and reduced healthcare worker (HCW)-patient contact rates is unknown. AIM To determine what proportion of the reduction in acquisition rates observed in the BUGG study was due to improved hand hygiene, reduced contact rates, and universal glove and gown use using agent-based simulation modelling. METHODS An existing agent-based model to simulate MRSA transmission dynamics in an ICU was modified, and the model was calibrated using site-specific data. Model validation was completed using data collected in the BUGG study. A full 2k factorial design was conducted to quantify the relative benefits of improving each of the aforementioned factors with respect to MRSA acquisition rates. FINDINGS Across 40 simulated replications for each factorial design point and intervention site, approximately 44% of the decrease in MRSA acquisition rates was due to universal glove and gown use, 38.1% of the decrease was due to improvement in hand hygiene compliance on exiting patient rooms, and 14.5% of the decrease was due to the reduction in HCW-patient contact rates. CONCLUSION Using mathematical modelling, the decrease in MRSA acquisition in the BUGG study was found to be due primarily to the barrier effects of gowns and gloves, followed by improved hand hygiene and lower HCW-patient contact rates.
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Affiliation(s)
- A D Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - D J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA; Veterans Affairs Maryland Healthcare System, Baltimore, MD, USA; Center for Disease Dynamics, Economics and Policy, Washington, DC, USA
| | - L Pineles
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - S L Barnes
- Robert H. Smith School of Business, University of Maryland, College Park, MD, USA
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Bowling JE, Taylor BS. Isolation Precautions for Hospitalized Patients: The Challenges of Identifying Unintended Individual Consequences and Measuring the Prevention of Community Harm. J Gen Intern Med 2017; 32:238-240. [PMID: 27864785 PMCID: PMC5331011 DOI: 10.1007/s11606-016-3926-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Jason E Bowling
- University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, MSC - 7881, San Antonio, TX, 78229-3900, USA.
| | - Barbara S Taylor
- University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, MSC - 7881, San Antonio, TX, 78229-3900, USA
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Cooper CC, Jump RLP, Chopra T. Prevention of Infection Due to Clostridium difficile. Infect Dis Clin North Am 2016; 30:999-1012. [PMID: 27660089 DOI: 10.1016/j.idc.2016.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Clostridium difficile is one of the foremost nosocomial pathogens. Preventing infection is particularly challenging. Effective prevention efforts typically require a multifaceted bundled approach. A variety of infection control procedures may be advantageous, including strict hand decontamination with soap and water, contact precautions, and using chlorine-containing decontamination agents. Additionally, risk factor reduction can help reduce the burden of disease. The risk factor modification is principally accomplished though antibiotic stewardship programs. Unfortunately, most of the current evidence for prevention is in acute care settings. This review focuses on preventative approaches to reduce the incidence of Clostridium difficile infection in healthcare settings.
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Affiliation(s)
- Christopher C Cooper
- Division of Infectious Diseases, Wayne State University, 3990 John R. Street, 5 Hudson, Detroit, MI 48201, USA
| | - Robin L P Jump
- Infectious Disease Section, Medical Division, Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA; Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Teena Chopra
- Division of Infectious Diseases, Wayne State University, 3990 John R. Street, 5 Hudson, Detroit, MI 48201, USA.
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Taylor G, Gravel D, Matlow A, Embree J, LeSaux N, Johnston L, Suh KN, John M, Embil J, Henderson E, Roth V, Wong A. Assessing the magnitude and trends in hospital acquired infections in Canadian hospitals through sequential point prevalence surveys. Antimicrob Resist Infect Control 2016; 5:19. [PMID: 27213039 PMCID: PMC4875760 DOI: 10.1186/s13756-016-0118-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/10/2016] [Indexed: 01/25/2023] Open
Abstract
Background Healthcare acquired infections (HAI) are an important public health problem in developed countries, but comprehensive data on trends over time are lacking. Prevalence surveys have been used as a surrogate for incidence studies and can be readily repeated. Methods The Canadian Nosocomial Infection Surveillance Program conducted prevalence surveys in 2002 and 2009 in a large network of major Canadian acute care hospitals. NHSN definitions of HAI were used. Use of isolation precautions on the survey day was documented. Results In 2009, 9,953 acute care inpatients were surveyed; 1,234 infections (124/1000) were found, compared to 111/1000 in 2002, (p < 0.0001). There was increased prevalence of urinary tract infection (UTI) and Clostridium difficile, offset by decreases in pneumonia and bloodstream infection. Use of isolation precautions increased from 77 to 148 per 1000 patients (p < 0.0001), attributable to increased use of contact precautions in patients infected or colonized with antimicrobial resistant organisms. Conclusion Between 2002 and 2009 HAI prevalence increased by 11.7 % in a network of major Canadian hospitals due to increases in Clostridium difficile and urinary tract infection. The use of isolation precautions increased by 92.2 % attributable to increased contact isolation. National prevalence surveys are useful tools to assess evolving trends in HAI.
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Affiliation(s)
- Geoffrey Taylor
- University of Alberta Hospital, 1-127 CSB, T6G 2G3 Edmonton, Alberta Canada
| | - Denise Gravel
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario Canada ; University of Alberta Hospital, Edmonton, Alberta Canada
| | - Anne Matlow
- The Hospital for Sick Children, Toronto, Ontario Canada
| | | | | | - Lynn Johnston
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia Canada
| | | | | | - John Embil
- Health Sciences Centre, Winnipeg, Manitoba Canada
| | | | | | - Alice Wong
- Royal University Hospital, Saskatoon, Saskatchewan Canada
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Durand A, Dupré C, Robriquet L. Faut-il isoler les patients porteurs de BMR ? MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-016-1184-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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