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A systematic review of the effectiveness of cohorting to reduce transmission of healthcare-associated C. difficile and multidrug-resistant organisms

Published online by Cambridge University Press:  27 March 2020

Cybele L. Abad Open the ORCID record for Cybele L. Abad [Opens in a new window] ,
Anna K. Barker  and
Nasia Safdar
Cybele L. Abad*
Affiliation:
Department of Medicine, Section of Infectious Diseases, University of the Philippines, Manila-Philippine General Hospital, Manila, Philippines Division of Infectious Diseases, The Medical City, Pasig, Philippines
Anna K. Barker
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
Nasia Safdar*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Wisconsin–Madison, Madison, Wisconsin, United States William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States Infection Control Department, University of Wisconsin–Madison, Madison, Wisconsin, United States
*
Authors for correspondence: Cybele L. Abad, E-mail address: crabad@up.edu, or cybelemd@yahoo.com. Or Nasia Safdar, E-mail: ns2@medicine.wisc.edu
Authors for correspondence: Cybele L. Abad, E-mail address: crabad@up.edu, or cybelemd@yahoo.com. Or Nasia Safdar, E-mail: ns2@medicine.wisc.edu
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Abstract

Background:

Cohorting of patients and staff is a control strategy often used to prevent the spread of infection in healthcare institutions. However, a comprehensive evaluation of cohorting as a prevention approach is lacking.

Methods:

We performed a systematic review of studies that used cohorting as part of an infection control strategy to reduce hospital-acquired infections. We included studies published between 1966 and November 30, 2019, on adult populations hospitalized in acute-care hospitals.

Results:

In total, 87 studies met inclusion criteria. Study types were quasi-experimental “before and after” (n = 35), retrospective (n = 49), and prospective (n = 3). Case-control analysis was performed in 7 studies. Cohorting was performed with other infection control strategies in the setting of methicillin-resistant Staphylococcus aureus (MRSA, n = 22), Clostridioides difficile infection (CDI, n = 6), vancomycin-resistant Enterococcus (VRE, n = 17), carbapenem-resistant Enterobacteriaceae infections (CRE, n = 22), A. baumannii (n = 15), and other gram-negative infections (n = 5). Cohorting was performed either simultaneously (56 of 87, 64.4%) or in phases (31 of 87, 35.6%) to help contain transmission. In 60 studies, both patients and staff were cohorted. Most studies (77 of 87, 88.5%) showed a decline in infection or colonization rates after a multifaceted approach that included cohorting as part of the intervention bundle. Hand hygiene compliance improved in approximately half of the studies (8 of 15) during the respective intervention.

Conclusion:

Cohorting of staff, patients, or both is a frequently used and reasonable component of an enhanced infection control strategy. However, determining the effectiveness of cohorting as a strategy to reduce transmission of MDRO and C. difficile infections is difficult, particularly in endemic situations.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 6 , June 2020 , pp. 691 - 709
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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