Hostname: page-component-848d4c4894-5nwft Total loading time: 0 Render date: 2024-06-02T06:45:30.961Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of Discontinuing Contact Precautions for MRSA and ESBLE in an Intensive Care Unit: A Prospective Noninferiority Before and After Study

Published online by Cambridge University Press:  20 September 2017

Laurie Renaudin ,
Mathieu Llorens ,
Christophe Goetz ,
Sébastien Gette ,
Vincente Citro ,
Sylvia Poulain ,
Marie-Laure Vanson  and
Jocelyne Sellies
Laurie Renaudin*
Affiliation:
Infection Control Unit, Metz-Thionville Regional Hospital, Mercy Hospital, Metz, France
Mathieu Llorens
Affiliation:
Infection Control Unit, Metz-Thionville Regional Hospital, Mercy Hospital, Metz, France
Christophe Goetz
Affiliation:
Clinical Research Support Unit, Metz-Thionville Regional Hospital, Mercy Hospital Metz, France
Sébastien Gette
Affiliation:
Intensive Care Unit, Metz-Thionville Regional Hospital, Mercy Hospital, Metz, France
Vincente Citro
Affiliation:
Intensive Care Unit, Metz-Thionville Regional Hospital, Mercy Hospital, Metz, France
Sylvia Poulain
Affiliation:
Infection Control Unit, Metz-Thionville Regional Hospital, Mercy Hospital, Metz, France
Marie-Laure Vanson
Affiliation:
Infection Control Unit, Metz-Thionville Regional Hospital, Mercy Hospital, Metz, France
Jocelyne Sellies
Affiliation:
Infection Control Unit, Metz-Thionville Regional Hospital, Mercy Hospital, Metz, France
*
Address correspondence to Laurie Renaudin, MD, Infection Control Unit, Metz-Thionville Regional Hospital, Mercy Hospital, 1 Allée du Château 57085, Metz Cedex 03, France (laurie.renaudin@gmail.com).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To compare incidence densities of methicillin-resistant Staphylococcus aureus (MRSA) or extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBLE) acquisition in the intensive care unit (ICU) before and after discontinuation of contact precautions (CP) and application of standard precautions (SP).

DESIGN

Prospective noninferiority before-and-after study comparing 2 periods: January 1, 2012, to January 31, 2014 (the CP period) and February 1, 2014, to February 29, 2016 (the SP period).

SETTING

A 16-bed polyvalent ICU in France with only single-bed rooms with dedicated equipment and reusable medical devices.

PATIENTS

All patients admitted to the ICU during the CP and SP periods were included: 1,547 and 1,577 patients, respectively.

METHODS

Incidence densities of ICU-acquired MRSA or ESBLE were determined per 1,000 patient days. Other studied factors included (1) patient characteristics, (2) incidence densities of MRSA or ESBLE carried at admission, (3) compliance with hand hygiene protocols, and (4) antibiotic consumption.

RESULTS

Incidence densities of ICU-acquired MRSA were 0.82 (95% confidence interval [CI], 0.31–1.33) and 0.79 (95% CI, 0.30–1.29) per 1,000 patient days during the CP and SP periods, respectively. For ESBLE, values were 2.7 (95% CI, 1.78–3.62) and 2.06 (95% CI, 1.27–2.86) per 1,000 patient days. These rates were significantly nonsuperior during the SP period compared to CP period, with a margin of 1 per 1,000 patient days for both MRSA (P=.002) and ESBLE (P=.004). Other factors were comparable during the 2 periods. Only ESBLE carried at admission was inferior during the SP period. We observed a high level of compliance to hand hygiene protocols.

CONCLUSIONS

Discontinuing CP did not increase acquired MRSA and ESBLE in our ICU with single rooms with dedicated equipment, strict application of hand hygiene, medical and paramedical leadership, and good antibiotic stewardship.

Infect Control Hosp Epidemiol 2017;38:1342–1350

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 11 , November 2017 , pp. 1342 - 1350
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION. This study was presented at the XXVIIe Congrès National de la Société Française d’Hygiène Hospitalière on June 8, 2017, Nice, France (abstract no. CLJ-03).

References

REFERENCES

1. World Health Organization. Antimicrobial resistance: global report on surveillance. World Health Organization website. http://www.who.int/drugresistance/en/. Accessed June 22, 2016.Google Scholar
2. Lautenbach, E, Patel, JB, Bilker, WB, Edelstein, PH, Fishman, NO. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes. Clin Infect Dis 2001;32:1162–1171.CrossRefGoogle ScholarPubMed
3. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L. Health Care Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control. 2007;35:S65–S164.Google Scholar
4. Cooper, BS, Stone, SP, Kibbler, CC, et al. Isolation measures in the hospital management of methicillin resistant Staphylococcus aureus (MRSA): systematic review of the literature. BMJ 2004;329:533.CrossRefGoogle ScholarPubMed
5. Landelle, C, Pagani, L, Harbarth, S. Is patient isolation the single most important measure to prevent the spread of multidrug-resistant pathogens? Virulence 2013;4:163–171.CrossRefGoogle ScholarPubMed
6. Girou, E, Chai, SH, Oppein, F, et al. Misuse of gloves: the foundation for poor compliance with hand hygiene and potential for microbial transmission? J Hosp Infect 2004;57:162–169.CrossRefGoogle ScholarPubMed
7. Kirkland, KB. Taking off the gloves: toward a less dogmatic approach to the use of contact isolation. Clin Infect Dis 2009;48:766–771.CrossRefGoogle Scholar
8. Almyroudis, NG, Osawa, R, Samonis, G, et al. Discontinuation of systematic surveillance and contact precautions for vancomycin-resistant Enterococcus (VRE) and its impact on the incidence of VRE faecium bacteremia in patients with hematologic malignancies. Infect Control Hosp Epidemiol 2016;37:398–403.CrossRefGoogle ScholarPubMed
9. Zahar, JR, Poirel, L, Dupont, C, Fortineau, N, Nassif, X, Nordmann, P. About the usefulness of contact precautions for carriers of extended-spectrum beta-lactamase-producing Escherichia coli . BMC Infect Dis 2015;15:512.CrossRefGoogle ScholarPubMed
10. Tschudin-Sutter, S, Frei, R, Schwahn, F, et al. Prospective validation of cessation of contact precautions for extended-spectrum beta-lactamase-producing Escherichia coli . Emerg Infect Dis 2016;22:1094–1097.CrossRefGoogle ScholarPubMed
11. Abad, C, Fearday, A, Safdar, N. Adverse effects of isolation in hospitalized patients: a systematic review. J Hosp Infect 2010;76:97–102.CrossRefGoogle ScholarPubMed
12. McLemore, A, Bearman, G, Edmond, MB. Effect of contact precautions on wait time from emergency room disposition to inpatient admission. Infect Control Hosp Epidemiol 2011;32:298–299.CrossRefGoogle ScholarPubMed
13. Harris, AD, Pineles, L, Belton, B, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 2013;310:1571–1580.Google ScholarPubMed
14. Stelfox, HT, Bates, DW, Redelmeier, DA. Safety of patients isolated for infection control. JAMA 2003;290:1899–1905.CrossRefGoogle ScholarPubMed
15. SF2H. Recommandations nationales. Prévention de la transmission croisée: précautions complémentaires contact. HygieneS 2009;XVII:1–81.Google Scholar
16. Desenclos, JC, Group, RW. RAISIN: a national program for early warning, investigation and surveillance of healthcare-associated infection in France. Euro Surveillance 2009:14.Google Scholar
17. Sax, H, Allegranzi, B, Chraiti, MN, Boyce, J, Larson, E, Pittet, D. The World Health Organization hand hygiene observation method. Am J Infect Control 2009;37:827–834.CrossRefGoogle ScholarPubMed
18. Mitchell, R, Roth, V, Gravel, D, et al. Canadian Nosocomial Infection Surveillance Program. Are health care workers protected? An observational study of selection and removal of personal protective equipment in Canadian acute care hospitals. Am J Infect Control 2013;41:240–244.CrossRefGoogle Scholar
19. Dingle, TC, Butler-Wu, SM. Maldi-tof mass spectrometry for microorganism identification. Clin Lab Med 2013;33:589–609.CrossRefGoogle ScholarPubMed
20. Instruction DGOS/PF2/DGS/RI1/DGCS/2015/202 du 15 juin 2015 relative au programme national d’actions de prévention des infections associées aux soins (Propias) 2015, 2015.Google Scholar
21. Instruction DGOS/PF2 n° 2015-67 du 11 mars 2015 relative au bilan des activités de lutte contre les infections nosocomiales dans les établissements de santé pour l’année 2014, 2015.Google Scholar
22. Grammatico-Guillon, L, Thiolet, JM, Bernillon, P, Coignard, B, Khoshnood, B, Desenclos, JC. Relationship between the prevalence of methicillin-resistant Staphylococcus aureus infection and indicators of nosocomial infection control measures: a population-based study in French hospitals. Infect Control Hosp Epidemiol 2009;30:861–869.CrossRefGoogle Scholar
23. Schuirmann, DJ. A comparison of the two one-sided tests procedure and the power approach for assessing the equivalence of average bioavailability. J Pharmacokinet Biopharm 1987;15:657–680.CrossRefGoogle ScholarPubMed
24. Le Gall, JR, Lemeshow, S, Saulnier, F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270:2957–2963.CrossRefGoogle ScholarPubMed
25. Bein, T, Hackner, K, Zou, T, et al. Socioeconomic status, severity of disease and level of family members’ care in adult surgical intensive care patients: the prospective ECSSTASI study. Intensive Care Med 2012;38:612–619.CrossRefGoogle Scholar
26. Hetem, DJ, Derde, LP, Empel, J, et al. Molecular epidemiology of MRSA in 13 ICUs from eight European countries. J Antimicrob Chemother 2016;71:45–52.CrossRefGoogle ScholarPubMed
27. Boyer, A, Couallier, V, Clouzeau, B, et al. Control of extended-spectrum beta-lactamase-producing Enterobacteriaceae nosocomial acquisition in an intensive care unit: a time series regression analysis. Am J Infect Control 2015;43:1296–1301.CrossRefGoogle Scholar
28. Tabah, A, Koulenti, D, Laupland, K, et al. Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study. Intensive Care Med 2012;38:1930–1945.CrossRefGoogle ScholarPubMed
29. Dulon, M, Haamann, F, Peters, C, Schablon, A, Nienhaus, A. MRSA prevalence in European healthcare settings: a review. BMC Infect Dis 2011;11:138.CrossRefGoogle ScholarPubMed
30. Alves, M, Lemire, A, Decre, D, et al. Extended-spectrum betalactamase–producing enterobacteriaceae in the intensive care unit: acquisition does not mean cross-transmission. BMC Infect Dis 2016;16:147.CrossRefGoogle Scholar
31. Schoevaerdts, D, Bogaerts, P, Grimmelprez, A, et al. Clinical profiles of patients colonized or infected with extended-spectrum beta-lactamase producing Enterobacteriaceae isolates: a 20 month retrospective study at a Belgian University Hospital. BMC Infect Dis 2011;11:12.CrossRefGoogle ScholarPubMed
32. Lucet, JC, Decre, D, Fichelle, A, et al. Control of a prolonged outbreak of extended-spectrum beta-lactamase-producing Enterobacteriaceae in a university hospital. Clin Infect Dis 1999;29:1411–1418.CrossRefGoogle ScholarPubMed
33. Institut de Veille Sanitaire. Surveillance de la consommation des antibiotiques. Réseau ATB-Raisin: Résultats 2014. Saint-Maurice: Institut de Veille Sanitaire.Google Scholar
34. Hessels, AJ, Genovese-Schek, V, Agarwal, M, Wurmser, T, Larson, EL. Relationship between patient safety climate and adherence to standard precautions. Am J Infect Control 2016;44:1128–1132.CrossRefGoogle ScholarPubMed
35. Hugonnet, S, Harbarth, S, Sax, H, Duncan, RA, Pittet, D. Nursing resources: a major determinant of nosocomial infection? Curr Opin Infect Dis 2004;17:329–333.CrossRefGoogle Scholar
36. Needleman, J, Buerhaus, P, Pankratz, VS, Leibson, CL, Stevens, SR, Harris, M. Nurse staffing and inpatient hospital mortality. N Engl J Med 2011;364:1037–1045.CrossRefGoogle ScholarPubMed
37. Morgan, DJ, Diekema, DJ, Sepkowitz, K, Perencevich, EN. Adverse outcomes associated with contact precautions: a review of the literature. Am J Infect Control 2009;37:85–93.CrossRefGoogle ScholarPubMed
38. Zahar, JR, Garrouste-Orgeas, M, Vesin, A, et al. Impact of contact isolation for multidrug-resistant organisms on the occurrence of medical errors and adverse events. Intensive Care Med 2013;39:2153–2160.CrossRefGoogle ScholarPubMed
39. Day, HR, Perencevich, EN, Harris, AD, et al. Depression, anxiety, and moods of hospitalized patients under contact precautions. Infect Control Hosp Epidemiol 2013;34:251–258.CrossRefGoogle ScholarPubMed