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Sequential introduction of single room isolation and hand hygiene campaign in the control of methicillin-resistant Staphylococcus aureus in intensive care unit.

Cheng VC, Tai JW, Chan WM, Lau EH, Chan JF, To KK, Li IW, Ho PL, Yuen KY - BMC Infect. Dis. (2010)

Bottom Line: Since the ICU renovation, all patients colonized or infected with MRSA were nursed in single rooms with contact precautions.The usage density of broad-spectrum antibiotics and fluoroquinolones increased from phase 1 to 3.Provision of single room isolation facilities and promotion of hand hygiene practice are important.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China.

ABSTRACT

Background: After renovation of the adult intensive care unit (ICU) with installation of ten single rooms, an enhanced infection control program was conducted to control the spread of methicillin-resistant Staphylococcus aureus (MRSA) in our hospital.

Methods: Since the ICU renovation, all patients colonized or infected with MRSA were nursed in single rooms with contact precautions. The incidence of MRSA infection in the ICU was monitored during 3 different phases: the baseline period (phase 1); after ICU renovation (phase 2) and after implementation of a hand hygiene campaign with alcohol-based hand rub (phase 3). Patients infected with extended spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella species were chosen as controls because they were managed in open cubicles with standard precautions.

Results: Without a major change in bed occupancy rate, nursing workforce, or the protocol of environmental cleansing throughout the study period, a stepwise reduction in ICU onset nonbacteraemic MRSA infection was observed: from 3.54 (phase 1) to 2.26 (phase 2, p = 0.042) and 1.02 (phase 3, p = 0.006) per 1000-patient-days. ICU onset bacteraemic MRSA infection was significantly reduced from 1.94 (phase 1) to 0.9 (phase 2, p = 0.005) and 0.28 (phase 3, p = 0.021) per 1000-patient-days. Infection due to ESBL-producing organisms did not show a corresponding reduction. The usage density of broad-spectrum antibiotics and fluoroquinolones increased from phase 1 to 3. However a significant trend improvement of ICU onset MRSA infection by segmented regression analysis can only be demonstrated when comparison was made before and after the severe acute respiratory syndrome (SARS) epidemic. This suggests that the deaths of fellow healthcare workers from an occupational acquired infection had an overwhelming effect on their compliance with infection control measures.

Conclusion: Provision of single room isolation facilities and promotion of hand hygiene practice are important. However compliance with infection control measures relies largely on a personal commitment, which may increase when personal safety is threatened.

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Related in: MedlinePlus

The trend of usage density of broad-spectrum antibiotics, fluoroquinolones, and incidence density of ICU onset MRSA infection. Note. ICU, adult intensive care unit; broad-spectrum antibiotics, include cefepime, ceftazidime, and cefoperazone-sulbactam, piperacillin-tazobactam, meropenem, imipenem-cilastatin; fluoroquinolones, include ciprofloxacin, levofloxacin, and moxifloxacin; MRSA; methicillin-resistant Staphylococcus aureus. The trend of ICU onset ESBL-producing organisms' infection is listed as reference.
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Figure 1: The trend of usage density of broad-spectrum antibiotics, fluoroquinolones, and incidence density of ICU onset MRSA infection. Note. ICU, adult intensive care unit; broad-spectrum antibiotics, include cefepime, ceftazidime, and cefoperazone-sulbactam, piperacillin-tazobactam, meropenem, imipenem-cilastatin; fluoroquinolones, include ciprofloxacin, levofloxacin, and moxifloxacin; MRSA; methicillin-resistant Staphylococcus aureus. The trend of ICU onset ESBL-producing organisms' infection is listed as reference.

Mentions: Between January 2002 and June 2009, there were 12073 patients admitted into ICU with a total of 48167 patient-days, of which 8501 patients (33194 patient-days) were admitted after renovation (Table 1). The occupancy rate in ICU ranged between 83.3% and 97.3% throughout the study period. The nursing manpower was maintained at a ratio of 1 nurse to 1 patient at day time and 1 nurse to 2 patients at night shift. The quarterly consumption patterns of antibiotics were shown in Figure 1, and the increasing trend of overall usage density of broad-spectrum antibiotics (cefepime, ceftazidime, cefoperazone-sulbactam, piperacillin-tazobactam, meropenem, and imipenem-cilastatin), and fluoroquinolones were illustrated in Figure 2.


Sequential introduction of single room isolation and hand hygiene campaign in the control of methicillin-resistant Staphylococcus aureus in intensive care unit.

Cheng VC, Tai JW, Chan WM, Lau EH, Chan JF, To KK, Li IW, Ho PL, Yuen KY - BMC Infect. Dis. (2010)

The trend of usage density of broad-spectrum antibiotics, fluoroquinolones, and incidence density of ICU onset MRSA infection. Note. ICU, adult intensive care unit; broad-spectrum antibiotics, include cefepime, ceftazidime, and cefoperazone-sulbactam, piperacillin-tazobactam, meropenem, imipenem-cilastatin; fluoroquinolones, include ciprofloxacin, levofloxacin, and moxifloxacin; MRSA; methicillin-resistant Staphylococcus aureus. The trend of ICU onset ESBL-producing organisms' infection is listed as reference.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2944349&req=5

Figure 1: The trend of usage density of broad-spectrum antibiotics, fluoroquinolones, and incidence density of ICU onset MRSA infection. Note. ICU, adult intensive care unit; broad-spectrum antibiotics, include cefepime, ceftazidime, and cefoperazone-sulbactam, piperacillin-tazobactam, meropenem, imipenem-cilastatin; fluoroquinolones, include ciprofloxacin, levofloxacin, and moxifloxacin; MRSA; methicillin-resistant Staphylococcus aureus. The trend of ICU onset ESBL-producing organisms' infection is listed as reference.
Mentions: Between January 2002 and June 2009, there were 12073 patients admitted into ICU with a total of 48167 patient-days, of which 8501 patients (33194 patient-days) were admitted after renovation (Table 1). The occupancy rate in ICU ranged between 83.3% and 97.3% throughout the study period. The nursing manpower was maintained at a ratio of 1 nurse to 1 patient at day time and 1 nurse to 2 patients at night shift. The quarterly consumption patterns of antibiotics were shown in Figure 1, and the increasing trend of overall usage density of broad-spectrum antibiotics (cefepime, ceftazidime, cefoperazone-sulbactam, piperacillin-tazobactam, meropenem, and imipenem-cilastatin), and fluoroquinolones were illustrated in Figure 2.

Bottom Line: Since the ICU renovation, all patients colonized or infected with MRSA were nursed in single rooms with contact precautions.The usage density of broad-spectrum antibiotics and fluoroquinolones increased from phase 1 to 3.Provision of single room isolation facilities and promotion of hand hygiene practice are important.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China.

ABSTRACT

Background: After renovation of the adult intensive care unit (ICU) with installation of ten single rooms, an enhanced infection control program was conducted to control the spread of methicillin-resistant Staphylococcus aureus (MRSA) in our hospital.

Methods: Since the ICU renovation, all patients colonized or infected with MRSA were nursed in single rooms with contact precautions. The incidence of MRSA infection in the ICU was monitored during 3 different phases: the baseline period (phase 1); after ICU renovation (phase 2) and after implementation of a hand hygiene campaign with alcohol-based hand rub (phase 3). Patients infected with extended spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella species were chosen as controls because they were managed in open cubicles with standard precautions.

Results: Without a major change in bed occupancy rate, nursing workforce, or the protocol of environmental cleansing throughout the study period, a stepwise reduction in ICU onset nonbacteraemic MRSA infection was observed: from 3.54 (phase 1) to 2.26 (phase 2, p = 0.042) and 1.02 (phase 3, p = 0.006) per 1000-patient-days. ICU onset bacteraemic MRSA infection was significantly reduced from 1.94 (phase 1) to 0.9 (phase 2, p = 0.005) and 0.28 (phase 3, p = 0.021) per 1000-patient-days. Infection due to ESBL-producing organisms did not show a corresponding reduction. The usage density of broad-spectrum antibiotics and fluoroquinolones increased from phase 1 to 3. However a significant trend improvement of ICU onset MRSA infection by segmented regression analysis can only be demonstrated when comparison was made before and after the severe acute respiratory syndrome (SARS) epidemic. This suggests that the deaths of fellow healthcare workers from an occupational acquired infection had an overwhelming effect on their compliance with infection control measures.

Conclusion: Provision of single room isolation facilities and promotion of hand hygiene practice are important. However compliance with infection control measures relies largely on a personal commitment, which may increase when personal safety is threatened.

Show MeSH
Related in: MedlinePlus