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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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Change in incidence density of ICU onset infection due to MRSA and ESBL-producing organisms from interrupted time-series with segmented regression analysis according to different phases of interventions.
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Figure 4: Change in incidence density of ICU onset infection due to MRSA and ESBL-producing organisms from interrupted time-series with segmented regression analysis according to different phases of interventions.

Mentions: Both the level change and trend change of the incidence density of ICU onset infections due to MRSA and ESBL-producing organisms had no significant difference across different phases during the study period (Table 2, Figure 4). When the incidence density of MRSA infection was analyzed according to the onset of SARS at the second quarter of 2003, the level change (-3.337, p < 0.001) and trend change (-0.658, p = 0.021) of ICU onset MRSA infection, but not infections due to ESBL-producing organisms, were shown to be significantly changed from an increase to decrease (Table 2, Figure 5).


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)

Change in incidence density of ICU onset infection due to MRSA and ESBL-producing organisms from interrupted time-series with segmented regression analysis according to different phases of interventions.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Change in incidence density of ICU onset infection due to MRSA and ESBL-producing organisms from interrupted time-series with segmented regression analysis according to different phases of interventions.
Mentions: Both the level change and trend change of the incidence density of ICU onset infections due to MRSA and ESBL-producing organisms had no significant difference across different phases during the study period (Table 2, Figure 4). When the incidence density of MRSA infection was analyzed according to the onset of SARS at the second quarter of 2003, the level change (-3.337, p < 0.001) and trend change (-0.658, p = 0.021) of ICU onset MRSA infection, but not infections due to ESBL-producing organisms, were shown to be significantly changed from an increase to decrease (Table 2, Figure 5).

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