Petra Gastmeier1, Klaus-Peter Kämpf2, Michael Behnke2, Christine Geffers2, Frank Schwab2. 1. Institute of Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Hindenburgdamm 27, 12203 Berlin, Germany petra.gastmeier@charite.de. 2. Institute of Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Hindenburgdamm 27, 12203 Berlin, Germany.
Abstract
OBJECTIVES: To investigate the effect of universal decolonization with octenidine on the incidence of ICU-acquired bloodstream infections (BSI) and MDR organisms (MDRO). METHODS: A system-wide change in practice was performed in the ICUs of a university hospital with three campuses (eight medical ICUs and nine surgical ICUs). All ICUs had a general admission screening strategy for MRSA with subsequent isolation in the 12 month baseline period, which was stopped. After a wash-in period of 1 month, decolonization of the nose with octenidine nasal gel and octenidine wash cloths was introduced. The endpoints were ICU-acquired BSI and ICU-acquired MDRO isolates from clinical cultures. Segmented regression analysis of interrupted time series was used to assess the effect of intervention. RESULTS: A total of 29 532 ICU patients (16 677 surgical and 12 855 medical) were included in the study. The baseline incidence density of ICU-acquired BSI was 5.1 per 1000 patient days and the baseline ICU-acquired MRSA rate was 0.97 per 1000 patient days. Whereas no significant effect on either outcome was found in surgical ICUs, we identified a significant effect on ICU-acquired BSI for the intervention in medical ICUs by means of multivariate analysis (incidence rate ratio 0.78; 95% CI 0.65-0.94). In addition, the intervention was also effective in decreasing ICU-acquired MRSA in medical ICUs (incidence rate ratio 0.58; 95% CI 0.41-0.82). No effect on ICU-acquired VRE and Gram-negative MDRO was found. CONCLUSIONS: System change was successful by decreasing infection rates in medical ICUs and improving the management in all ICUs.
OBJECTIVES: To investigate the effect of universal decolonization with octenidine on the incidence of ICU-acquired bloodstream infections (BSI) and MDR organisms (MDRO). METHODS: A system-wide change in practice was performed in the ICUs of a university hospital with three campuses (eight medical ICUs and nine surgical ICUs). All ICUs had a general admission screening strategy for MRSA with subsequent isolation in the 12 month baseline period, which was stopped. After a wash-in period of 1 month, decolonization of the nose with octenidine nasal gel and octenidine wash cloths was introduced. The endpoints were ICU-acquired BSI and ICU-acquired MDRO isolates from clinical cultures. Segmented regression analysis of interrupted time series was used to assess the effect of intervention. RESULTS: A total of 29 532 ICU patients (16 677 surgical and 12 855 medical) were included in the study. The baseline incidence density of ICU-acquired BSI was 5.1 per 1000 patient days and the baseline ICU-acquired MRSA rate was 0.97 per 1000 patient days. Whereas no significant effect on either outcome was found in surgical ICUs, we identified a significant effect on ICU-acquired BSI for the intervention in medical ICUs by means of multivariate analysis (incidence rate ratio 0.78; 95% CI 0.65-0.94). In addition, the intervention was also effective in decreasing ICU-acquired MRSA in medical ICUs (incidence rate ratio 0.58; 95% CI 0.41-0.82). No effect on ICU-acquired VRE and Gram-negative MDRO was found. CONCLUSIONS: System change was successful by decreasing infection rates in medical ICUs and improving the management in all ICUs.
Authors: G Pichler; C Pux; R Babeluk; B Hermann; E Stoiser; A De Campo; A Grisold; I Zollner-Schwetz; R Krause; W Schippinger Journal: Eur J Clin Microbiol Infect Dis Date: 2017-08-28 Impact factor: 3.267
Authors: R Alvarez-Marin; M Aires-de-Sousa; P Nordmann; N Kieffer; L Poirel Journal: Eur J Clin Microbiol Infect Dis Date: 2017-08-19 Impact factor: 3.267
Authors: Carl Hinrichs; Miriam Wiese-Posselt; Barbara Graf; Christine Geffers; Beate Weikert; Philipp Enghard; Alexander Aldejohann; Annette Schrauder; Andreas Knaust; Kai-Uwe Eckardt; Petra Gastmeier; Oliver Kurzai Journal: Mycoses Date: 2022-04-24 Impact factor: 4.931