E Shaw1, L Gavaldà2, J Càmara3, R Gasull4, S Gallego4, F Tubau5, R M Granada4, P Ciercoles6, M A Dominguez7, R Mañez4, J Carratalà8, M Pujol9. 1. Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: eshawp@gmail.com. 2. Department of Preventive Medicine, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain. 3. Department of Microbiology, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain. 4. Department of Intensive Medicine, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain. 5. Department of Microbiology, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain. 6. Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain. 7. Department of Microbiology, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain; University of Barcelona, Barcelona, Spain. 8. Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain; University of Barcelona, Barcelona, Spain. 9. Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.
Abstract
BACKGROUND: Contaminated handwashing sinks have been identified as reservoirs that can facilitate colonization/infection of patients with multidrug-resistant (MDR) Gram-negative bacteria (GNB) in intensive care units (ICUs). AIM: To assess the impact of removing patients' sinks and implementing other water-safe strategies on the annual rates of ICU-acquired MDR-GNB. METHODS: This six-year quasi-experimental study was conducted from January 2011 to December 2016. The intervention was carried out in August 2014 in two adult ICU wards with 12 rooms each. To assess the changes in annual MDR-GNB rates before and after the intervention, we used segmented regression analysis of an interrupted time-series. Crude relative risk (RR) rates were also calculated. FINDINGS: The incidence rates of MDR-GNB were 9.15 and 2.20 per 1000 patient-days in the pre- and post-intervention periods, respectively. This yielded a crude RR of acquiring MDR-GNB of 0.24 (95% confidence interval: 0.17-0.34). A significant change in level was observed between the MDR-GNB rate at the first point of the post-intervention period and the rate predicted by the pre-intervention time trend. CONCLUSION: The implementation of a new water-safe policy, which included the removal of sinks from all patient rooms, successfully improved the control of MDR-GNB spread in an ICU with endemic infection. Our results support the contribution of sink use with the incidence of MDR-GNB in endemic environments.
BACKGROUND: Contaminated handwashing sinks have been identified as reservoirs that can facilitate colonization/infection of patients with multidrug-resistant (MDR) Gram-negative bacteria (GNB) in intensive care units (ICUs). AIM: To assess the impact of removing patients' sinks and implementing other water-safe strategies on the annual rates of ICU-acquired MDR-GNB. METHODS: This six-year quasi-experimental study was conducted from January 2011 to December 2016. The intervention was carried out in August 2014 in two adult ICU wards with 12 rooms each. To assess the changes in annual MDR-GNB rates before and after the intervention, we used segmented regression analysis of an interrupted time-series. Crude relative risk (RR) rates were also calculated. FINDINGS: The incidence rates of MDR-GNB were 9.15 and 2.20 per 1000 patient-days in the pre- and post-intervention periods, respectively. This yielded a crude RR of acquiring MDR-GNB of 0.24 (95% confidence interval: 0.17-0.34). A significant change in level was observed between the MDR-GNB rate at the first point of the post-intervention period and the rate predicted by the pre-intervention time trend. CONCLUSION: The implementation of a new water-safe policy, which included the removal of sinks from all patient rooms, successfully improved the control of MDR-GNB spread in an ICU with endemic infection. Our results support the contribution of sink use with the incidence of MDR-GNB in endemic environments.
Authors: Joost Hopman; Corianne Meijer; Nikki Kenters; Jordy P M Coolen; Mohammad R Ghamati; Shaheen Mehtar; Reinout van Crevel; Wim J Morshuis; Ad F T M Verhagen; Michel M van den Heuvel; Andreas Voss; Heiman F L Wertheim Journal: JAMA Netw Open Date: 2019-02-01
Authors: Cheryl Volling; Narges Ahangari; Jessica J Bartoszko; Brenda L Coleman; Felipe Garcia-Jeldes; Alainna J Jamal; Jennie Johnstone; Christopher Kandel; Philipp Kohler; Helena C Maltezou; Lorraine Maze Dit Mieusement; Nneka McKenzie; Dominik Mertz; Adam Monod; Salman Saeed; Barbara Shea; Rhonda L Stuart; Sera Thomas; Elizabeth Uleryk; Allison McGeer Journal: Open Forum Infect Dis Date: 2020-12-08 Impact factor: 3.835
Authors: Caitlin R Proctor; William J Rhoads; Tim Keane; Maryam Salehi; Kerry Hamilton; Kelsey J Pieper; David M Cwiertny; Michele Prévost; Andrew J Whelton Journal: AWWA Water Sci Date: 2020-08-06