Andrea C Büchler1, Marc Dangel1, Reno Frei1, Sammy Jäger1, Jan A Roth1, Helena M B Seth-Smith2, Adrian Egli2, Andreas F Widmer3. 1. Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland. 2. Division of Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland. 3. Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland. Electronic address: andreas.widmer@usb.ch.
Abstract
BACKGROUND: Conflicting results have been published on the impact of contact precautions (CP) on reduction of transmission of multidrug-resistant microorganisms (MDROs) in the endemic setting. Ambiguous definitions coupled with low adherence partly explain these differences. AIM: We prospectively monitored the level of adherence to CP and aimed to relate it to in-hospital transmission of MDROs. METHODS: Between 1/2016-3/2018, all patients under CP underwent continuous monitoring of adherence to CP by routine on-site visits on day 0, 3 and 7 after initiating CP using a standardized checklist. The protocol included ten interventions that were routinely checked such as CP sign at the door as well as wearing gowns and gloves upon entry to the patient room. Patients requiring CP were defined as colonized or infected with MDROs (methicillin-resistant Staphylococcus aureus [MRSA], non-Escherichia coli ESBL-Enterobacterales, vancomycin-resistant enterococci [VRE] and carbapenem-resistant Gram-negative microorganisms [CRGN]) as well as patients infected with respiratory viruses, norovirus, scabies and hypervirulent strains of Clostridioides difficile. FINDINGS: Overall, data from 13,756 CP records from 1,378 visits of 812 patients were analyzed. Adherence varied between 93-100% for each intervention, except for "separate space for contaminated material" with an adherence of 5.3-6.1%. The incidence of in-hospital transmission during the study period was extremely low for MRSA, VRE, non-E.coli ESBL-Enterobacterales and CRGN with 0.00-0.064 cases/1,000 patient days. CONCLUSION: High adherence coupled with continuous monitoring of CP correlated to a very low in-hospital transmission rate. These results indicate that CP is highly effective if routine monitoring of adherence is implemented.
BACKGROUND: Conflicting results have been published on the impact of contact precautions (CP) on reduction of transmission of multidrug-resistant microorganisms (MDROs) in the endemic setting. Ambiguous definitions coupled with low adherence partly explain these differences. AIM: We prospectively monitored the level of adherence to CP and aimed to relate it to in-hospital transmission of MDROs. METHODS: Between 1/2016-3/2018, all patients under CP underwent continuous monitoring of adherence to CP by routine on-site visits on day 0, 3 and 7 after initiating CP using a standardized checklist. The protocol included ten interventions that were routinely checked such as CP sign at the door as well as wearing gowns and gloves upon entry to the patient room. Patients requiring CP were defined as colonized or infected with MDROs (methicillin-resistant Staphylococcus aureus [MRSA], non-Escherichia coliESBL-Enterobacterales, vancomycin-resistant enterococci [VRE] and carbapenem-resistant Gram-negative microorganisms [CRGN]) as well as patientsinfected with respiratory viruses, norovirus, scabies and hypervirulent strains of Clostridioides difficile. FINDINGS: Overall, data from 13,756 CP records from 1,378 visits of 812 patients were analyzed. Adherence varied between 93-100% for each intervention, except for "separate space for contaminated material" with an adherence of 5.3-6.1%. The incidence of in-hospital transmission during the study period was extremely low for MRSA, VRE, non-E.coliESBL-Enterobacterales and CRGN with 0.00-0.064 cases/1,000 patient days. CONCLUSION: High adherence coupled with continuous monitoring of CP correlated to a very low in-hospital transmission rate. These results indicate that CP is highly effective if routine monitoring of adherence is implemented.
Authors: Andrea C Büchler; Silvio Ragozzino; Melanie Wicki; Violeta Spaniol; Sammy Jäger; Helena M B Seth-Smith; Daniel Goldenberger; Vladimira Hinic; Adrian Egli; Reno Frei; Andreas F Widmer Journal: Antimicrob Resist Infect Control Date: 2022-04-13 Impact factor: 4.887