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Control of extended-spectrum β-lactamase-producing Enterobacteriaceae nosocomial acquisition in an intensive care unit: A time series regression analysis.
- Source :
-
American journal of infection control [Am J Infect Control] 2015 Dec 01; Vol. 43 (12), pp. 1296-301. Date of Electronic Publication: 2015 Sep 11. - Publication Year :
- 2015
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Abstract
- Background: This study was undertaken to determine the temporal relationship between implementation of different interventions in an intensive care unit (ICU) and control of endemic nosocomial acquisition of extended-spectrum β-lactamase Enterobacteriaceae (ESBLE).<br />Methods: This was a prospective observational study with time-series analysis of the monthly incidence of ESBLE and its predictors. In November 2007, after a 14-month baseline period, an intervention consisting of restriction of third-generation cephalosporins (3 GC) and increased use of alcohol-based hand rubs was implemented. In January 2008, an increased health care worker (HCW):patient ratio was also implemented. In March 2010, the ICU was closed, and patients were moved to a clean ICU.<br />Results: The first intervention resulted in global reduction in 3 GC and increased use of alcohol-based hand rub. A significant change in ESBLE incidence was observed in a full segmented univariate regression analysis (mean change in level, -0.91 ± 0.19; P < .0001). After ICU closure, there was a dramatic reduction in ESBLE acquisition. According to the multivariate model, the ICU closure was the main protective factor. Before ICU closure, an increase in the HCW:patient ratio of 0.1 point tended to be associated with a decreased risk of ESBLE acquisition (relative risk, 0.28; 95% confidence interval, 0.06-1.25; P = .09).<br />Conclusions: This study shows that ICU closure was associated with, but not necessarily the reason for, control of ESBLE cross-transmission in a nonoutbreak setting. Environmental ESBE sources may play a role in cross-transmission.<br /> (Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Cross Infection microbiology
Enterobacteriaceae isolation & purification
Enterobacteriaceae Infections microbiology
Humans
Intensive Care Units
Middle Aged
Prospective Studies
Regression Analysis
Cross Infection epidemiology
Cross Infection prevention & control
Enterobacteriaceae enzymology
Enterobacteriaceae Infections epidemiology
Enterobacteriaceae Infections prevention & control
Infection Control methods
beta-Lactamases metabolism
Subjects
Details
- Language :
- English
- ISSN :
- 1527-3296
- Volume :
- 43
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- American journal of infection control
- Publication Type :
- Academic Journal
- Accession number :
- 26364520
- Full Text :
- https://doi.org/10.1016/j.ajic.2015.07.026