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Impact of active surveillance and infection control measures on carbapenem-resistant Gram-negative bacterial colonization and infections in intensive care
- Source :
- Journal of Hospital Infection. 99:396-404
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Summary Background Carbapenem-resistant Gram-negative bacteria (CRGNB) infections constitute a global threat for critically ill patients and the outcome of their hospitalization. Early identification of CRGNB through rectal surveillance cultures and routine infection control measures including contact precautions, use of appropriate disinfectants, staff education on cleaning, and hand hygiene may reduce the dissemination of CRGNB. Aim To assess the impact of enhanced infection control measures on CRGNB infections in a nine-bed polyvalent intensive care unit in a tertiary level hospital in an endemic area. Methods A quasi-experimental study, which included patients with CRGNB infection retrospectively for six months and those participating in an active surveillance programme prospectively for the subsequent 22 months. Active surveillance programme (weekly rectal swabs) was implemented including two sub-periods with infection control measures and enhanced infection control measures. CRGNB incidence, prevalence, colonization pressure, infections and compliance with infection control measures and enhanced infection control measures were recorded. Analysis was performed through time-series and interrupted time-series. Findings During the active surveillance programme, enhanced infection control measures led to a steeper downwards trend in incidence, prevalence, and colonization pressure for CRGNB compared to the infection control measures sub-period. The linear trend was for carbapenem-resistant Klebsiella pneumoniae (CRKP) and Pseudomonas aeruginosa (CRPA) infections to decrease from 19.6 to 8.1 infections per 1000 bed-days (IBD) (P = 0.001) and from 5.1 to 1.79 IBD (P = 0.043), respectively. By contrast, carbapenem-resistant Acinetobacter baumannii infections increased from 5.2 to 15.3 IBD (P = 0.001). Conclusion Enhanced infection control measures including enhanced hand hygiene, active surveillance combined with contact precautions, education, audits and feedback policies and interventions could reduce CRKP and CRPA in endemic areas.
- Subjects :
- Acinetobacter baumannii
Male
0301 basic medicine
Non-Randomized Controlled Trials as Topic
030501 epidemiology
medicine.disease_cause
law.invention
law
Hygiene
Prevalence
Infection control
Colonization
Prospective Studies
media_common
Aged, 80 and over
biology
Incidence
Incidence (epidemiology)
General Medicine
Middle Aged
Intensive care unit
Anti-Bacterial Agents
Intensive Care Units
Klebsiella pneumoniae
Infectious Diseases
Epidemiological Monitoring
Pseudomonas aeruginosa
Female
0305 other medical science
Adult
Microbiology (medical)
medicine.medical_specialty
Adolescent
Critical Illness
media_common.quotation_subject
030106 microbiology
beta-Lactam Resistance
Young Adult
03 medical and health sciences
Intensive care
Internal medicine
medicine
Humans
Aged
Retrospective Studies
Infection Control
business.industry
biology.organism_classification
Carbapenems
Gram-Negative Bacterial Infections
business
Subjects
Details
- ISSN :
- 01956701
- Volume :
- 99
- Database :
- OpenAIRE
- Journal :
- Journal of Hospital Infection
- Accession number :
- edsair.doi.dedup.....d34416d459efffcb9b4d4ac785b9c77c
- Full Text :
- https://doi.org/10.1016/j.jhin.2018.05.010