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Impact of Discontinuing Contact Precautions for MRSA and ESBLE in an Intensive Care Unit: A Prospective Noninferiority Before and After Study

Published online by Cambridge University Press:  20 September 2017

Laurie Renaudin ,
Mathieu Llorens ,
Christophe Goetz ,
Sébastien Gette ,
Vincente Citro ,
Sylvia Poulain ,
Marie-Laure Vanson  and
Jocelyne Sellies
Laurie Renaudin*
Affiliation:
Infection Control Unit, Metz-Thionville Regional Hospital, Mercy Hospital, Metz, France
Mathieu Llorens
Affiliation:
Infection Control Unit, Metz-Thionville Regional Hospital, Mercy Hospital, Metz, France
Christophe Goetz
Affiliation:
Clinical Research Support Unit, Metz-Thionville Regional Hospital, Mercy Hospital Metz, France
Sébastien Gette
Affiliation:
Intensive Care Unit, Metz-Thionville Regional Hospital, Mercy Hospital, Metz, France
Vincente Citro
Affiliation:
Intensive Care Unit, Metz-Thionville Regional Hospital, Mercy Hospital, Metz, France
Sylvia Poulain
Affiliation:
Infection Control Unit, Metz-Thionville Regional Hospital, Mercy Hospital, Metz, France
Marie-Laure Vanson
Affiliation:
Infection Control Unit, Metz-Thionville Regional Hospital, Mercy Hospital, Metz, France
Jocelyne Sellies
Affiliation:
Infection Control Unit, Metz-Thionville Regional Hospital, Mercy Hospital, Metz, France
*
Address correspondence to Laurie Renaudin, MD, Infection Control Unit, Metz-Thionville Regional Hospital, Mercy Hospital, 1 Allée du Château 57085, Metz Cedex 03, France ([email protected]).
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Abstract

OBJECTIVE

To compare incidence densities of methicillin-resistant Staphylococcus aureus (MRSA) or extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBLE) acquisition in the intensive care unit (ICU) before and after discontinuation of contact precautions (CP) and application of standard precautions (SP).

DESIGN

Prospective noninferiority before-and-after study comparing 2 periods: January 1, 2012, to January 31, 2014 (the CP period) and February 1, 2014, to February 29, 2016 (the SP period).

SETTING

A 16-bed polyvalent ICU in France with only single-bed rooms with dedicated equipment and reusable medical devices.

PATIENTS

All patients admitted to the ICU during the CP and SP periods were included: 1,547 and 1,577 patients, respectively.

METHODS

Incidence densities of ICU-acquired MRSA or ESBLE were determined per 1,000 patient days. Other studied factors included (1) patient characteristics, (2) incidence densities of MRSA or ESBLE carried at admission, (3) compliance with hand hygiene protocols, and (4) antibiotic consumption.

RESULTS

Incidence densities of ICU-acquired MRSA were 0.82 (95% confidence interval [CI], 0.31–1.33) and 0.79 (95% CI, 0.30–1.29) per 1,000 patient days during the CP and SP periods, respectively. For ESBLE, values were 2.7 (95% CI, 1.78–3.62) and 2.06 (95% CI, 1.27–2.86) per 1,000 patient days. These rates were significantly nonsuperior during the SP period compared to CP period, with a margin of 1 per 1,000 patient days for both MRSA (P=.002) and ESBLE (P=.004). Other factors were comparable during the 2 periods. Only ESBLE carried at admission was inferior during the SP period. We observed a high level of compliance to hand hygiene protocols.

CONCLUSIONS

Discontinuing CP did not increase acquired MRSA and ESBLE in our ICU with single rooms with dedicated equipment, strict application of hand hygiene, medical and paramedical leadership, and good antibiotic stewardship.

Infect Control Hosp Epidemiol 2017;38:1342–1350

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 11 , November 2017 , pp. 1342 - 1350
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. This study was presented at the XXVIIe Congrès National de la Société Française d’Hygiène Hospitalière on June 8, 2017, Nice, France (abstract no. CLJ-03).

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