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Long-Term Impact of Universal Contact Precautions on Rates of Multidrug-Resistant Organisms in ICUs: A Comparative Effectiveness Study

Published online by Cambridge University Press:  22 March 2018

E. Yoko Furuya ,
Bevin Cohen ,
Haomiao Jia  and
Elaine L. Larson
E. Yoko Furuya*
Affiliation:
Division of Infectious Diseases, Columbia University Medical Center, New York, New York Department of Infection Prevention & Control, New York-Presbyterian Hospital, New York, New York
Bevin Cohen
Affiliation:
School of Nursing, Columbia University, New York, New York Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
Haomiao Jia
Affiliation:
School of Nursing, Columbia University, New York, New York Department of Biostatitics, Mailman School of Public Health, Columbia University, New York, New York
Elaine L. Larson
Affiliation:
School of Nursing, Columbia University, New York, New York Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
*
Address correspondence to E. Yoko Furuya, MD, MS, 622 W 168th St, PH-8W #876, New York, NY 10032 ([email protected]).
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Abstract

OBJECTIVE

To evaluate the impact of universal contact precautions (UCP) on rates of multidrug-resistant organisms (MDROs) in intensive care units (ICUs) over 9 years

DESIGN

Retrospective, nonrandomized observational study

SETTING

An 800-bed adult academic medical center in New York City

PARTICIPANTS

All patients admitted to 6 ICUs, 3 of which instituted UCP in 2007

METHODS

Using a comparative effectiveness approach, we studied the longitudinal impact of UCP on MDRO incidence density rates, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and carbapenem-resistant Klebsiella pneumoniae. Data were extracted from a clinical research database for 2006–2014. Monthly MDRO rates were compared between the baseline period and the UCP period, utilizing time series analyses based on generalized linear models. The same models were also used to compare MDRO rates in the 3 UCP units to 3 ICUs without UCPs.

RESULTS

Overall, MDRO rates decreased over time, but there was no significant decrease in the trend (slope) during the UCP period compared to the baseline period for any of the 3 intervention units. Furthermore, there was no significant difference between UCP units (6.6% decrease in MDRO rates per year) and non-UCP units (6.0% decrease per year; P=.840).

CONCLUSION

The results of this 9-year study suggest that decreases in MDROs, including multidrug-resistant gram-negative bacilli, were more likely due to hospital-wide improvements in infection prevention during this period and that UCP had no detectable additional impact.

Infect Control Hosp Epidemiol 2018;39:534–540

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 5 , May 2018 , pp. 534 - 540
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Sievert, DM, Ricks, P, Edwards, JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infect Control Hosp Epidemiol 2013;34:1–14.Google Scholar
2. Neidell, MJ, Cohen, B, Furuya, Y, et al. Costs of healthcare- and community-associated infections with antimicrobial-resistant versus antimicrobial-susceptible organisms. Clin Infect Dis 2012;55:807–815.Google Scholar
3. Yokoe, DS, Mermel, LA, Anderson, DJ, et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(Suppl 1):S12–S21.Google Scholar
4. Harris, AD, Furuno, JP, Roghmann, MC, et al. Targeted surveillance of methicillin-resistant Staphylococcus aureus and its potential use to guide empiric antibiotic therapy. Antimicrob Agents Chemother 2010;54:3143–3148.Google Scholar
5. Chassin, MR, Mayer, C, Nether, K. Improving hand hygiene at eight hospitals in the United States by targeting specific causes of noncompliance. Jt Comm J Qual Patient Saf 2015;41:4–12.Google Scholar
6. Huskins, WC, Huckabee, CM, O’Grady, NP, et al. Intervention to reduce transmission of resistant bacteria in intensive care. New Eng J Med 2011;364:1407–1418.CrossRefGoogle ScholarPubMed
7. Harris, AD, Pineles, L, Belton, B, et al. Universal gown and glove use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 2013;310:1571–1580.Google ScholarPubMed
8. Apte, M, Neidell, M, Furuya, EY, et al. Using electronically available inpatient hospital data for research. Clin Transl Sci 2011;4:338–345.Google Scholar
9. Multidrug-resistant organism and Clostridium difficile infection (MDRO/CDI) module. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/12pscMDRO_CDADcurrent.pdf. Published January 2017. Accessed August 15, 2017.Google Scholar
10. Li, WK. Time series models based on generalized linear models: some further results. Biometrics 1994;50:506–511.Google Scholar
11. Kullar, R, Vassallo, A, Turkel, S, Chopra, T, Kaye, KS, Dhar, S. Degowning the controversies of contact precautions for methicillin-resistant Staphylococcus aureus: a review. Am J Infect Contr 2016;44:97–103.Google Scholar
12. Ho, AL, Chambers, R, Malic, C, Papp, A. Universal contact precautions do not change the prevalence of antibiotic resistant organisms in a tertiary burn center. Burns 2017;43:265–272.Google Scholar
13. Harris, AD, Morgan, DJ, Pineles, L, Perencevich, EN, Barnes, SL. Deconstructing the relative benefits of a universal glove and gown intervention on MRSA acquisition. J Hosp Infect 2017;96:49–53.Google Scholar
14. Martin, EM, Russell, D, Rubin, Z, et al. Elimination of routine contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: a retrospective quasi-experimental study. Infect Contr Hosp Epidemiol 2016;37:1323–1330.CrossRefGoogle ScholarPubMed
15. Park, SO, Liu, J, Furuya, EY, Larson, EL. Carbapenem-resistant Klebsiella pneumoniae infection in three New York City hospitals trended downwards from 2006 to 2014. Open Foreum . Infect Dis 2016;3:ofw222.Google Scholar