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Hand Hygiene, Cohorting, or Antibiotic Restriction to Control Outbreaks of Multidrug-Resistant Enterobacteriaceae

Published online by Cambridge University Press:  28 December 2015

Camille Pelat ,
Lidia Kardaś-Słoma ,
Gabriel Birgand ,
Etienne Ruppé ,
Michaël Schwarzinger ,
Antoine Andremont ,
Jean-Christophe Lucet  and
Yazdan Yazdanpanah
Camille Pelat*
Affiliation:
INSERM, Infection, Antimicrobials, Modelization, Evolution (IAME), UMR 1137, F-75018 Paris, France University of Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France
Lidia Kardaś-Słoma
Affiliation:
INSERM, Infection, Antimicrobials, Modelization, Evolution (IAME), UMR 1137, F-75018 Paris, France University of Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, F-75018 Paris, France
Gabriel Birgand
Affiliation:
INSERM, Infection, Antimicrobials, Modelization, Evolution (IAME), UMR 1137, F-75018 Paris, France University of Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, F-75018 Paris, France
Etienne Ruppé
Affiliation:
AP-HP, Bichat-Claude Bernard Hospital, Bacteriology Laboratory, F-75018 Paris, France
Michaël Schwarzinger
Affiliation:
INSERM, Infection, Antimicrobials, Modelization, Evolution (IAME), UMR 1137, F-75018 Paris, France University of Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France
Antoine Andremont
Affiliation:
AP-HP, Bichat-Claude Bernard Hospital, Bacteriology Laboratory, F-75018 Paris, France
Jean-Christophe Lucet
Affiliation:
INSERM, Infection, Antimicrobials, Modelization, Evolution (IAME), UMR 1137, F-75018 Paris, France University of Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, F-75018 Paris, France
Yazdan Yazdanpanah
Affiliation:
INSERM, Infection, Antimicrobials, Modelization, Evolution (IAME), UMR 1137, F-75018 Paris, France University of Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France AP-HP, Bichat-Claude Bernard Hospital, Infectious and Tropical Diseases Department, F-75018 Paris, France
*
Address correspondence to Camille Pelat, PhD, Infectious Disease Department, Institut de Veille Sanitaire, 12 rue du Val d’Osne, 94415 Saint-Maurice Cedex, France ([email protected]).
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Abstract

BACKGROUND

The best strategy for controlling extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) transmission in intensive care units (ICUs) remains elusive.

OBJECTIVE

We developed a stochastic transmission model to quantify the effectiveness of interventions aimed at reducing the spread of ESBL-PE in an ICU.

METHODS

We modeled the evolution of an outbreak caused by the admission of a single carrier in a 10-bed ICU free of ESBL-PE. Using data obtained from recent muticenter studies, we studied 26 strategies combining different levels of the following 3 interventions: (1) increasing healthcare worker compliance with hand hygiene before and after contact with a patient; (2) cohorting; (3) reducing antibiotic prevalence at admission with or without reducing antibiotherapy duration.

RESULTS

Improving hand hygiene compliance from 55% before patient contact and 60% after patient contact to 80% before and 80% after patient contact reduced the nosocomial incidence rate of ESBL-PE colonization by 91% at 90 days. Adding cohorting to hand hygiene improvement intervention decreased the proportion of ESBL-PE acquisitions by an additional 7%. Antibiotic restriction had the lowest impact on the epidemic. When combined with other interventions, it only marginally improved effectiveness, despite strong hypotheses regarding antibiotic impact on transmission.

CONCLUSION

Our results suggest that hand hygiene is the most effective intervention to control ESBL-PE transmission in an ICU.

Infect. Control Hosp. Epidemiol. 2016;37(3):272–280

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Supplement 3 , March 2016 , pp. 272 - 280
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION: Part of this work was presented at the 53rd Interscience Conference of Antimicrobial Agents and Chemotherapy (ICAAC), September 2013, Denver, Colorado (abstract no. 1095).

References

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