Reduction in Acquisition of Vancomycin-Resistant Enterococcus after Enforcement of Routine Environmental Cleaning Measures
Mary K. Hayden,Marc J. M. Bonten,Donald Blom,Elizabeth A. Lyle,David A. M. C. van de Vijver,Robert A. Weinstein +5 more
TLDR
Investigating the effects of improved environmental cleaning with and without promotion of hand hygiene adherence on the spread of vancomycin-resistant enterococci as a marker organism found decreased in period 2 and remained low thereafter, suggesting decreasing environmental contamination may help to control thespread of some antibiotic-resistant bacteria in hospitals.Abstract:
Background The role of environmental contamination in nosocomial cross-transmission of antibiotic-resistant bacteria has been unresolved. Using vancomycin-resistant enterococci (VRE) as a marker organism, we investigated the effects of improved environmental cleaning with and without promotion of hand hygiene adherence on the spread of VRE in a medical intensive care unit. Methods The study comprised a baseline period (period 1), a period of educational intervention to improve environmental cleaning (period 2), a "washout" period without any specific intervention (period 3), and a period of multimodal hand hygiene intervention (period 4). We performed cultures for VRE of rectal swab samples obtained from patients at admission to the intensive care unit and daily thereafter, and we performed cultures of environmental samples and samples from the hands of health care workers twice weekly. We measured patient clinical and demographic variables and monitored intervention adherence frequently. Results Our study included 748 admissions to the intensive care unit over a 9-month period. VRE acquisition rates were 33.47 cases per 1000 patient-days at risk for period 1 and 16.84, 12.09, and 10.40 cases per 1000 patient-days at risk for periods 2, 3, and 4, respectively. The mean (+/-SD) weekly rate of environmental sites cleaned increased from 0.48+/-0.08 at baseline to 0.87+/-0.08 in period 2; similarly high cleaning rates persisted in periods 3 and 4. Mean (+/-SD) weekly hand hygiene adherence rate was 0.40+/-0.01 at baseline and increased to 0.57+/-0.11 in period 2, without a specific intervention to improve adherence, but decreased to 0.29+/-0.26 in period 3 and 0.43+/-0.1 in period 4. Mean proportions of positive results of cultures of environmental and hand samples decreased in period 2 and remained low thereafter. In a Cox proportional hazards model, the hazard ratio for acquiring VRE during periods 2-4 was 0.36 (95% confidence interval, 0.19-0.68); the only determinant explaining the difference in VRE acquisition was admission to the intensive care unit during period 1. Conclusions Decreasing environmental contamination may help to control the spread of some antibiotic-resistant bacteria in hospitals.read more
Citations
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Journal ArticleDOI
The role played by contaminated surfaces in the transmission of nosocomial pathogens.
TL;DR: Evidence is accumulating that contaminated surfaces make an important contribution to the epidemic and endemic transmission of Clostridium difficile, vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, Acinetobacter baumannii, Pseudomonas aeruginosa, and norovirus and that improved environmental decontamination contributes to the control of outbreaks.
Journal ArticleDOI
The role of environmental cleaning in the control of hospital-acquired infection
TL;DR: This review will examine the links between the hospital environment and various pathogens, including meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, norovirus, Clostridium difficile and acinetobacter.
Journal ArticleDOI
Importance of the environment in meticillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning
TL;DR: This Review will show why the removal of dirt might have more impact on the control of MRSA than previously thought.
Journal ArticleDOI
Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination
TL;DR: Forthcoming evidence on the role of antimicrobial surfaces could supplement infection prevention strategies for health care environments, including those targeting multidrug-resistant pathogens.
The role of understaffing in central venous catheter-associated bloodstream infections [see comments]
S. Fridkin,SM Pear +1 more
Abstract: OBJECTIVE
To determine risk factors for central venous catheter-associated bloodstream infections (CVC-BSI) during a protracted outbreak.
DESIGN
Case-control and cohort studies of surgical intensive care unit (SICU) patients.
SETTING
A university-affiliated Veterans Affairs medical center.
PATIENTS
Case-control study: all patients who developed a CVC-BSI during the outbreak period (January 1992 through September 1993) and randomly selected controls. Cohort study: all SICU patients during the study period (January 1991 through September 1993).
MEASUREMENTS
CVC-BSI or site infection rates, SICU patient clinical data, and average monthly SICU patient-to-nurse ratio.
RESULTS
When analyzed by hospital location and site, only CVC-BSI in the SICU had increased significantly in the outbreak period compared to the previous year (January 1991 through December 1991: pre-outbreak period). In SICU patients, CVC-BSI were associated with receipt of total parenteral nutrition [TPN]; odds ratio, 16; 95% confidence interval, 4 to 73). When we controlled for TPN use, CVC-BSI were associated with increasing severity of illness and days on assisted ventilation. SICU patients in the outbreak period had shorter SICU and hospital stays, were younger, and had similar mortality rates, but received more TPN compared with patients in the pre-outbreak period. Furthermore, the patient-to-nurse ratio significantly increased in the outbreak compared with the pre-outbreak period. When we controlled for TPN use, assisted ventilation, and the period of hospitalization, the patient-to-nurse ratio was an independent risk factor for CVC-BSI in SICU patients.
CONCLUSIONS
Nursing staff reductions below a critical level, during a period of increased TPN use, may have contributed to the increase in CVC-BSI in the SICU by making adequate catheter care difficult. During healthcare reforms and hospital downsizing, the effect of staffing reductions on patient outcome (i.e., nosocomial infection) needs to be critically assessed.
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