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
More filters
Journal ArticleDOI
Outbreak of hospital-adapted clonal complex-17 vancomycin-resistant Enterococcus faecium strain in a haematology unit: role of rapid typing for early control
Ariane Deplano,Olivier Denis,Claire Nonhoff,F. Rost,Baudouin Byl,Frédérique Jacobs,Vanessa Vankerckhoven,Herman Goossens,Herman Goossens,Marc Struelens +9 more
TL;DR: Rapid typing and infection control measures, including early reinforcement of barrier precautions combined with weekly rectal surveillance cultures, were followed by control of nosocomial spread of this VREF clone.
Journal ArticleDOI
Current preventive measures for health-care associated surgical site infections: a review.
David M. Tsai,Edward J. Caterson +1 more
TL;DR: It is argued that current systems in place are often insufficient, and the benefits of institution-wide adoption of multiple preventive interventions to combat SSIs are emphasized.
Journal ArticleDOI
Dissemination of antibiotic-resistant enterococci within the ward environment: The role of airborne bacteria and the risk posed by unrecognized carriers
TL;DR: Investigation of how far Enterococcus spp can spread from isolated and nonisolated patients found unrecognized colonization and/or the aerosolization of enterococci together with inadequate cleaning can lead to heavy, widespread, and persistent environmental contamination.
Journal ArticleDOI
Hydrogen peroxide vapor room disinfection and hand hygiene improvements reduce Clostridium difficile infection, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and extended-spectrum β-lactamase
TL;DR: A statistically significant reduction in Clostridium difficile infection, vancomycin-resistant enterococci, and extended-spectrum β-lactamase-producing gram-negative bacteria is reported associated with the introduction of hydrogen peroxide vapor for terminal decontamination of patient rooms and improvements in hand hygiene compliance.
References
More filters
Journal ArticleDOI
APACHE II: a severity of disease classification system.
TL;DR: The form and validation results of APACHE II, a severity of disease classification system that uses a point score based upon initial values of 12 routine physiologic measurements, age, and previous health status, are presented.
Journal ArticleDOI
APACHE II--a severity of disease classification system.
Journal ArticleDOI
Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.
John M. Boyce,Didier Pittet +1 more
TL;DR: The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis and provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health- Care settings.
Journal ArticleDOI
Effectiveness of a hospital-wide programme to improve compliance with hand hygiene
Didier Pittet,Stéphane Hugonnet,Stéphan Juergen Harbarth,Philippe Mourouga,V Sauvan,Sylvie Touveneau,Thomas V. Perneger +6 more
TL;DR: The campaign produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction of nosocomial infections and MRSA transmission, and the promotion of bedside, antiseptic handrubs largely contributed to the increase in compliance.
Journal ArticleDOI
SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus.
Carlene A. Muto,John A. Jernigan,Belinda E. Ostrowsky,Hervé Richet,William R. Jarvis,John M. Boyce,Barry M. Farr +6 more
TL;DR: Active surveillance cultures are essential to identify the reservoir for spread of MRSA and VRE infections and make control possible using the CDC's long-recommended contact precautions, demonstrating consistency of evidence, high strength of association, reversibility, dose gradient, and specificity for control with this approach.