RESUMO
OBJECTIVE: To understand how healthcare facilities employ contact precautions for patients with multidrug-resistant organisms (MDROs) in the post-coronavirus disease 2019 (COVID-19) era and explore changes since 2014. DESIGN: Cross-sectional survey. PARTICIPANTS: Emerging Infections Network (EIN) physicians involved in infection prevention or hospital epidemiology. METHODS: In September 2022, we sent via email an 8-question survey on contact precautions and adjunctive measures to reduce MDRO transmission in inpatient facilities. We also asked about changes since the COVID-19 pandemic. We used descriptive statistics to summarize data and compared results to a similar survey administered in 2014. RESULTS: Of 708 EIN members, 283 (40%) responded to the survey and 201 reported working in infection prevention. A majority of facilities (66% and 69%) routinely use contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) respectively, compared to 93% and 92% in 2014. Nearly all (>90%) use contact precautions for Candida auris, carbapenem-resistant Enterobacterales (CRE), and carbapenem-resistant Acinetobacter baumannii. More variability was reported for carbapenem-resistant Pseudomonas aeruginosa and extended-spectrum ß-lactamase-producing gram-negative organisms. Compared to 2014, fewer hospitals perform active surveillance for MRSA and VRE. Overall, 90% of facilities used chlorhexidine gluconate bathing in all or select inpatients, and 53% used ultraviolet light or hydrogen peroxide vapor disinfection at discharge. Many respondents (44%) reported changes to contact precautions since COVID-19 that remain in place. CONCLUSIONS: Heterogeneity exists in the use of transmission-based precautions and adjunctive infection prevention measures aimed at reducing MDRO transmission. This variation reflects a need for updated and specific guidance, as well as further research on the use of contact precautions in healthcare facilities.
Assuntos
COVID-19 , Infecção Hospitalar , Farmacorresistência Bacteriana Múltipla , Controle de Infecções , Humanos , Estudos Transversais , COVID-19/prevenção & controle , COVID-19/epidemiologia , Controle de Infecções/métodos , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/epidemiologia , Inquéritos e Questionários , Staphylococcus aureus Resistente à Meticilina , Enterococos Resistentes à Vancomicina , SARS-CoV-2 , Estados Unidos/epidemiologiaAssuntos
Anti-Infecciosos , Infecções por Klebsiella , Humanos , Klebsiella pneumoniae/genética , Proteínas de Bactérias/genética , beta-Lactamases/genética , beta-Lactamases/análise , Reação em Cadeia da Polimerase , Infecções por Klebsiella/diagnóstico , Testes de Sensibilidade Microbiana , Antibacterianos/farmacologiaRESUMO
Coronavirus disease 2019 (COVID-19) changed healthcare across the world. With this change came an increase in healthcare-associated infections (HAIs) and a concerning concurrent proliferation of MDR organisms (MDROs). In this narrative review, we describe the impact of COVID-19 on HAIs and MDROs, describe potential causes of these changes, and discuss future directions to combat the observed rise in rates of HAIs and MDRO infections.
RESUMO
Contact precautions are used to prevent the spread of extended-spectrum ß-lactamase (ESBL)-producing organisms in acute-care hospitals, but supporting data are lacking. We discontinued such precautions for ESBL Escherichia coli and Klebsiella spp and found no increased prevalence of these organisms with our change in practice.