The association between infection control interventions and carbapenem-resistant Enterobacteriaceae incidence in an endemic hospital.
J Hosp Infect
; 97(3): 218-225, 2017 Nov.
Article
em En
| MEDLINE
| ID: mdl-28743504
ABSTRACT
BACKGROUND:
Israel experienced a national outbreak of carbapenem-resistant Enterobacteriaceae (CRE) starting in 2006.AIM:
To assess the association between infection control (IC) interventions implemented in a referral hospital in Israel and CRE incidence.METHODS:
Retrospective quasi-experimental study of prospectively collected data. CRE incidence, defined as the number of patients newly acquiring CRE in surveillance or clinical samples per 100,000 hospital-days, was plotted quarterly between 2005 and 2016. IC interventions were applied at different time-points throughout this period. Data were collected on IC staffing, number of rectal surveillance cultures, and carbapenem consumption. Autocorrelated segmented linear regression analysis was used to assess the time-points at which a significant change in the CRE incidence trend occurred, and the association between the timing of IC intervention implementation and observed CRE trends was assessed. Trends between time-points were expressed as quarterly percent change (QPC) with 95% confidence intervals (CIs).FINDINGS:
Between 2005 and 2008, CRE incidence increased significantly (QPC 19.7%; CI 11.5-28.4), reaching a peak of 186.6 new acquisitions per 100,000 hospital-days. From mid-2011 until the end of follow-up, there was a significantly decreasing incidence trend (QPC -4.5; CI -6.4 to -2.5). Cohorting of patients, screening of contacts and high-risk patients on admission were insufficient to control the epidemic. Improved hand hygiene compliance, cohorting with dedicated nursing staff, addition of regular screening in high-risk departments, and carbapenem restriction were required. Decreasing CRE incidence was observed with an infectious diseases/IC staffing of 1.2-1.5 per 100 beds and 20,000-36,000 yearly CRE surveillance samples.CONCLUSION:
A multi-faceted hospital-wide intervention programme is required to control CRE in hospital settings.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Infecção Hospitalar
/
Controle de Infecções
/
Transmissão de Doença Infecciosa
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Infecções por Enterobacteriaceae
/
Enterobacteriáceas Resistentes a Carbapenêmicos
Tipo de estudo:
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
País/Região como assunto:
Asia
Idioma:
En
Revista:
J Hosp Infect
Ano de publicação:
2017
Tipo de documento:
Article