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Optimization of pre-emptive isolations in a polyvalent ICU through implementation of an intervention strategy.
Álvarez Lerma, F; Granado Solano, J; García Sanz, A; López Martínez, C; Herrera Sebastián, R; Salvat Cobeta, C; Rey Pérez, A; Balaguer Blasco, R M; Plasencia, V; Horcajada, J P.
Afiliação
  • Álvarez Lerma F; Servicio de Medicina Intensiva, Hospital del Mar, Consorci Mar Parc de Salut, Universitat Autònoma, Barcelona, España. Electronic address: Falvarez@parcdesalutmar.cat.
  • Granado Solano J; Servicio de Medicina Intensiva, Hospital del Mar, Consorci Mar Parc de Salut, Universitat Autònoma, Barcelona, España.
  • García Sanz A; Servicio de Medicina Intensiva, Hospital del Mar, Consorci Mar Parc de Salut, Universitat Autònoma, Barcelona, España.
  • López Martínez C; Servicio de Medicina Intensiva, Hospital del Mar, Consorci Mar Parc de Salut, Universitat Autònoma, Barcelona, España.
  • Herrera Sebastián R; Servicio de Medicina Intensiva, Hospital del Mar, Consorci Mar Parc de Salut, Universitat Autònoma, Barcelona, España.
  • Salvat Cobeta C; Servicio de Medicina Intensiva, Hospital del Mar, Consorci Mar Parc de Salut, Universitat Autònoma, Barcelona, España.
  • Rey Pérez A; Servicio de Medicina Intensiva, Hospital del Mar, Consorci Mar Parc de Salut, Universitat Autònoma, Barcelona, España.
  • Balaguer Blasco RM; Servicio de Medicina Intensiva, Hospital del Mar, Consorci Mar Parc de Salut, Universitat Autònoma, Barcelona, España.
  • Plasencia V; Sección de Microbiología, Laboratorio de Referencia de Catalunya, Barcelona, España.
  • Horcajada JP; Servicio de Medicina Interna-Infecciosas, Hospital del Mar, Consorci Mar Parc de Salut, Barcelona, España.
Med Intensiva ; 39(9): 543-51, 2015 Dec.
Article em En, Es | MEDLINE | ID: mdl-25798954
BACKGROUND: Pre-emptive isolation refers to the application of contact precaution measures in patients with strongly suspected colonization by multiresistant bacteria. OBJECTIVE: To assess the impact of an intervention program involving the implementation of a consensus-based protocol of pre-emptive isolation (CPPI) on admission to a polyvalent ICU of a general hospital. METHODS: A comparative analysis of 2 patient cohorts was made: a historical cohort including patients in which pre-emptive isolation was established according to physician criterion prior to starting CPPI (from January 2010 to February 2011), and a prospective cohort including patients in which CPPI was implemented (from March to November 2011). CPPI included the identification and diffusion of pre-emptive isolation criteria, the definition of sampling methodology, the evaluation of results, and the development of criteria for discontinuation of pre-emptive isolation. Pre-emptive isolation was indicated by the medical staff, and follow-up was conducted by the nursing staff. Pre-emptive isolation was defined as "adequate" when at least one multiresistant bacteria was identified in any of the samples. Comparison of data between the 2 periods was made with the chi-square test for categorical variables and the Student t-test for quantitative variables. Statistical significance was set at P<.05. RESULTS: Among the 1,740 patients admitted to the ICU (1,055 during the first period and 685 during the second period), pre-emptive isolation was indicated in 199 (11.4%); 111 (10.5%) of these subjects corresponded to the historical cohort (control group) and 88 (12.8%) to the posterior phase after the implementation of CPPI (intervention group). No differences were found in age, APACHE II score or patient characteristics between the 2 periods. The implementation of CPPI was related to decreases in non-indicated pre-emptive isolations (29.7 vs. 6.8%, P<.001), time of requesting surveillance cultures (1.56 vs. 0.37 days, P<.001), and days of duration of treatment (4.77 vs. 3.58 days, P<.001). In 44 patients (22.1%) in which pre-emptive isolation was indicated, more than one multiresistant bacteria was identified, with an "adequate pre-emptive isolation rate" of 19.8% in the first period and 25.0% in the second period (P<.382). CONCLUSIONS: The implementation of CPPI resulted in a significant decrease in pre-emptive isolations which were not indicated correctly, a decrease in the time elapsed between isolation and collection of samples, and a decrease in the duration of isolation measures in cases in which isolation was unnecessary, without increasing the rate of "adequate pre-emptive isolation".
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Isolamento de Pacientes / Infecções Bacterianas / Infecção Hospitalar / Unidades de Terapia Intensiva Tipo de estudo: Etiology_studies / Guideline / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged País como assunto: Europa Idioma: En / Es Ano de publicação: 2015 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Isolamento de Pacientes / Infecções Bacterianas / Infecção Hospitalar / Unidades de Terapia Intensiva Tipo de estudo: Etiology_studies / Guideline / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged País como assunto: Europa Idioma: En / Es Ano de publicação: 2015 Tipo de documento: Article