Abstract

BackgroundCross-transmission of nosocomial pathogens occurs frequently in intensive care units (ICU). The aim of this study was to investigate whether the introduction of a single room policy resulted in a decrease in transmission of multidrug-resistant (MDR) bacteria in an ICU.MethodsWe performed a retrospective study covering two periods: between January 2002 and April 2009 (old-ICU) and between May 2009 and March 2013 (new-ICU, single-room). These periods were compared with respect to the occurrence of representative MDR Gram-negative bacteria. Routine microbiological screening, was performed on all patients on admission to the ICU and then twice a week. Multi-drug resistance was defined according to a national guideline. The first isolates per patient that met the MDR-criteria, detected during the ICU admission were included in the analysis. To investigate the clonality, isolates were genotyped by DiversiLab (bioMérieux, France) or Amplified Fragment Length Polymorphism (AFLP). To guarantee the comparability of the two periods, the ‘before’ and ‘after’ periods were chosen such that they were approximately identical with respect to the following factors: number of admissions, number of beds, bed occupancy rate, per year and month.ResultsDespite infection prevention efforts, high prevalence of MRD bacteria continue to occur in the original facility. A marked and sustained decrease in the prevalence of MDR-GN bacteria was observed after the migration to the new ICU, while there appear to be no significant changes in the other variables including bed occupancy and numbers of patient admissions.ConclusionSingle room ICU design contributes significantly to the reduction of cross transmission of MRD-bacteria.

Highlights

  • Cross-transmission of nosocomial pathogens occurs frequently in intensive care units (ICU)

  • The total number of beds in use was 18, since a maximum of nine out of the 12 open bay beds was used for admissions at any given time. This ICU was closed on two occasions: from January through May 2003 because of an ongoing outbreak with ESBL-producing Klebsiella pnumoniae (ESBL-Kp) which started in 2001 [13], and between January and March 2008 because of an outbreak with multi-drug resistant Acinetobacter baumannii (MDR-Ab)

  • Antimicrobial susceptibility testing was performed by the agar dilution method according to the National Committee on Clinical Laboratory Standards (NCCLS), called Clinical and Laboratory Standards Institute (CLSI) [14]

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Summary

Introduction

Cross-transmission of nosocomial pathogens occurs frequently in intensive care units (ICU). The aim of this study was to investigate whether the introduction of a single room policy resulted in a decrease in transmission of multidrug-resistant (MDR) bacteria in an ICU. Cross-transmission of nosocomial pathogens has been shown to occur frequently in intensive care units (ICU) [1]. It may be promoted by several factors including environmental source [2], invasive procedures, and understaffing [3]. Interventions aimed at reducing the spread of nosocomial pathogens. In this retrospective study we describe the long-term persistence and transmission of MDR-GN organisms in an ICU despite extensive infection control precautions.

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