Prevention in Adults of Transmission of Infection With Multidrug-Resistant Organisms. Rapid Review

Abstract

Objectives. This rapid review summarizes literature for patient safety practices intended to prevent and control the transmission of multidrug-resistant organisms (MDROs). Methods. We followed rapid review processes of the Agency for Healthcare Research and Quality Evidence-based Practice Center Program. We searched PubMed to identify eligible systematic reviews from 2011 to May 2023 and primary studies published from 2011 to May 2023, supplemented by targeted gray literature searches. We included literature that addressed patient safety practices intending to prevent or control transmission of MDROs which were implemented in hospitals and nursing homes and that included clinical outcomes of infection or colonization with MDROs as well as unintended consequences such as mental health effects and noninfectious adverse healthcare-associated outcomes. The protocol for the review has been registered in PROSPERO (CRD42023444973). Findings. Our search retrieved 714 citations, of which 42 articles were eligible for review. Systematic reviews, which were primarily of observational studies, included a wide variety of infection prevention and control (IPC) practices, including universal gloving, contact isolation precautions, adverse effects of patient isolation, patient and/or staff cohorting, room decontamination, patient decolonization, IPC practices specifically in nursing homes, features of organizational culture to facilitate implementation of IPC practices and the role of dedicated IPC staff. While systematic reviews were of good or fair quality, strength of evidence for the conclusions was always low or very low, due to reliance on observational studies. Decolonization strategies showed some benefit in certain populations, such as nursing home patients and patients discharging from acute care hospitalization. Universal gloving showed a small benefit in the intensive care unit. Contact isolation targeting patients colonized or infected with MDROs showed mixed effects in the literature and may be associated with mental health and noninfectious (e.g., falls and pressure ulcers) adverse effects when compared with standard precautions, though based on before/after studies in which such precautions were ceased. There was no significant evidence of benefit for patient cohorting (except possibly in outbreak settings), automated room decontamination or cleaning feedback protocols, and IPC practices in long-term settings. Infection rates may be improved when IPC practices are implemented in the context of certain logistical and staffing characteristics including a supportive organizational culture, though again strength of evidence was low. Dedicated infection prevention staff likely improve compliance with other patient safety practices, though there is little evidence of their downstream impact on rates of infection. Conclusions. Selected infection prevention and control interventions had mixed evidence for reducing healthcare-associated infection and colonization by multidrug resistant organisms. Where these practices did show benefit, they often had evidence that applied only to certain subpopulations (such as intensive care unit patients), though overall strength of evidence was low.