Regional variation in the interpretation of contact precautions for multi-drug-resistant Gram-negative bacteria: a cross-sectional survey

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES Journal of Hospital Infection Pub Date : 2024-07-26 DOI:10.1016/j.jhin.2024.06.020

A. van Veen , I. de Goeij , M. Damen , E.G.W. Huijskens , S. Paltansing , M. van Rijn , R.G. Bentvelsen , J. Veenemans , M. van der Linden , M.C. Vos , J.A. Severin , the Infection Prevention and Antimicrobial Resistance Care Network South-western Netherlands

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Abstract

Background

Contact precautions are recommended when caring for patients with carbapenemase-producing Enterobacterales (CPE), carbapenemase-producing Pseudomonas aeruginosa (CPPA), and extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E).

Aim

Our aim was to determine the interpretation of contact precautions and associated infection prevention and control (IPC) measures in the non-ICU hospital setting for patients with CPE, CPPA or ESBL-E in 11 hospitals in the Southwest of the Netherlands.

Methods

A cross-sectional survey was developed to collect information on all implemented IPC measures, including use of personal protective equipment, IPC measures for visitors, cleaning and disinfection, precautions during outpatient care and follow-up strategies. All 11 hospitals were invited to participate between November 2020 and April 2021.

Findings

The survey was filled together with each hospital. All hospitals installed isolation precautions for patients with CPE and CPPA during inpatient care and day admissions, whereas 10 hospitals (90.9%) applied isolation precautions for patients with ESBL-E. Gloves and gowns were always used during physical contact with the patient in isolation. Large variations were identified in IPC measures for visitors, cleaning and disinfection products used, and precautions during outpatient care. Four hospitals (36.4%) actively followed up on CPE or CPPA patients with the aim of declaring them CPE- or CPPA-negative as timely as possible, and two hospitals (20.0%) actively followed up on ESBL-E patients.

Conclusion

Contact precautions are interpreted differently between hospitals, leading to regional differences in IPC measures applied in clinical settings. Harmonizing infection-control policies between the hospitals could facilitate patient transfers and benefit collective efforts of preventing transmission of multi-drug-resistant Gram-negative bacteria.

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针对耐多药革兰氏阴性菌的接触防护措施的地区性解释差异：一项横断面调查。

背景：目的：我们的目的是确定荷兰西南部 11 家医院在非重症监护病房环境中对 CPE、CPPA 或 ESBL-E 患者采取的接触预防措施和相关感染预防与控制 (IPC) 措施的解释：方法：开展横断面调查，收集所有已实施 IPC 措施的信息，包括个人防护设备的使用、访客 IPC 措施、清洁和消毒、门诊护理期间的预防措施以及后续策略。所有 11 家医院均受邀在 2020 年 11 月至 2021 年 4 月期间参与调查：每家医院都填写了调查问卷。所有医院都对住院治疗和日间入院的 CPE 和 CPPA 患者采取了隔离预防措施，而 10 家医院（90.9%）对 ESBL-E 患者采取了隔离预防措施。在与隔离患者进行身体接触时，始终使用手套和隔离衣。针对探视者的 IPC 措施、使用的清洁和消毒产品以及门诊护理期间的预防措施存在很大差异。四家医院（36.4%）对 CPE 或 CPPA 患者进行了积极跟踪，目的是尽可能及时地宣布 CPE 或 CPPA 阴性，两家医院（20.0%）对 ESBL-E 患者进行了积极跟踪：结论：不同医院对 CP 的解释不同，导致在临床环境中采用的 IPC 措施存在地区差异。统一医院间的感染控制政策可促进患者转院，有利于共同预防 MDR-GNB 的传播。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.