Ethical Implications of Active Surveillance Cultures and Contact Precautions for Controlling Multidrug Resistant Organisms in the Hospital Setting

2008 ◽  
Vol 1 (3) ◽  
pp. 235-245 ◽  
Author(s):  
M. Edmond ◽  
L. Lyckholm ◽  
D. Diekema
Keyword(s):  
Active Surveillance ◽  
Hospital Setting ◽  
Multidrug Resistant ◽  
Contact Precautions ◽  
Ethical Implications ◽  
Surveillance Cultures ◽  
Multidrug Resistant Organisms

Management of Inpatients Colonized or Infected With Antimicrobial-Resistant Bacteria in Hospitals in the United States

2005 ◽  
Vol 26 (2) ◽  
pp. 138-143 ◽  
Author(s):  
Rebecca H. Sunenshine ◽  
Laura A. Liedtke ◽  
Scott K. Fridkin ◽  
Larry J. Strausbaugh ◽  
Keyword(s):  
Infectious Diseases ◽  
The United States ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Resistant Organism ◽  
Emerging Infections ◽  
Contact Precautions ◽  
Surveillance Cultures ◽  
Multidrug Resistant Organisms ◽  
General Wards

AbstractBackground:Although guidelines for multidrug-resistant organisms generally include recommendations for contact precautions and surveillance cultures, it is not known how frequently U.S. hospitals implement these measures on a routine basis and whether infectious diseases consultants endorse their use.Methods:The Emerging Infections Network surveyed its members, infectious diseases consultants, to assess their use of and support for contact precautions and surveillance cultures for routine management of multidrug-resistant organisms in their principal inpatient workplace. Specifically, members were asked about use of these strategies for methicillin-resistantStaphylococcus aureus, vancomycin-resistant enterococci, and multidrug-resistant, gram-negative bacilli on general wards, ICUs, and transplant units.Results:Overall, 400 (86%) of 463 respondents supported the routine use of contact precautions to control one or more multidrug-resistant organisms in at least one unit, and 89% worked in hospitals that use them. In contrast, 50% of respondents favored routine use of surveillance cultures to manage at least one multidrug-resistant organism in any unit, and 30% of respondents worked in hospitals that use them routinely in any unit. Members favored routine use of surveillance cultures significantly more in ICUs and transplant units than in general wards for each multidrug-resistant organism (P<.001).Conclusions:Most of the infectious diseases consultants endorsed the use of contact precautions for routine management of patients colonized or infected with multidrug-resistant organisms and work in hospitals that have implemented them. In contrast, infectious diseases consultants are divided about the role of routine surveillance cultures in multidrug-resistant organism management, and few work in hospitals that use them.

Colonization With Multidrug-Resistant Organisms in Evacuees After Hurricane Katrina

2007 ◽  
Vol 28 (6) ◽  
pp. 726-729 ◽  
Author(s):  
Ulrich Seybold ◽  
Nancy White ◽  
Yun F. Wang ◽  
J. Sue Halvosa ◽  
Henry M. Blumberg
Keyword(s):  
Infection Control ◽  
Hurricane Katrina ◽  
Medical Records ◽  
Bacterial Colonization ◽  
Multidrug Resistant ◽  
Memorial Hospital ◽  
Contact Precautions ◽  
Surveillance Cultures ◽  
Multidrug Resistant Organisms ◽  
Control Department

After Hurricane Katrina, 50 patients were evacuated to Grady Memorial Hospital in Atlanta, Georgia, with limited medical records. The infection control department ordered contact precautions for 16 Patients. Surveillance cultures performed on admission identified colonization with multidrug-resistant (MDR) bacteria in 9 patients (18%). Presence of a wound was the strongest predictor for MDR colonization. More data are needed to reliably predict MDR bacterial colonization.

The Limits of Serial Surveillance Cultures in Predicting Clearance of Colonization with Carbapenemase-Producing Enterobacteriaceae

2015 ◽  
Vol 36 (7) ◽  
pp. 835-837 ◽  
Author(s):  
Jessica D. Lewis ◽  
Kyle B. Enfield ◽  
Amy J. Mathers ◽  
Eve T. Giannetta ◽  
Costi D. Sifri
Keyword(s):  
Multidrug Resistant ◽  
Infect Control Hosp ◽  
Contact Precautions ◽  
Surveillance Cultures ◽  
Multidrug Resistant Organisms ◽  
Accepted Practice

An accepted practice for patients colonized with multidrug-resistant organisms is to discontinue contact precautions following 3 consecutive negative surveillance cultures. Our experience with surveillance cultures to detect persistent carbapenemase-producing Enterobacteriaceae (CPE) colonization suggests that extrapolation of this practice to CPE-colonized patients may not be appropriate.Infect Control Hosp Epidemiol 2015;36(7):835–837

Contact precautions for colonisation with multidrug-resistant organisms and haemodialysis patient quality of life and mood: a pilot case-control study

2019 ◽  
pp. 19-25 ◽  
Author(s):  
Rathika Krishnasamy
Keyword(s):  
Quality Of Life ◽  
Qualitative Interviews ◽  
Social Function ◽  
Multidrug Resistant ◽  
Contact Precautions ◽  
Dialysis Vintage ◽  
Multidrug Resistant Organisms ◽  
And Gender ◽  
The Impact

Background: The rate of multidrug-resistant organisms (MDRO) colonisation in dialysis populations has increased over time. This study aimed to assess the effect of contact precautions and isolation on quality of life and mood for haemodialysis (HD) patients colonised with MDRO. Methods: Patients undergoing facility HD completed the Kidney Disease Quality of Life (KDQOL–SFTM), Beck Depression Inventory (BDI) and Personal Wellbeing-Index Adult (PWI-A). Patients colonised with MDRO were case-matched by age and gender with patients not colonised. Results: A total of 16 MDRO-colonised patients were matched with 16 controls. Groups were well matched for demographics and co-morbidities, other than a trend for older dialysis vintage in the MDRO group [7.2 years (interquartile range 4.6–10.0) compared to 3.2 (1.4–7.6) years, p=0.05]. Comparing MDRO-positive with negative patients, physical (30.5±10.7 vs. 34.6±7.3; p=0.2) and mental (46.5±11.2 vs. 48.5±12.5; p = 0.6) composite scores were not different between groups. The MDRO group reported poorer sleep quality (p=0.01) and sleep patterns (p=0.05), and lower social function (p=0.02). BDI scores were similar (MDRO-positive 10(3.5–21.0) vs. MDRO-negative 12(6.5–16.0), p=0.6). PWI-A scores were also similar in both groups; however, MDRO patients reported lower scores for “feeling safe”, p=0.03. Conclusion: While overall scores of quality of life and depression were similar between groups, the MDRO group reported poorer outcomes in sleep and social function. A larger cohort and qualitative interviews may give more detail of the impact of contact precautions and isolation on HD patients. The necessity for contact precautions for different MDRO needs consideration.

A controlled trial of universal gloving versus contact precautions for preventing the transmission of multidrug-resistant organisms

2007 ◽  
Vol 35 (10) ◽  
pp. 650-655 ◽  
Author(s):  
Gonzalo M.L. Bearman ◽  
Alexandre R. Marra ◽  
Curtis N. Sessler ◽  
Wally R. Smith ◽  
Adriana Rosato ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Multidrug Resistant ◽  
Contact Precautions ◽  
Multidrug Resistant Organisms

scholarly journals Long-Term Impact of Universal Contact Precautions on Rates of Multidrug-Resistant Organisms in ICUs: A Comparative Effectiveness Study

2018 ◽  
Vol 39 (5) ◽  
pp. 534-540 ◽  
Author(s):  
E. Yoko Furuya ◽  
Bevin Cohen ◽  
Haomiao Jia ◽  
Elaine L. Larson
Keyword(s):  
Comparative Effectiveness ◽  
Baseline Period ◽  
Multidrug Resistant ◽  
Incidence Density ◽  
Research Database ◽  
Longitudinal Impact ◽  
Contact Precautions ◽  
Significant Difference ◽  
Multidrug Resistant Organisms ◽  
The Impact

OBJECTIVETo evaluate the impact of universal contact precautions (UCP) on rates of multidrug-resistant organisms (MDROs) in intensive care units (ICUs) over 9 yearsDESIGNRetrospective, nonrandomized observational studySETTINGAn 800-bed adult academic medical center in New York CityPARTICIPANTSAll patients admitted to 6 ICUs, 3 of which instituted UCP in 2007METHODSUsing a comparative effectiveness approach, we studied the longitudinal impact of UCP on MDRO incidence density rates, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and carbapenem-resistant Klebsiella pneumoniae. Data were extracted from a clinical research database for 2006–2014. Monthly MDRO rates were compared between the baseline period and the UCP period, utilizing time series analyses based on generalized linear models. The same models were also used to compare MDRO rates in the 3 UCP units to 3 ICUs without UCPs.RESULTSOverall, MDRO rates decreased over time, but there was no significant decrease in the trend (slope) during the UCP period compared to the baseline period for any of the 3 intervention units. Furthermore, there was no significant difference between UCP units (6.6% decrease in MDRO rates per year) and non-UCP units (6.0% decrease per year; P=.840).CONCLUSIONThe results of this 9-year study suggest that decreases in MDROs, including multidrug-resistant gram-negative bacilli, were more likely due to hospital-wide improvements in infection prevention during this period and that UCP had no detectable additional impact.Infect Control Hosp Epidemiol 2018;39:534–540

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