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Determinants of Implementation of Isolation Precautions Against Infections by Multidrug-Resistant Microorganisms: A Hospital-Based, Multicenter, Observational Study

Published online by Cambridge University Press:  31 July 2017

Thomas Bénet ,
Raphaele Girard ,
Solweig Gerbier-Colomban ,
Cédric Dananché ,
Elisabeth Hodille ,
Olivier Dauwalder  and
Philippe Vanhems
Thomas Bénet*
Affiliation:
Service d’Hygiène, Epidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon, Lyon, France Equipe épidémiologie et santé internationale, Laboratoire des Pathogènes Emergents – Fondation Mérieux, Centre International de Recherche en Infectiologie, Inserm U1111, CNRS, UMR 5308, ENS de Lyon, UCBL1, Lyon, France
Raphaele Girard
Affiliation:
Service d’Hygiène, Epidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon, Lyon, France
Solweig Gerbier-Colomban
Affiliation:
Service d’Hygiène, Epidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon, Lyon, France
Cédric Dananché
Affiliation:
Service d’Hygiène, Epidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon, Lyon, France Equipe épidémiologie et santé internationale, Laboratoire des Pathogènes Emergents – Fondation Mérieux, Centre International de Recherche en Infectiologie, Inserm U1111, CNRS, UMR 5308, ENS de Lyon, UCBL1, Lyon, France
Elisabeth Hodille
Affiliation:
Laboratoire de Microbiologie, Hospices Civils de Lyon, Lyon, France
Olivier Dauwalder
Affiliation:
Laboratoire de Microbiologie, Hospices Civils de Lyon, Lyon, France
Philippe Vanhems
Affiliation:
Service d’Hygiène, Epidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon, Lyon, France Equipe épidémiologie et santé internationale, Laboratoire des Pathogènes Emergents – Fondation Mérieux, Centre International de Recherche en Infectiologie, Inserm U1111, CNRS, UMR 5308, ENS de Lyon, UCBL1, Lyon, France
*
Address correspondence to Thomas Bénet, MD, PhD, Service d’Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, 5 place d’Arsonval, 69437 Lyon Cedex 03, France ([email protected]).
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Abstract

OBJECTIVES

We aimed to ascertain the factors associated with lack of isolation precautions (IP) in patients infected or colonized by third-generation cephalosporin-resistant Enterobacteriaceae (3GCR-E) and methicillin-resistant Staphylococcus aureus (MRSA) in hospital settings.

DESIGN

Prospective surveillance and audit of practices.

SETTING

The study included 4 university hospitals in Lyon, France.

PARTICIPANTS

All patients hospitalized between April and June in 2013 and 2015 were included. Case patients had ≥1 clinical sample positive for MRSA and/or 3GCR-E.

METHODS

Factors associated with the lack of IP implementation were identified using multivariate logistic regression. The incidence of MDRO infections was expressed per 10,000 patient days.

RESULTS

Overall, 57,222 patients accounting for 192,234 patient days of hospitalization were included, and 635 (1.1%) MDRO cases were identified. MRSA incidence was 2.5 per 10,000 patient days (95% confidence interval [95% CI], 2.1–3.0) and 3GCR-E incidence was 10.1 per 10,000 patient days (95% CI, 9.2–11.0), with no crude difference between 2013 and 2015 (P=.15 and P=.11, respectively). Among 3GCR-E, the main species were Escherichia coli (43.8%) and Klebsiella pneumoniae (31.0%). Isolation precautions were implemented in 78.5% of cases. Lack of IP implementation was independently associated with patient age, year, specialty, hospital, colonization compared with infection, and lack of medical prescription for IPs (adjusted odds ratio, 17.4; 95% CI, 8.5–35.8; P<.001).

CONCLUSIONS

MRSA and 3GCR-E infections and/or colonizations are frequent in healthcare settings, and IPs are implemented in most cases. When IPs are lacking, the main factor is the absence of medical prescription for IPs, underscoring the need for alerts to physicians by the microbiological laboratory and/or the infection control team.

Infect Control Hosp Epidemiol 2017;38:1188–1195

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 10 , October 2017 , pp. 1188 - 1195
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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