Background
This study was undertaken to determine the temporal relationship between implementation
of different interventions in an intensive care unit (ICU) and control of endemic
nosocomial acquisition of extended-spectrum β-lactamase Enterobacteriaceae (ESBLE).
Methods
This was a prospective observational study with time-series analysis of the monthly
incidence of ESBLE and its predictors. In November 2007, after a 14-month baseline
period, an intervention consisting of restriction of third-generation cephalosporins
(3 GC) and increased use of alcohol-based hand rubs was implemented. In January 2008,
an increased health care worker (HCW):patient ratio was also implemented. In March
2010, the ICU was closed, and patients were moved to a clean ICU.
Results
The first intervention resulted in global reduction in 3 GC and increased use of alcohol-based
hand rub. A significant change in ESBLE incidence was observed in a full segmented
univariate regression analysis (mean change in level, −0.91 ± 0.19; P < .0001). After ICU closure, there was a dramatic reduction in ESBLE acquisition.
According to the multivariate model, the ICU closure was the main protective factor.
Before ICU closure, an increase in the HCW:patient ratio of 0.1 point tended to be
associated with a decreased risk of ESBLE acquisition (relative risk, 0.28; 95% confidence
interval, 0.06-1.25; P = .09).
Conclusions
This study shows that ICU closure was associated with, but not necessarily the reason
for, control of ESBLE cross-transmission in a nonoutbreak setting. Environmental ESBE
sources may play a role in cross-transmission.
Key Words
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Article info
Publication history
Published online: September 10, 2015
Footnotes
A.B. and V.C. contributed equally to this work.
Conflicts of interest: None to report.
Identification
Copyright
© 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
