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Published on: August 30, 2018
Universal versus targeted additional contact precautions for multidrug-resistant organism carriage for patients
Michel Djibré1, Samuel Fedun1, Pierre Le Guen1
1Unité de Réanimation et USC médico-chirurgicale, Hôpital Tenon des Assistance Publique-Hôpitaux de Paris, Paris, France.
Background:
Although additional contact precautions (ACPs) are routinely used to reduce cross-transmission of multidrug-resistant organisms (MDROs), the relevance of isolation precautions remains debated. We hypothesized that the collection of recognized risk factors for MDRO carriage on intensive care unit (ICU) admission might be helpful to target ACPs without increasing MDRO acquisition during ICU stays, compared with universal ACPs.
Materials And Methods:
This is a sequential single-center observational study performed in consecutive patients admitted to a French medical and surgical ICU. During the first 6-month period, screening for MDRO carriage and ACPs were performed in all patients. During the second 6-month period, screening was maintained, but ACP use was guided by the presence of at least 1 defined risk factor for MDRO.
Results:
During both periods, 33 (10%) and 30 (10%) among 327 and 297 admissions were, respectively, associated with a positive admission MDRO carriage. During both periods, a second screening was performed in 147 (45%) and 127 (43%) patients. Altogether, the rate of acquired MDRO (positive screening or clinical specimen) was similar during both periods (10% [n = 15] and 11.8% [n = 15], respectively; P = .66).
Conclusions:
The results of our study contribute to support the safety of an isolation-targeted screening policy on ICU admission compared with universal screening and isolation regarding the rate of ICU-acquired MDRO colonization or infection.
Insights
Targeting additional contact precautions (ACPs) based on multidrug-resistant organism (MDRO) risk factors on intensive care unit (ICU) admission is safe. This approach did not increase MDRO acquisition compared to universal ACPs, supporting targeted screening policies.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Additional contact precautions (ACPs) are standard for reducing multidrug-resistant organism (MDRO) transmission, but their necessity is debated.
- Universal ACPs may not be the most efficient strategy for infection control in intensive care units (ICUs).
Purpose of the Study:
- To evaluate if targeting ACPs based on identified MDRO carriage risk factors at ICU admission is as safe as universal ACPs.
- To determine if a targeted screening policy impacts the rate of MDRO acquisition during ICU stays.
Main Methods:
- A sequential, single-center observational study in a French medical and surgical ICU.
- Phase 1: Universal MDRO screening and ACPs for all ICU admissions.
- Phase 2: MDRO screening maintained, but ACPs were selectively applied based on predefined risk factors for MDRO carriage.
Main Results:
- The rate of positive MDRO carriage on admission was similar in both periods (10%).
- The rate of ICU-acquired MDROs (colonization or infection) was comparable between the universal ACP period (10%) and the targeted ACP period (11.8%).
- No statistically significant difference (P=.66) in MDRO acquisition was observed between the two strategies.
Conclusions:
- Targeted screening policies for MDROs upon ICU admission are safe and effective.
- This approach can potentially optimize resource allocation without compromising patient safety regarding MDRO acquisition.
- Findings support the implementation of risk-factor-guided ACPs in ICUs.
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