Contact isolation versus standard precautions to decrease acquisition of extended-spectrum β-lactamase-producing...

Area of Science:

• Infection Control and Hospital Epidemiology
• Antimicrobial Resistance
• Clinical Microbiology

Background:

• The effectiveness of contact isolation in reducing the transmission of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) is debated.
• ESBL-E poses a significant threat in healthcare settings, necessitating effective control strategies.
• Active surveillance culture programs are employed to monitor and manage the spread of multidrug-resistant organisms.

Purpose of the Study:

• To evaluate the benefits of contact isolation compared to standard precautions for reducing ESBL-E colonization and infection.
• To assess the impact of contact isolation on the incidence density of ESBL-E in adult medical and surgical wards.
• To determine the efficacy of enhanced infection control measures in a real-world hospital setting with active surveillance.

Main Methods:

• A cluster-randomised crossover trial was conducted in 20 adult wards across four European university hospitals.
• Wards were randomised to either standard precautions alone or contact isolation in addition to standard precautions for 12-month periods.
• Patients were screened for ESBL-E carriage upon admission, weekly, and at discharge; incidence density was the primary outcome.

Main Results:

• The incidence density of ward-acquired ESBL-E was similar between contact isolation periods (6.0 events/1000 patient-days) and standard precaution periods (6.1 events/1000 patient-days).
• Multivariable analysis, adjusted for relevant factors, showed no significant difference in ESBL-E incidence rates between the two strategies (Incidence Rate Ratio: 0.99; p=0.9177).
• The study included 38,357 admitted patients, with 11,368 patients (75%) meeting the criteria for the per-protocol population analysis.

Conclusions:

• Contact isolation, when added to standard precautions, provided no additional benefit in controlling the spread of ESBL-E on non-critical care wards.
• Extensive surveillance screening may influence the perceived effectiveness of isolation strategies.
• Standard precautions appear sufficient for managing ESBL-E on these types of hospital wards.