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Published on: March 17, 2023
Effects of Cessation of Single-Room Isolation on Transmission of Vancomycin-Resistant Enterococcus in a Hospital
Si-Ho Kim1,2, Yu Jin Lee1, Ji Hong Park1
1Center for Infection Prevention and Control, Samsung Changwon Hospital, Changwon, Korea.
Background:
Single room isolation with contact precautions is widely regarded as a fundamental strategy to prevent the transmission of multidrug-resistant organisms (MDROs). However, its implementation demands substantial resources, limiting its universal application to all MDROs. In this study, we assessed the effect of discontinuing single room isolation for vancomycin-resistant Enterococcus (VRE).
Methods:
This is a retrospective, observational study conducted at a single 750-bed tertiary center. We conducted an interrupted time series analysis to compare incidence rates and trends of new-onset VRE colonization and bacteremia during the one year before and after the strategy change on January 1, 2023.
Results:
Single-room occupancy decreased from 79.7% pre-intervention to 23.6% post-intervention (P < 0.001). The incidence rate of new-onset VRE colonization was 0.452 and 0.535 per 1,000 patient-days in the pre- and post-intervention periods, respectively, with no statistically significant difference (P = 0.202). However, there was a slightly increasing trend (0.036 [95% confidence interval, -0.002, 0.074] increase per month, P = 0.066). The new-onset VRE bacteremia incidence rate was not differed in incidence (0.060 and 0.055, P = 0.571) or trend (P = 0.720).
Conclusion:
Our study suggests that discontinuing single-room isolation for VRE patients may not affect the incidence of new-onset VRE bacteremia, but caution is needed due to the potential increase in colonization.
Insights
Discontinuing single room isolation for vancomycin-resistant Enterococcus (VRE) did not significantly impact VRE bacteremia rates. However, a slight increase in VRE colonization suggests caution is warranted.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Infection Control
Background:
- Single room isolation is a standard infection control measure for multidrug-resistant organisms (MDROs).
- Implementing universal single room isolation is resource-intensive and may not be feasible for all MDROs.
- This study evaluated the impact of discontinuing single room isolation for vancomycin-resistant Enterococcus (VRE).
Purpose of the Study:
- To assess the effect of discontinuing single room isolation on VRE transmission.
- To compare VRE colonization and bacteremia rates before and after the policy change.
Main Methods:
- Retrospective, observational study at a single tertiary care center.
- Interrupted time series analysis comparing one year pre- and post-intervention (January 1, 2023).
- Monitored incidence rates and trends of new-onset VRE colonization and bacteremia.
Main Results:
- Single-room occupancy significantly decreased post-intervention (79.7% to 23.6%).
- No significant difference in new-onset VRE colonization incidence (0.452 vs. 0.535 per 1,000 patient-days).
- VRE bacteremia incidence and trends remained unchanged; a slight increasing trend in colonization was observed.
Conclusions:
- Discontinuing single room isolation for VRE patients did not increase VRE bacteremia.
- A potential increase in VRE colonization warrants careful monitoring and consideration.
- Resource allocation for infection control strategies requires re-evaluation.
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