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Impact of Multifaceted Interventions Including Waterless Patient Care on Endemic Occurrence of Serratia marcescens in
Romain Martischang1, Gaud Catho1,2, Abdessalam Cherkaoui3
1Infection Control Program, WHO Collaborating Center for Patient Safety, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil, 4, CH-1205 Geneva, Switzerland.
Abstract:
Serratia marcescens acquisition is a common problem in intensive care units (ICUs). Following an initial outbreak in 2017 with ongoing endemicity, this study aimed to analyze the impact of behavioral interventions and sink removals on S. marcescens incidence in a tertiary-care ICU. We conducted a quasi-experimental, interventional study including patients with a positive screening or clinical culture for S. marcescens, from 48 h (D2) after ICU admission to 14 days after ICU discharge. A sub-analysis considered patients positive for S. marcescens from ICU admission (D0) to 14 days after ICU discharge. Multivariate Poisson regression analyses were performed. Between January 2014 and December 2022, 167 cases of S. marcescens infection or colonization were identified (respiratory samples, 71%). Despite the presence of an aquatic reservoir, we found that neither behavioral nor architectural interventions (sink removal) reduced significantly S. marcescens incidence, yielding incidence ratios of 1.02 [95%CI 0.33-3.11] and 4.25 [95%CI 0.59-30.56], respectively. However, an association was observed with administration of selective oral decontamination (SOD) in the sub-cohort (OR 1.01; 95%CI 1.00-1.03). Behavioral change interventions and transition to a waterless ICU did not control endemic, polyclonal S. marcescens occurrence. The selective pressure exercised by SOD may have reduced the effectiveness of waterless care.
Insights
Neither behavioral changes nor sink removal effectively reduced Serratia marcescens in ICUs. Selective oral decontamination (SOD) showed a potential association with increased incidence, suggesting it may counteract waterless care effectiveness.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Intensive Care Medicine
Background:
- Serratia marcescens is a common pathogen in intensive care units (ICUs), posing a significant challenge.
- An outbreak in 2017 led to ongoing endemicity, necessitating an evaluation of control strategies.
Purpose of the Study:
- To assess the impact of behavioral interventions and sink removal on Serratia marcescens incidence in a tertiary-care ICU.
- To analyze the association between selective oral decontamination (SOD) and S. marcescens occurrence.
Main Methods:
- A quasi-experimental, interventional study design was employed.
- Data included patients with positive S. marcescens cultures from ICU admission or shortly after, up to 14 days post-discharge.
- Multivariate Poisson regression analyses were used to evaluate intervention impacts.
Main Results:
- Between 2014 and 2022, 167 cases of S. marcescens infection or colonization were identified, predominantly in respiratory samples (71%).
- Neither behavioral interventions (IR 1.02) nor sink removal (IR 4.25) significantly reduced S. marcescens incidence.
- Selective oral decontamination (SOD) showed a potential association with increased incidence (OR 1.01).
Conclusions:
- Behavioral changes and architectural modifications (waterless ICU) did not control endemic Serratia marcescens.
- The selective pressure from SOD might have diminished the efficacy of waterless care strategies.
- Further research is needed to understand the complex interplay of interventions and S. marcescens control.
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