Reduction of nosocomial bloodstream infections and nosocomial vancomycin-resistant Enterococcus faecium on an intensive care unit after introduction of antiseptic octenidine-based bathing.
Anti-Infective Agents, Local
/ administration & dosage
Baths
/ methods
Cross Infection
/ microbiology
Disease Transmission, Infectious
/ prevention & control
Disinfection
/ methods
Enterococcus faecium
/ isolation & purification
Germany
Gram-Positive Bacterial Infections
/ microbiology
Hospitals, University
Humans
Imines
Intensive Care Units
Prevalence
Pyridines
/ administration & dosage
Sepsis
/ microbiology
Vancomycin-Resistant Enterococci
/ isolation & purification
Antiseptic bathing
Enterococcus spp.
Octenidine
VRE
Vancomycin resistance
Journal
The Journal of hospital infection
ISSN: 1532-2939
Titre abrégé: J Hosp Infect
Pays: England
ID NLM: 8007166
Informations de publication
Date de publication:
Mar 2019
Mar 2019
Historique:
received:
31
08
2018
accepted:
30
10
2018
pubmed:
9
11
2018
medline:
19
3
2019
entrez:
9
11
2018
Statut:
ppublish
Résumé
Vancomycin-resistant Enterococcus faecium (VRE) is emerging in German intensive care units (ICUs). On a 32-bed surgical ICU at a university hospital, increasing numbers of nosocomial cases occurred despite enforcement of hand hygiene and environmental disinfection. To introduce universal octenidine-based bathing in order to reduce the burden of VRE. Between January 2012 and March 2014, patients were screened for VRE on admission and twice weekly. Active surveillance was undertaken for VRE infections and colonizations, and for bloodstream infections (BSI) with any pathogen. Intervention in this before-after study comprised of standardized octenidine-based bathing. Distinct subgroups of VRE colonizations or infections were defined and used for statistical analysis of frequency, prevalence and incidence density. In the pre-intervention period (January 2012 to April 2013), the admission prevalence of VRE was 4/100 patients and the mean incidence density of nosocomial cases was 7.55/1000 patient-days (PD). Pulsed-field gel electrophoresis analysis revealed prevalence of three vanA and two vanB clusters. In the post-intervention period (August 2013 to March 2014), the admission prevalence of VRE was 2.41/100 patients and the mean incidence density of nosocomial cases was 2.61/1000 PD [P = 0.001 (pre- vs post-intervention)]. Thirteen nosocomial VRE infections were identified in the pre-intervention period, compared with one nosocomial VRE infection in the post-intervention period. Incidence densities of BSI pre- and post-intervention were 2.98 and 2.06/1000 PD (P = 0.15), respectively. The epidemiology of emerging VRE appeared as a complex mix of admitted cases and transmissions in small clusters, challenging infection control measures. The implementation of universal octenidine-based bathing combined with a standardized washing regime led to a significant reduction in nosocomial VRE.
Sections du résumé
BACKGROUND
BACKGROUND
Vancomycin-resistant Enterococcus faecium (VRE) is emerging in German intensive care units (ICUs). On a 32-bed surgical ICU at a university hospital, increasing numbers of nosocomial cases occurred despite enforcement of hand hygiene and environmental disinfection.
AIM
OBJECTIVE
To introduce universal octenidine-based bathing in order to reduce the burden of VRE.
METHODS
METHODS
Between January 2012 and March 2014, patients were screened for VRE on admission and twice weekly. Active surveillance was undertaken for VRE infections and colonizations, and for bloodstream infections (BSI) with any pathogen. Intervention in this before-after study comprised of standardized octenidine-based bathing. Distinct subgroups of VRE colonizations or infections were defined and used for statistical analysis of frequency, prevalence and incidence density.
FINDINGS
RESULTS
In the pre-intervention period (January 2012 to April 2013), the admission prevalence of VRE was 4/100 patients and the mean incidence density of nosocomial cases was 7.55/1000 patient-days (PD). Pulsed-field gel electrophoresis analysis revealed prevalence of three vanA and two vanB clusters. In the post-intervention period (August 2013 to March 2014), the admission prevalence of VRE was 2.41/100 patients and the mean incidence density of nosocomial cases was 2.61/1000 PD [P = 0.001 (pre- vs post-intervention)]. Thirteen nosocomial VRE infections were identified in the pre-intervention period, compared with one nosocomial VRE infection in the post-intervention period. Incidence densities of BSI pre- and post-intervention were 2.98 and 2.06/1000 PD (P = 0.15), respectively.
CONCLUSION
CONCLUSIONS
The epidemiology of emerging VRE appeared as a complex mix of admitted cases and transmissions in small clusters, challenging infection control measures. The implementation of universal octenidine-based bathing combined with a standardized washing regime led to a significant reduction in nosocomial VRE.
Identifiants
pubmed: 30408504
pii: S0195-6701(18)30584-X
doi: 10.1016/j.jhin.2018.10.023
pii:
doi:
Substances chimiques
Anti-Infective Agents, Local
0
Imines
0
Pyridines
0
octenidine
OZE0372S5A
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
264-271Informations de copyright
Copyright © 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.