Iordanou Stelios, Palazis Lakis, Timiliotou-Matsentidou Chrystalla, Mendris Michalis, Raftopoulos Vasilios
Intensive Care Unit, Limassol General Hospital, Limassol, CYP.
Intensive Care Unit, Nicosia General Hospital, Nicosia, CYP.
Cureus. 2021 Mar 1;13(3):e13636. doi: 10.7759/cureus.13636.
Background The need for the implementation of an infection prevention strategy that included patient isolation and a cohorting procedure emerged in our ICU. Yet, isolation, as well as cohorting, were not feasible due to certain barriers associated with a high colonization pressure, open-plan ICU, inadequate bed separation, a limited number of isolation rooms, and nursing shortage. Despite these limitations, we tried to upgrade our ICU's infection prevention efforts by developing the "universal use of contact precautions approach" for infection prevention and control for all the patients with and without multidrug-resistant organisms (MDROs), cohorting, and single room isolation. The study aimed to evaluate the effectiveness of our approach. Methods A prospective cohort study using surveillance screening cultures for () and MDROs for a period of 18 weeks from October 1, 2018, to January 31, 2019. The main purpose of the approach was to isolate all patients (regardless of their MDRO/MRSA status) in their own bed space as if they were in an isolation room for the entire duration of their ICU hospitalization, in such a way as to prevent horizontal transmission of infection (infection acquisition) in our open-plan ICU. Results Seventy-eight patients were admitted to our ICU for a total of 942 patient-days; a total of 432 swabs were collected during the study period. A total of 17 (21.8%) patients were admitted with a pre-existing infection while two (2.5%) patients acquired an infection during their ICU stay (one with andonewith ; 1.28 acquisition per 1000 patient-days). No transmission was documented for , and Conclusions Our MDRO acquisition rates suggested that the implementation of our infection control strategy potentially prevents the horizontal transmission of pathogens in an open-plan ICU, despite the high colonization pressure and the lack of isolation and cohorting procedures.
在我们的重症监护病房（ICU）中，出现了实施包括患者隔离和分组程序在内的感染预防策略的需求。然而，由于与高定植压力、开放式ICU、床位分隔不足、隔离病房数量有限以及护理短缺相关的某些障碍，隔离以及分组都不可行。尽管存在这些限制，我们仍试图通过为所有有和没有多重耐药菌（MDRO）的患者制定“普遍采用接触预防措施方法”、分组和单人房间隔离来加强我们ICU的感染预防工作。该研究旨在评估我们方法的有效性。方法：一项前瞻性队列研究，从2018年10月1日至2019年1月31日，为期18周，使用监测筛查培养物检测（）和MDRO。该方法的主要目的是在患者整个ICU住院期间，将所有患者（无论其MDRO/耐甲氧西林金黄色葡萄球菌[MRSA]状态如何）隔离在自己的床位空间，就好像他们处于隔离病房一样，以防止在我们的开放式ICU中发生感染的水平传播（感染获得）。结果：78名患者入住我们的ICU，总计942个患者日；在研究期间共采集了432份拭子。共有17名（21.8%）患者入院时已有感染，而2名（2.5%）患者在ICU住院期间获得感染（1名感染[具体感染类型未明确]，1名感染[具体感染类型未明确]；每1000个患者日感染发生率为1.28）。未记录到[具体病原体未明确]、[具体病原体未明确]和[具体病原体未明确]的传播。结论：我们的MDRO获得率表明，尽管存在高定植压力以及缺乏隔离和分组程序，但实施我们的感染控制策略可能会防止开放式ICU中病原体的水平传播。
