Less contact isolation is more in the ICU: con
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LESS IS MORE IN INTENSIVE CARE
Less contact isolation is more in the ICU: con Gabriel Birgand1, Jeroen Schouten2 and Etienne Ruppé3* © 2019 Springer-Verlag GmbH Germany, part of Springer Nature
Nearly half of all hospital-acquired infections (HAI) occur in intensive care units (ICU) [1]. Among HAIs, those caused by multidrug-resistant organisms (MDRO) are associated with poor patient outcomes. The ICU setting involves multiple facilitators for the development of antimicrobial resistance: loss of physiological barriers, high transmission risk, and high ecological antibiotic pressure (an average of 70% of patients in ICU are prescribed antibiotics [2]). MDRO may be transmitted from patient-to-patient via staff hands, from the environment or event directly from person to person. Furthermore, ICU represents a hub in the hospital network and MDRO can spread from the ICU to other wards, other hospitals, or long-term care facilities, where patients are discharged [3]. The epidemiology of MDRO has been changing dramatically during the last decade, especially due to the rise in the community settings of carbapenemase-producing Enterobacterales (CPE) species (namely, those producing NDM and OXA-48-like carbapenemases) in addition to the common MDRO already well settled in the ICU (methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant enterococci [VRE], extendedspectrum beta-lactamases-producing Enterobacterales [ESBLE], other CPE, Pseudomonas aeruginosa, and Acinetobacter baumannii). To circumvent the circulation of MDRO, the basics of infection control are pivotal. Standard precautions primarily represent the horizontal approach based on hand hygiene compliance and thorough environmental cleaning. As a consequence, compliance of staff with these standard precautions is critical for the control of MDRO dissemination [4]. Nonetheless, compliance with the World Health Organization’s “Five Moments for Hand *Correspondence: [email protected] 3 Université de Paris, IAME, INSERM, 75018 Paris, France Full author information is available at the end of the article
Hygiene” remains poor in ICU with an estimated rate of 59.6% in a recent review [5]. To overcome this issue, a vertical approach, including active surveillance culture and contact precautions (CPs) for colonized patients was introduced. CPs include wearing gowns and gloves when in direct contact with the patient and are usually associated with isolation of the patient in a single-bed room. These measures contribute to a better knowledge and awareness by healthcare workers making tangible the risk of transmission. Studies performed in ICU describe a substantial (15–21%) increase in hand hygiene compliance for patients under CPs [6, 7]. However, large clinical trials have failed to clarify that CPs could have a beneficial effect for preventing the transmission of MDRO. Indeed, assessing the effectiveness of CPs as a single measure is challenging. One of the reasons for that is that most of studies published in the field have been performed in var
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