Less contact isolation is more in the ICU: pro

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LESS IS MORE IN INTENSIVE CARE

Less contact isolation is more in the ICU: pro Garyphallia Poulakou1*  , Saad Nseir2,3 and George L. Daikos4 © 2020 Springer-Verlag GmbH Germany, part of Springer Nature

Additional contact precautions (ACP) have been endorsed by International Recommendations in patients with colonisation or infection by multidrug-resistant organisms (MDRO) [1, 2]. Contact isolation (CI), considered initially as the holy grail of the interruption of transmission of MDROs, currently remains debated [3, 4]. Suboptimal contact of healthcare personnel with the patients has been associated with service care errors including falls, pressure ulcers, fluid/electrolyte disorders and suboptimal documentation of vital signs or physician notes. Patients’ dissatisfaction and stress as well as increased healthcare costs are the major downsides of CI [3]. In view of the divergent opinions in the literature, infection control practices in ICU vary considerably. In this narrative review, we will focus on the most relevant studies, with messages in line with the principle “less is more” (Table  1). In the present manuscript, we considered “less CI” as surrogate to “not universal" or “targeted” CI (and evidently not “no CI”). However, we also discuss studies in which CI seems less important or less effective compared to other pivotal infection control measures, therefore, less desirable. Search methods are shown in Supplement Table. The efficacy of CI over properly enforced standard precautions with particular focus on adherence to hand hygiene has been questioned. Huskins et  al. performed universal screening of patients and then pre-emptive isolation followed by barrier precautions for identified carriers; no significant change in acquisition of MRSA or VRE was demonstrated [4]. Also, Cepeda et  al. showed that transfer of MRSA-colonised patients into single rooms or cohorting did not confer to reduced cross-infection [5]

*Correspondence: [email protected] 1 3rd Department of Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, Address 152 Mesogion st, 11527 Athens, Greece Full author information is available at the end of the article

As far as MDR Gram-negative bacteria (MDR-GNB) are concerned, despite international recommendations, no single infection control approach (and particularly not CI) alone was associated with positive outcomes, especially in endemic settings. A recent systematic review and network meta-analysis evaluating (1) standard care (including contact precautions), (2) antimicrobial stewardship, (3) environmental cleaning, (4) source control or (5) decolonization methods for the prevention of multidrug-resistant Gram-negative bacteria (MDR-GNB) in adult Intensive Care Units (ICUs) showed that only fourcomponent strategies adopting components (1)–(5) were effective to prevent MDR-GNB acquisition [6]. Environmental cleaning seems important component for Acinetobacter baumannii, whereas decolonization strategy was pivotal in K. pneumoniae albeit data

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