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Transmission-Based Precautions for Multidrug-Resistant Organisms: What to Prioritize When Resources Are Limited

  • Infection Prevention and Safety in Low and Middle Income Countries (C Bardossy, Section Editor)
  • Published:
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Opinion statement

Isolation precautions are infection control precautions intended to be used in healthcare settings to decrease the probability of transmission of multidrug-resistant pathogens through the hands of healthcare workers. It consists of the use of gown and gloves when touching the patient or his surroundings. The effectiveness of isolation precaution could be enhanced by the use of surveillance cultures which are cultures collected for the identification of colonized patients who had not been identified previously. To guarantee its cost-effectiveness, it is important to apply contact precautions in situations where the patient is colonized by an epidemiologically important pathogen for each specific setting. An excessive adoption of contact precautions could increase costs, banalize the intervention, and end up reaching low compliance rates by healthcare workers (HCW).

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. MacPherson DW. Population mobility, globalization, and antimicrobial drug resistance. Emerg Infect Dis. 2009; https://doi.org/10.3201/eid1511.090419.

  2. van Kleef E, Robotham JV, Jit M, Deeny SR, Edmunds WJ. Modelling the transmission of healthcare associated infections: a systematic review. BMC Infect Dis. 2013;13(1):294. https://doi.org/10.1186/1471-2334-13-294.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Feldman N, Adler A, Molshatzki N, Navon-Venezia S, Khabra E, Cohen D, et al. Gastrointestinal colonization by KPC-producing Klebsiella pneumoniae following hospital discharge: duration of carriage and risk factors for persistent carriage. Clin Microbiol Infect. 2013;19(4):E190–6. https://doi.org/10.1111/1469-0691.12099.

    Article  CAS  PubMed  Google Scholar 

  4. Zimmerman FS, Assous MV, Bdolah-Abram T, Lachish T, Yinnon AM, Wiener-Well Y. Duration of carriage of carbapenem-resistant Enterobacteriaceae following hospital discharge. Am J Infect Control. 2013;41(3):190–4. https://doi.org/10.1016/j.ajic.2012.09.020.

    Article  PubMed  Google Scholar 

  5. WHO Guidelines on Hand Hygiene in Health Care. World Health Organization. WHO Guidelines On Hand Hygiene In Health Care. 2009. World Health Organization Website. http://apps.who.int/iris/bitstream/10665/44102/1/9789241597906_eng.pdf Published 2009. Acessed 29 July 2017. This is the most complete guideline on hand hygiene in healthcare and strategies of implementation.

  6. Siegel JD, Rhinehart E, Jackson M, Chiarello L, the Healthcare Infection Control Practices Advisory Committee. Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. 2007. https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html.

  7. DalBen MF, Teixeira Mendes E, Moura ML, et al. A model-based strategy to control the spread of carbapenem-resistant Enterobacteriaceae: simulate and implement. Infect Control Hosp Epidemiol. 2016;37(11):1315–22. https://doi.org/10.1017/ice.2016.168.

    Article  Google Scholar 

  8. Morgan DJ, Rogawski E, Thom KA, Johnson JK, Perencevich EN, Shardell M, et al. Transfer of multidrug-resistant bacteria to healthcare workers’ gloves and gowns after patient contact increases with environmental contamination. Crit Care Med. 2012;40(4):1045–51. https://doi.org/10.1097/CCM.0b013e31823bc7c8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Cohen MJ, Block C, Levin PD, Schwartz C, Gross I, Weiss Y, et al. Institutional control measures to curtail the epidemic spread of carbapenem-resistant Klebsiella pneumoniae: a 4-year perspective. Infect Control Hosp Epidemiol. 2011;32(7):673–8. https://doi.org/10.1086/660358.

    Article  PubMed  Google Scholar 

  10. Gbaguidi-Haore H, Legast S, Thouverez M, Bertrand X, Talon D. Ecological study of the effectiveness of isolation precautions in the management of hospitalized patients colonized or infected with Acinetobacter baumannii. Infect Control Hosp Epidemiol. 2008;29(12):1118–23. https://doi.org/10.1086/592697.

    Article  PubMed  Google Scholar 

  11. Vonberg R-P, Wolter A, Chaberny IF, Kola A, Ziesing S, Suerbaum S, et al. Epidemiology of multi-drug-resistant Gram-negative bacteria: data from an university hospital over a 36-month period. Int J Hyg Environ Health. 2008;211(3–4):251–7. https://doi.org/10.1016/j.ijheh.2007.08.008.

    Article  PubMed  Google Scholar 

  12. Rodríguez-Baño J, García L, Ramírez E, Martínez-Martínez L, Muniain MA, Fernández-Cuenca F, et al. Long-term control of hospital-wide, endemic multidrug-resistant Acinetobacter baumannii through a comprehensive “bundle” approach. Am J Infect Control. 2009;37(9):715–22. https://doi.org/10.1016/j.ajic.2009.01.008.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kochar S, Sheard T, Sharma R, Hui A, Tolentino E, Allen G, et al. Success of an infection control program to reduce the spread of carbapenem-resistant Klebsiella pneumoniae. Infect Control Hosp Epidemiol. 2009;30(5):447–52. https://doi.org/10.1086/596734.

    Article  PubMed  Google Scholar 

  14. • Cohen CC, Cohen B, Shang J. Effectiveness of contact precautions against multidrug-resistant organism transmission in acute care: a systematic review of the literature. J Hosp Infect. 2015;90(4):275–84. https://doi.org/10.1016/j.jhin.2015.05.003. This systematic review analyzes articles aimed at evaluating contact precaution effectiveness.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. •• Tacconelli E, Cataldo MA, Dancer SJ, de Angelis G, Falcone M, Frank U, et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect. 2014;20:1–55. https://doi.org/10.1111/1469-0691.12427. The authors reviewed the evidence for infection control strategies in the control of multidrug-resistant gram-negatives.

    Article  PubMed  Google Scholar 

  16. Tschudin-Sutter S, Frei R, Dangel M, Stranden A, Widmer AF. Rate of transmission of extended-spectrum beta-lactamase-producing Enterobacteriaceae without contact isolation. Clin Infect Dis. 2012;55(11):1505–11. https://doi.org/10.1093/cid/cis770.

    Article  PubMed  Google Scholar 

  17. Han JH, Bilker WB, Nachamkin I, Zaoutis TE, Coffin SE, Linkin DR, et al. The effect of a hospital-wide urine culture screening intervention on the incidence of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella species. Infect Control Hosp Epidemiol. 2013;34(11):1160–6. https://doi.org/10.1086/673453.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Huskins WC, Huckabee CM, O’Grady NP, et al. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med. 2011;364(15):1407–18. https://doi.org/10.1056/NEJMoa1000373.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Harris AD, Pineles L, Belton B, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU. JAMA. 2013;310(15):1571–80. https://doi.org/10.1001/jama.2013.277815.

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Morgan DJ, Wenzel RP, Bearman G. Contact precautions for endemic MRSA and VRE. JAMA. 2017;318(4):329–30. https://doi.org/10.1001/jama.2017.7419.

    Article  PubMed  Google Scholar 

  21. Tschudin-Sutter S, Lucet J-C, Mutters NT, Tacconelli E, Zahar JR, Harbarth S. Contact precautions for preventing nosocomial transmission of extended-spectrum β lactamase–producing Escherichia coli: a point/counterpoint review. Clin Infect Dis. 2017;65(2):342–7. https://doi.org/10.1093/cid/cix258.

    Article  PubMed  Google Scholar 

  22. Safdar N, Sengupta S, Musuuza JS, Juthani-Mehta M, Drees M, Abbo LM, et al. Status of the prevention of multidrug-resistant organisms in international settings: a survey of the Society for Healthcare Epidemiology of America Research Network. Infect Control Hosp Epidemiol. 2017;38(1):53–60. https://doi.org/10.1017/ice.2016.242.

    Article  PubMed  Google Scholar 

  23. Debby BD, Ganor O, Yasmin M, David L, Nathan K, Ilana T, et al. Epidemiology of carbapenem resistant Klebsiella pneumoniae colonization in an intensive care unit. Eur J Clin Microbiol Infect Dis. 2012;31(8):1811–7. https://doi.org/10.1007/s10096-011-1506-5.

    Article  CAS  PubMed  Google Scholar 

  24. Kurup A, Chlebicka N, Tan KY, Chen EX, Oon L, Ling TA, et al. Active surveillance testing and decontamination strategies in intensive care units to reduce methicillin-resistant Staphylococcus aureus infections. Am J Infect Control. 2010;38(5):361–7. https://doi.org/10.1016/j.ajic.2009.09.018.

    Article  PubMed  Google Scholar 

  25. Siddiqui AH, Harris AD, Hebden J, Wilson PD, Morris JG, Roghmann M-C. The effect of active surveillance for vancomycin-resistant enterococci in high-risk units on vancomycin-resistant enterococci incidence hospital-wide. Am J Infect Control. 2002;30(1):40–3. https://doi.org/10.1067/mic.2002.118616.

    Article  PubMed  Google Scholar 

  26. Lucet J-C, Paoletti X, Lolom I, Paugam-Burtz C, Trouillet JL, Timsit JF, et al. Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med. 2005;31(8):1051–7. https://doi.org/10.1007/s00134-005-2679-0.

    Article  PubMed  Google Scholar 

  27. Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol. 2003;24(5):362–86. https://doi.org/10.1087/502213.

    Article  PubMed  Google Scholar 

  28. Ostrowsky BE, Trick WE, Sohn AH, Quirk SB, Holt S, Carson LA, et al. Control of vancomycin-resistant enterococcus in health care facilities in a region. N Engl J Med. 2001;344(19):1427–33. https://doi.org/10.1056/NEJM200105103441903.

    Article  CAS  PubMed  Google Scholar 

  29. Benenson S, Levin PD, Block C, Adler A, Ergaz Z, Peleg O, et al. Continuous surveillance to reduce extended-spectrum b-lactamase Klebsiella pneumoniae colonization in the neonatal intensive care unit. Neonatology. 2013;103(2):155–60. https://doi.org/10.1159/000343150.

    Article  CAS  PubMed  Google Scholar 

  30. Bonten MJ, Slaughter S, Ambergen AW, et al. The role of colonization pressure in the spread of vancomycin-resistant enterococci: an important infection control variable. Arch Intern Med. 1998;158(10):1127–32. https://doi.org/10.1001/archinte.158.10.1127.

    Article  CAS  PubMed  Google Scholar 

  31. Merrer J, Santoli F, Vecchi CA-D, Tran B, De Jonghe B, Outin H. “Colonization pressure” and risk of acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol. 2000;21(11):718–23. https://doi.org/10.1086/501721.

    Article  CAS  PubMed  Google Scholar 

  32. DalBen MF, Basso M, Garcia CP, Costa SF, Toscano CM, Jarvis WR, et al. Colonization pressure as a risk factor for colonization by multiresistant Acinetobacter spp and carbapenem-resistant Pseudomonas aeruginosa in an intensive care unit. Clinics (Sao Paulo). 2013;68(8):1128–33. https://doi.org/10.6061/clinics/2013(08)11.

    Article  Google Scholar 

  33. Williams VR, Callery S, Vearncombe M, Simor AE. The role of colonization pressure in nosocomial transmission of methicillin-resistant Staphylococcus aureus. Am J Infect Control. 2009;37(2):106–10. https://doi.org/10.1016/j.ajic.2008.05.007.

    Article  PubMed  Google Scholar 

  34. Ajao AO, Harris AD, Roghmann M-C, Johnson JK, Zhan M, McGregor JC, et al. Systematic review of measurement and adjustment for colonization pressure in studies of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and Clostridium difficile acquisition. Infect Control Hosp Epidemiol. 2011;32(5):481–9. https://doi.org/10.1086/659403.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Swaminathan M, Sharma S, Blash SP, Patel G, Banach DB, Phillips M, et al. Prevalence and risk factors for acquisition of carbapenem-resistant Enterobacteriaceae in the setting of endemicity. Infect Control Hosp Epidemiol. 2013;34(8):809–17. https://doi.org/10.1086/671270.

    Article  PubMed  Google Scholar 

  36. Torres-Gonzalez P, Cervera-Hernandez ME, Niembro-Ortega MD, Leal-Vega F, Cruz-Hervert LP, García-García L, et al. Factors associated to prevalence and incidence of carbapenem-resistant Enterobacteriaceae fecal carriage: a cohort study in a Mexican tertiary care hospital. Conly J, ed. PLoS One. 2015;10(10):e0139883. https://doi.org/10.1371/journal.pone.0139883.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Papadimitriou-Olivgeris M, Christofidou M, Fligou F, Bartzavali C, Vrettos T, Filos KS, et al. The role of colonization pressure in the dissemination of colistin or tigecycline resistant KPC-producing Klebsiella pneumoniae in critically ill patients. Infection. 2014;42(5):883–90. https://doi.org/10.1007/s15010-014-0653-x.

    Article  CAS  PubMed  Google Scholar 

  38. Bootsma MCJ, Diekmann O, Bonten MJM. Controlling methicillin-resistant Staphylococcus aureus: quantifying the effects of interventions and rapid diagnostic testing. Proc Natl Acad Sci. 2006;103(14):5620–5. https://doi.org/10.1073/pnas.0510077103.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Muto CA, Giannetta ET, Durbin LJ, Simonton BM, Farr BM. Cost-effectiveness of perirectal surveillance cultures for controlling vancomycin-resistant enterococcus. Infect Control Hosp Epidemiol. 2002;23(8):429–35. https://doi.org/10.1086/502080.

    Article  PubMed  Google Scholar 

  40. Perencevich EN, Fisman DN, Lipsitch M, Harris AD, Morris JG Jr, Smith DL. Projected benefits of active surveillance for vancomycin-resistant enterococci in intensive care units. Clin Infect Dis. 2004;38(8):1108–15. https://doi.org/10.1086/382886.

    Article  PubMed  Google Scholar 

  41. Yoon YK, Kim HJ, Lee WJ, Lee SE, Yang KS, Park DW, et al. Clinical prediction rule for identifying patients with vancomycin-resistant enterococci (VRE) at the time of admission to the intensive care unit in a low VRE prevalence setting. J Antimicrob Chemother. 2012;67(12):2963–9. https://doi.org/10.1093/jac/dks303.

    Article  CAS  PubMed  Google Scholar 

  42. Furuno JP, McGregor JC, Harris AD, et al. Identifying groups at high risk for carriage of antibiotic-resistant bacteria. Arch Intern Med. 2006;166(5):580–5. https://doi.org/10.1001/archinte.166.5.580.

    Article  PubMed  Google Scholar 

  43. Harbarth S, Sax H, Fankhauser-Rodriguez C, Schrenzel J, Agostinho A, Pittet D. Evaluating the probability of previously unknown carriage of MRSA at hospital admission. Am J Med. 2006;119(3):275.e15–23. https://doi.org/10.1016/j.amjmed.2005.04.042.

    Article  Google Scholar 

  44. Jernigan JA, Clemence MA, Stott GA, Titus MG, Alexander CH, Palumbo CM, et al. Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol. 1995;16(12):686–96. https://doi.org/10.2307/30141911.

    Article  CAS  PubMed  Google Scholar 

  45. Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet. 2000;356(9238):1307–12. https://doi.org/10.1016/S0140-6736(00)02814-2.

    Article  CAS  PubMed  Google Scholar 

  46. Larson E. Skin hygiene and infection prevention: more of the same or different approaches? Clin Infect Dis. 1999;29(5):1287–94. https://doi.org/10.1086/313468.

    Article  CAS  PubMed  Google Scholar 

  47. Kollef MH, Fraser VJ. Antibiotic resistance in the intensive care unit. Ann Intern Med. 2001;134(4):298–314. https://doi.org/10.7326/0003-4819-134-4-200102200-00014.

    Article  CAS  PubMed  Google Scholar 

  48. Trick WE, Vernon MO, Welbel SF, DeMarais P, Hayden MK, Weinstein RA, et al. Multicenter intervention program to increase adherence to hand hygiene recommendations and glove use and to reduce the incidence of antimicrobial resistance. Infect Control Hosp Epidemiol. 2007;28(1):42–9. https://doi.org/10.1086/510809.

    Article  PubMed  Google Scholar 

  49. French CE, Coope C, Conway L, Higgins JPT, McCulloch J, Okoli G, et al. Control of carbapenemase-producing Enterobacteriaceae outbreaks in acute settings: an evidence review. J Hosp Infect. 2017;95(1):3–45. https://doi.org/10.1016/j.jhin.2016.10.006. This is an important reference as it is a complete review of measures to control carbapenem resistant Enterobacteriaceae in acute settings.

    Article  CAS  PubMed  Google Scholar 

  50. Birgand G, Leroy C, Nerome S, Luong Nguyen LB, Lolom I, Armand-Lefevre L, et al. Costs associated with implementation of a strict policy for controlling spread of highly resistant microorganisms in France. BMJ Open. 2016;6(1):e009029. https://doi.org/10.1136/bmjopen-2015-009029.

    Article  PubMed  PubMed Central  Google Scholar 

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  1. Hospital Sírio Libanês, Rua Frei Caneca, 640 01307-000, São Paulo, Brazil

    Mirian F. DalBen MD, Msc

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DalBen, M.F. Transmission-Based Precautions for Multidrug-Resistant Organisms: What to Prioritize When Resources Are Limited. Curr Treat Options Infect Dis 10, 40–47 (2018). https://doi.org/10.1007/s40506-018-0143-2

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