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Control of endemic multidrug-resistant Gram-negative bacteria after removal of sinks and implementing a new water-safe policy in an intensive care unit

  • E. Shaw
    Correspondence
    Corresponding author. Address: Department of Infectious Diseases, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 Hospitalet de Llobregat, Barcelona, Spain. Tel.: +34 93 2607274; fax: +34 93 2607637.
    Affiliations
    Department of Infectious Diseases, Hospital Universitari de Bellvitge–IDIBELL, Barcelona, Spain

    Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
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  • L. Gavaldà
    Affiliations
    Department of Preventive Medicine, Hospital Universitari de Bellvitge–IDIBELL, Barcelona, Spain
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  • J. Càmara
    Affiliations
    Department of Microbiology, Hospital Universitari de Bellvitge–IDIBELL, Barcelona, Spain
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  • R. Gasull
    Affiliations
    Department of Intensive Medicine, Hospital Universitari de Bellvitge–IDIBELL, Barcelona, Spain
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  • S. Gallego
    Affiliations
    Department of Intensive Medicine, Hospital Universitari de Bellvitge–IDIBELL, Barcelona, Spain
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  • F. Tubau
    Affiliations
    Department of Microbiology, Hospital Universitari de Bellvitge–IDIBELL, Barcelona, Spain

    CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
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  • R.M. Granada
    Affiliations
    Department of Intensive Medicine, Hospital Universitari de Bellvitge–IDIBELL, Barcelona, Spain
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  • P. Ciercoles
    Affiliations
    Department of Infectious Diseases, Hospital Universitari de Bellvitge–IDIBELL, Barcelona, Spain
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  • M.A. Dominguez
    Affiliations
    Department of Microbiology, Hospital Universitari de Bellvitge–IDIBELL, Barcelona, Spain

    Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain

    University of Barcelona, Barcelona, Spain
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  • R. Mañez
    Affiliations
    Department of Intensive Medicine, Hospital Universitari de Bellvitge–IDIBELL, Barcelona, Spain
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  • J. Carratalà
    Affiliations
    Department of Infectious Diseases, Hospital Universitari de Bellvitge–IDIBELL, Barcelona, Spain

    Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain

    University of Barcelona, Barcelona, Spain
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  • M. Pujol
    Affiliations
    Department of Infectious Diseases, Hospital Universitari de Bellvitge–IDIBELL, Barcelona, Spain

    Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
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Published:November 02, 2017DOI:https://doi.org/10.1016/j.jhin.2017.10.025

      Summary

      Background

      Contaminated handwashing sinks have been identified as reservoirs that can facilitate colonization/infection of patients with multidrug-resistant (MDR) Gram-negative bacteria (GNB) in intensive care units (ICUs).

      Aim

      To assess the impact of removing patients' sinks and implementing other water-safe strategies on the annual rates of ICU-acquired MDR-GNB.

      Methods

      This six-year quasi-experimental study was conducted from January 2011 to December 2016. The intervention was carried out in August 2014 in two adult ICU wards with 12 rooms each. To assess the changes in annual MDR-GNB rates before and after the intervention, we used segmented regression analysis of an interrupted time-series. Crude relative risk (RR) rates were also calculated.

      Findings

      The incidence rates of MDR-GNB were 9.15 and 2.20 per 1000 patient-days in the pre- and post-intervention periods, respectively. This yielded a crude RR of acquiring MDR-GNB of 0.24 (95% confidence interval: 0.17–0.34). A significant change in level was observed between the MDR-GNB rate at the first point of the post-intervention period and the rate predicted by the pre-intervention time trend.

      Conclusion

      The implementation of a new water-safe policy, which included the removal of sinks from all patient rooms, successfully improved the control of MDR-GNB spread in an ICU with endemic infection. Our results support the contribution of sink use with the incidence of MDR-GNB in endemic environments.

      Keywords

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      Linked Article

      • Response to Shaw et al.
        Journal of Hospital InfectionVol. 100Issue 1
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          We read with interest the work of Shaw et al. which aimed ‘to assess the impact of removing patients’ sinks and implementing other water-safe strategies on the annual rates of ICU [intensive care unit]-acquired MDR-GNB [multi-drug-resistant Gram-negative bacteria]’ [1]. The authors used segmented regression analysis of an interrupted time-series (ITS) and estimated the relative risk (RR) of their intervention on water. We commend the authors for performing this interesting study. However, we have several statistical suggestions and queries that we would like to communicate with the authors.
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