Summary
Background
Contact precautions are widely used to prevent the transmission of carbapenem-resistant
organisms (CROs) in hospital wards. However, evidence for their effectiveness in natural
hospital environments is limited.
Objective
To determine which contact precautions, healthcare worker (HCW)–patient interactions,
and patient and ward characteristics are associated with greater risk of CRO infection
or colonization.
Design, setting and participants
CRO clinical and surveillance cultures from two high-acuity wards were assessed through
probabilistic modelling to characterize a susceptible patient's risk of CRO infection
or colonization during a ward stay. User- and time-stamped electronic health records
were used to build HCW-mediated contact networks between patients. Probabilistic models
were adjusted for patient (e.g. antibiotic administration) and ward (e.g. hand hygiene
compliance, environmental cleaning) characteristics. The effects of risk factors were
assessed by adjusted odds ratio (aOR) and 95% Bayesian credible intervals (CrI).
Exposures
The degree of interaction with CRO-positive patients, stratified by whether CRO-positive
patients were on contact precautions.
Main outcomes and measures
The prevalence of CROs and number of new carriers (i.e. incident CRO aquisition).
Results
Among 2193 ward visits, 126 (5.8%) patients became colonized or infected with CROs.
Susceptible patients had 4.8 daily interactions with CRO-positive individuals on contact
precautions (vs 1.9 interactions with those not on contact precautions). The use of
contact precautions for CRO-positive patients was associated with a reduced rate (7.4
vs 93.5 per 1000 patient-days at risk) and odds (aOR 0.03, 95% CrI 0.01–0.17) of CRO
acquisition among susceptible patients, resulting in an estimated absolute risk reduction
of 9.0% (95% CrI 7.6–9.2%). Also, carbapenem administration to susceptible patients
was associated with increased odds of CRO acquisition (aOR 2.38, 95% CrI 1.70–3.29).
Conclusions and relevance
In this population-based cohort study, the use of contact precautions for patients
colonized or infected with CROs was associated with lower risk of CRO acquisition
among susceptible patients, even after adjusting for antibiotic exposure. Further
studies that include organism genotyping are needed to confirm these findings.
Keywords
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Article info
Publication history
Published online: March 10, 2023
Accepted:
February 3,
2023
Received:
August 22,
2022
Identification
Copyright
© 2023 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
