title: Decreased transmission of Enterobacteriaceae with extended-spectrum beta-lactamases in an intensive care unit by nursing reorganization.
abstract: In our gastrointestinal surgical intensive care unit (SICU), the large number of patients with multiple enterostomies enhances the risk of nosocomial transmission of gut extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) by health care workers. A control study performed in our SICU from June-August 1992 showed an ESBLE gut colonization rate of 70%. To reduce this rate, nursing procedures were intensified or modified, particularly handwashing, single-use equipment and waste control. To test the efficiency of these procedures, 64 patients hospitalized for more than two days from September 1992-March 1993 were screened for gut acquisition of ESBLE. Rectal samples were taken within 48 h after admission and then weekly. After nursing reorganization, the ESBLE colonization rate dropped significantly to 40% (P < 0.001). Twenty patients (31.7%) acquired a gut ESBLE, after a mean of 24.3 +/- 13.7 days. Each patient was colonized with one, two or three ESBLE (Klebsiella pneumoniae, Escherichia coli and Enterobacter aerogenes). Baseline characteristics of the 20 colonized and 39 non-colonized patients showed no significant difference (Student's t-test, P > 0.05). The nursing workload, estimated as a omega index, was greater in the colonized group (P < 0.001). These findings show that strict observance of nursing procedures can significantly reduce ESBLE acquisition in a high-risk surgical unit.
authors.affiliation: Department of Anesthesiology and Intensive care, Saint-Antoine Hospital, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Soulier
authors.forename: F
authors.initials: F
authors.lastname: Barbut
authors.forename: J M
authors.initials: JM
authors.lastname: Ollivier
authors.forename: J C
authors.initials: JC
authors.lastname: Petit
authors.forename: A
authors.initials: A
authors.lastname: Lienhart
mesh_terms: D000368:Aged; D003428:Cross Infection / Q000517:prevention & control* / Q000635:transmission; D004756:Enterobacteriaceae Infections / Q000517:prevention & control* / Q000635:transmission; D005260:Female; D005602:France; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D009738:Nursing Service, Hospital / Q000458:organization & administration*; D009936:Organizational Innovation; D011446:Prospective Studies; D012307:Risk Factors; D016526:Workload; D018440:beta-Lactam Resistance