title: Patient isolation measures for infants with candida colonization or infection for preventing or reducing transmission of candida in neonatal units.
abstract: BACKGROUND
  Candida is a common nosocomial infection and is associated with increased healthcare costs. In neonates, candida infection is associated with high mortality and morbidity and is transmitted by direct and indirect contact. Patient isolation measures, i.e. single room isolation or cohorting, are usually recommended for infections that spread by contact.
  
  
  OBJECTIVE
  To determine the effect of patient isolation measures (single room isolation and/or cohorting) for infants with candida colonization or infection as an adjunct to routine infection control measures on the transmission of candida to other infants in the neonatal unit.
  
  
  METHODS
  Relevant trials in any language were searched in the following databases in July 2011: The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2011), MEDLINE, BIOSIS, EMBASE and CINAHL. Proceedings of the Pediatric Academic Societies (from 1987) and ongoing trials were searched.
  
  
  METHODS
  Types of studies: Cluster randomized trials (where clusters may be defined by hospital, ward, or other subunits of the hospital).
  
  
  METHODS
  Neonatal units caring for infants colonized or infected with Candida. Types of interventions: A policy of patient isolation measures (single room isolation or cohorting of infants with Candida colonization or infection) compared to routine isolation measures.
  
  
  METHODS
  The standard methods of the Cochrane Neonatal Review Group (CNRG) were used to identify studies and to assess the methodological quality of eligible cluster-randomized trials. Infection rates and colonization rates were to be expressed as rate ratios for each trial and if appropriate for meta-analysis, the generic inverse variance method in RevMan was to be used.
  
  
  RESULTS
  No eligible trials were identified.
  
  
  CONCLUSIONS
  The review found no evidence to either support or refute the use of patient isolation measures (single room isolation or cohorting) in neonates with candida colonization or infection.Despite the evidence for transmission of candida by contact and evidence of cross-infection by health care workers, no standard policy of patient isolation measures beyond routine infection control measures exists in the neonatal unit. There is an urgent need to research the role of patient isolation measures for preventing transmission of candida in the neonatal unit. Well designed trials randomizing clusters of units or hospitals to a type of patient isolation method intervention are needed.
authors.affiliation: Section of Neonatology, Department of Pediatrics, Baylor College ofMedicine, Houston, Texas, USA. mohanv@bcm.tmc.edu
authors.forename: Mohan
authors.initials: M
authors.lastname: Pammi
authors.forename: Oya
authors.initials: O
authors.lastname: Eddama
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Weisman
mesh_terms: D002177:Candidiasis / Q000517:prevention & control* / Q000635:transmission; D003428:Cross Infection / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D009725:Nurseries, Hospital; D010356:Patient Isolation / Q000379:methods*
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