title: Optimization of pre-emptive isolations in a polyvalent ICU through implementation of an intervention strategy.
abstract: BACKGROUND
  Pre-emptive isolation refers to the application of contact precaution measures in patients with strongly suspected colonization by multiresistant bacteria.
  
  
  OBJECTIVE
  To assess the impact of an intervention program involving the implementation of a consensus-based protocol of pre-emptive isolation (CPPI) on admission to a polyvalent ICU of a general hospital.
  
  
  METHODS
  A comparative analysis of 2 patient cohorts was made: a historical cohort including patients in which pre-emptive isolation was established according to physician criterion prior to starting CPPI (from January 2010 to February 2011), and a prospective cohort including patients in which CPPI was implemented (from March to November 2011). CPPI included the identification and diffusion of pre-emptive isolation criteria, the definition of sampling methodology, the evaluation of results, and the development of criteria for discontinuation of pre-emptive isolation. Pre-emptive isolation was indicated by the medical staff, and follow-up was conducted by the nursing staff. Pre-emptive isolation was defined as "adequate" when at least one multiresistant bacteria was identified in any of the samples. Comparison of data between the 2 periods was made with the chi-square test for categorical variables and the Student t-test for quantitative variables. Statistical significance was set at P<.05.
  
  
  RESULTS
  Among the 1,740 patients admitted to the ICU (1,055 during the first period and 685 during the second period), pre-emptive isolation was indicated in 199 (11.4%); 111 (10.5%) of these subjects corresponded to the historical cohort (control group) and 88 (12.8%) to the posterior phase after the implementation of CPPI (intervention group). No differences were found in age, APACHE II score or patient characteristics between the 2 periods. The implementation of CPPI was related to decreases in non-indicated pre-emptive isolations (29.7 vs. 6.8%, P<.001), time of requesting surveillance cultures (1.56 vs. 0.37 days, P<.001), and days of duration of treatment (4.77 vs. 3.58 days, P<.001). In 44 patients (22.1%) in which pre-emptive isolation was indicated, more than one multiresistant bacteria was identified, with an "adequate pre-emptive isolation rate" of 19.8% in the first period and 25.0% in the second period (P<.382).
  
  
  CONCLUSIONS
  The implementation of CPPI resulted in a significant decrease in pre-emptive isolations which were not indicated correctly, a decrease in the time elapsed between isolation and collection of samples, and a decrease in the duration of isolation measures in cases in which isolation was unnecessary, without increasing the rate of "adequate pre-emptive isolation".
authors: Servicio de Medicina Intensiva, Hospital del Mar, Consorci Mar Parc de Salut, Universitat Autònoma, Barcelona, España. Electronic address: Falvarez@parcdesalutmar.cat.
authors: F
authors: F
authors: Álvarez Lerma
authors: Servicio de Medicina Intensiva, Hospital del Mar, Consorci Mar Parc de Salut, Universitat Autònoma, Barcelona, España.
authors: J
authors: J
authors: Granado Solano
authors: Servicio de Medicina Intensiva, Hospital del Mar, Consorci Mar Parc de Salut, Universitat Autònoma, Barcelona, España.
authors: A
authors: A
authors: García Sanz
authors: Servicio de Medicina Intensiva, Hospital del Mar, Consorci Mar Parc de Salut, Universitat Autònoma, Barcelona, España.
authors: C
authors: C
authors: López Martínez
authors: Servicio de Medicina Intensiva, Hospital del Mar, Consorci Mar Parc de Salut, Universitat Autònoma, Barcelona, España.
authors: R
authors: R
authors: Herrera Sebastián
authors: Servicio de Medicina Intensiva, Hospital del Mar, Consorci Mar Parc de Salut, Universitat Autònoma, Barcelona, España.
authors: C
authors: C
authors: Salvat Cobeta
authors: Servicio de Medicina Intensiva, Hospital del Mar, Consorci Mar Parc de Salut, Universitat Autònoma, Barcelona, España.
authors: A
authors: A
authors: Rey Pérez
authors: Servicio de Medicina Intensiva, Hospital del Mar, Consorci Mar Parc de Salut, Universitat Autònoma, Barcelona, España.
authors: R M
authors: RM
authors: Balaguer Blasco
authors: Sección de Microbiología, Laboratorio de Referencia de Catalunya, Barcelona, España.
authors: V
authors: V
authors: Plasencia
authors: Servicio de Medicina Interna-Infecciosas, Hospital del Mar, Consorci Mar Parc de Salut, Barcelona, España.
authors: J P
authors: JP
authors: Horcajada
mesh_terms: D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control*; D002985:Clinical Protocols; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D003953:Diagnosis-Related Groups; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D065386:Historically Controlled Study; D006769:Hospitals, General; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D010356:Patient Isolation / Q000379:methods / Q000458:organization & administration* / Q000706:statistics & numerical data; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology
keywords: Aislamiento preventivo; Bacterias multirresistentes; Intensive Care Unit; Multiresistant bacteria; Pre-emptive isolation; Unidad de Cuidados Intensivos