Journal
CLINICAL INFECTIOUS DISEASES
Volume 73, Issue 9, Pages E2781-E2788Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciaa1663
Keywords
contact precautions; Pseudomonas aeruginosa; ICU; patient-to-patient transmission; PFGE
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Funding
- French Ministry of Health (Programme Hospitalier de Recherche Clinique [PHRC] National) [12.08]
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The study showed that adding contact precautions to standard precautions for Pa-positive patients with a surveillance screening program did not significantly reduce ICU-acquired Pa infections in non-outbreak situations.
Background. The issue of contact precautions as contributory factors for reducing Pseudomonas aeruginosa (Pa) infections in intensive care units (ICUs) remains questioned. We evaluated the impact of the addition of contact precautions to standard precautions for Pa-positive patients on incidence of ICU-acquired Pa infections. Methods. In this multicenter, cluster-randomized crossover trial, 10 French ICUs were randomly assigned (1:1) to sequence 0-1 (6-month control period [CP]/3-month washout period/6-month intervention period [IP]) or sequence 1-0 (6-month IP/3-month washout period/6-month CP). A surveillance screening program for Pa was implemented. Competing-risks regression models were built with death and discharge without the occurrence of ICU-acquired Pa infection (the primary outcome) as competing events. Models were adjusted for within-ICU correlation and patient- and ICU-level covariates. The Simpson diversity index (SDI) and transmission index (TI) of Pa isolates were derived from pulsed-field gel electrophoresis typing. Results. Within recruited ICUs, the cumulative incidence and incidence rate of ICU-acquired Pa infections were 3.38% (55/1625) versus 3.44% (57/1658) and 3.31 versus 3.52 per 1000 patient-days at risk during the CP and IP, respectively. Multivariable models indicated that the intervention did not significantly change the cumulative incidence (subdistribution hazard ratio,.91; 95% confidence interval [CI], .49-1.67; P =.76) or rate (cause-specific hazard ratio, 1.36; 95% CI,.71-2.63; P =.36) of the primary outcome. SDI and TI did not significantly differ between CP and IP. Conclusions. The addition of contact precautions to standard precautions for Pa-positive patients with a surveillance screening program does not significantly reduce ICU-acquired Pa infections in non-outbreak situations.
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