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Infection-prevention and control interventions to reduce colonisation and infection of intensive care unit-acquired carbapenem-resistant Klebsiella pneumoniae: a 4-year quasi-experimental before-and-after study

OBJECTIVE: To determine whether infection-prevention and control (IPC) interventions can reduce the colonisation and infection of intensive care unit (ICU)-acquired carbapenem-resistant Klebsiella pneumoniae (CRKP) in a general ICU ward in China. METHODS: We used a quasi-experimental before-and-afte...

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Autores principales: Li, Meiling, Wang, Xiaoli, Wang, Jiahui, Tan, Ruoming, Sun, Jingyong, Li, Lei, Huang, Jie, Wu, Jun, Gu, Qiuying, Zhao, Yujin, Liu, Jialin, Qu, Hongping
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6329090/
https://www.ncbi.nlm.nih.gov/pubmed/30651974
http://dx.doi.org/10.1186/s13756-018-0453-7
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author Li, Meiling
Wang, Xiaoli
Wang, Jiahui
Tan, Ruoming
Sun, Jingyong
Li, Lei
Huang, Jie
Wu, Jun
Gu, Qiuying
Zhao, Yujin
Liu, Jialin
Qu, Hongping
author_facet Li, Meiling
Wang, Xiaoli
Wang, Jiahui
Tan, Ruoming
Sun, Jingyong
Li, Lei
Huang, Jie
Wu, Jun
Gu, Qiuying
Zhao, Yujin
Liu, Jialin
Qu, Hongping
author_sort Li, Meiling
collection PubMed
description OBJECTIVE: To determine whether infection-prevention and control (IPC) interventions can reduce the colonisation and infection of intensive care unit (ICU)-acquired carbapenem-resistant Klebsiella pneumoniae (CRKP) in a general ICU ward in China. METHODS: We used a quasi-experimental before-and-after study design. The study was conducted in 4 stages: baseline period, January 2013–June 2013; IPC interventions period including de-escalation and targeted bundle interventions, July 2013–June 2014; modified IPC interventions period, July 2014–June 2015; and follow-up period, July 2015–June 2016. We used modified de-escalation interventions according to patient-risk assessments to prevent the transmission of CRKP. RESULTS: A total of 629 patients were enrolled in study. The incidence of ICU-acquired CRKP colonisation/infection was 10.08 (4.43–16.43) per 1000 ICU patient-days during the baseline period, and significantly decreased early during the IPC interventions, but the colonisation/infections reappeared in April 2014. During the modified IPC intervention and follow-up periods, the incidence of ICU-acquired CRKP colonisations/infections reduced to 5.62 (0.69–6.34) and 2.84 (2.80–2.89), respectively, with ongoing admission of cases with previously acquired CRKP. The incidence of ICU-acquired CRKP catheter-related bloodstream infections decreased from 2.54 during the baseline period to 0.41 during the follow-up period. The incidence of ventilator-associated pneumonia and skin and soft tissue infections showed a downward trend from 2.84 to 0.41 and from 3.4 to 0.47, respectively, with slight fluctuations. CONCLUSIONS: Comprehensive IPC interventions including de-escalation and targeted bundle interventions showed a significant reduction in ICU-acquired CRKP colonisations/infections, despite ongoing admission of patients colonised/infected with CRKP. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13756-018-0453-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-63290902019-01-16 Infection-prevention and control interventions to reduce colonisation and infection of intensive care unit-acquired carbapenem-resistant Klebsiella pneumoniae: a 4-year quasi-experimental before-and-after study Li, Meiling Wang, Xiaoli Wang, Jiahui Tan, Ruoming Sun, Jingyong Li, Lei Huang, Jie Wu, Jun Gu, Qiuying Zhao, Yujin Liu, Jialin Qu, Hongping Antimicrob Resist Infect Control Research OBJECTIVE: To determine whether infection-prevention and control (IPC) interventions can reduce the colonisation and infection of intensive care unit (ICU)-acquired carbapenem-resistant Klebsiella pneumoniae (CRKP) in a general ICU ward in China. METHODS: We used a quasi-experimental before-and-after study design. The study was conducted in 4 stages: baseline period, January 2013–June 2013; IPC interventions period including de-escalation and targeted bundle interventions, July 2013–June 2014; modified IPC interventions period, July 2014–June 2015; and follow-up period, July 2015–June 2016. We used modified de-escalation interventions according to patient-risk assessments to prevent the transmission of CRKP. RESULTS: A total of 629 patients were enrolled in study. The incidence of ICU-acquired CRKP colonisation/infection was 10.08 (4.43–16.43) per 1000 ICU patient-days during the baseline period, and significantly decreased early during the IPC interventions, but the colonisation/infections reappeared in April 2014. During the modified IPC intervention and follow-up periods, the incidence of ICU-acquired CRKP colonisations/infections reduced to 5.62 (0.69–6.34) and 2.84 (2.80–2.89), respectively, with ongoing admission of cases with previously acquired CRKP. The incidence of ICU-acquired CRKP catheter-related bloodstream infections decreased from 2.54 during the baseline period to 0.41 during the follow-up period. The incidence of ventilator-associated pneumonia and skin and soft tissue infections showed a downward trend from 2.84 to 0.41 and from 3.4 to 0.47, respectively, with slight fluctuations. CONCLUSIONS: Comprehensive IPC interventions including de-escalation and targeted bundle interventions showed a significant reduction in ICU-acquired CRKP colonisations/infections, despite ongoing admission of patients colonised/infected with CRKP. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13756-018-0453-7) contains supplementary material, which is available to authorized users. BioMed Central 2019-01-10 /pmc/articles/PMC6329090/ /pubmed/30651974 http://dx.doi.org/10.1186/s13756-018-0453-7 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Li, Meiling
Wang, Xiaoli
Wang, Jiahui
Tan, Ruoming
Sun, Jingyong
Li, Lei
Huang, Jie
Wu, Jun
Gu, Qiuying
Zhao, Yujin
Liu, Jialin
Qu, Hongping
Infection-prevention and control interventions to reduce colonisation and infection of intensive care unit-acquired carbapenem-resistant Klebsiella pneumoniae: a 4-year quasi-experimental before-and-after study
title Infection-prevention and control interventions to reduce colonisation and infection of intensive care unit-acquired carbapenem-resistant Klebsiella pneumoniae: a 4-year quasi-experimental before-and-after study
title_full Infection-prevention and control interventions to reduce colonisation and infection of intensive care unit-acquired carbapenem-resistant Klebsiella pneumoniae: a 4-year quasi-experimental before-and-after study
title_fullStr Infection-prevention and control interventions to reduce colonisation and infection of intensive care unit-acquired carbapenem-resistant Klebsiella pneumoniae: a 4-year quasi-experimental before-and-after study
title_full_unstemmed Infection-prevention and control interventions to reduce colonisation and infection of intensive care unit-acquired carbapenem-resistant Klebsiella pneumoniae: a 4-year quasi-experimental before-and-after study
title_short Infection-prevention and control interventions to reduce colonisation and infection of intensive care unit-acquired carbapenem-resistant Klebsiella pneumoniae: a 4-year quasi-experimental before-and-after study
title_sort infection-prevention and control interventions to reduce colonisation and infection of intensive care unit-acquired carbapenem-resistant klebsiella pneumoniae: a 4-year quasi-experimental before-and-after study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6329090/
https://www.ncbi.nlm.nih.gov/pubmed/30651974
http://dx.doi.org/10.1186/s13756-018-0453-7
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