Effective cohorting and "superisolation" in a single intensive care unit in response to an outbreak of diverse multi-drug-resistant organisms

Laura H. Rosenberger, Tjasa Hranjec, Amani Politano, Brian R. Swenson, Rosemarie Metzger, Hugo Bonatti, Robert G. Sawyer

Research output: Contribution to journalReview article

24 Citations (Scopus)

Abstract

Background: Cohorting patients in dedicated hospital wards or wings during infection outbreaks reduces transmission of organisms, yet frequently, this may not be feasible because of inadequate capacity, especially in the intensive care unit (ICU). We hypothesized that cohorting isolation patients in one geographic location in a single ICU and using enhanced isolation procedures ("superisolation") can prevent the further spread of highly multi-drug-resistant organisms (MDRO). Methods: Six patients dispersed throughout our Surgical Trauma Burn ICU had infections with carbapenem- resistant, non-clonal gram-negative MDRO, namely Klebsiella pneumoniae, Citrobacter freundii, Stenotrophomonas maltophilia, Aeromonas hydrophilia, Proteus mirabilis, Pseudomonas aeruginosa, and Providencia rettgeri. Five of the six patients also had simultaneous isolation of vancomycin-resistant enterococci (VRE). Under threat of unit closure and after all standard isolation procedures had been enacted, these six patients were moved to the front six beds of the unit, the front entrance was closed, and all traffic was redirected through the back entrance. Nursing staff were assigned to either two isolation or two non-isolation patients. In accordance with the practice of Semmelweis, rounds were conducted so as to end at the rooms of the patients with the most highly-resistant bacterial infections. Results: A few months after these interventions, all six patients had been discharged from the ICU (three alive and three dead), and no new cases of infection with any of their pathogens (based on species and antibiogram) or VRE occurred. The mean ICU stay and overall hospital length of stay for these six patients were 78.3 days and 117.2 days respectively, with a mortality rate of 50%. Conclusion: Cohorting patients to one area and altering work routines to minimize contact with patients with MDRO (essentially designating a "high-risk" zone) may be beneficial in stopping patient-to-patient spread of highly resistant bacteria without the need for a dedicated isolation unit.

Original languageEnglish (US)
Pages (from-to)345-350
Number of pages6
JournalSurgical Infections
Volume12
Issue number5
DOIs
StatePublished - Oct 1 2011
Externally publishedYes

Fingerprint

Disease Outbreaks
Intensive Care Units
Pharmaceutical Preparations
Length of Stay
Infection
Providencia
Citrobacter freundii
Patient Isolation
Stenotrophomonas maltophilia
Aeromonas
Geographic Locations
Patients' Rooms
Proteus mirabilis
Carbapenems
Nursing Staff
Klebsiella pneumoniae
Microbial Sensitivity Tests
Bacterial Infections
Pseudomonas aeruginosa
Bacteria

ASJC Scopus subject areas

  • Surgery
  • Infectious Diseases
  • Microbiology (medical)

Cite this

Effective cohorting and "superisolation" in a single intensive care unit in response to an outbreak of diverse multi-drug-resistant organisms. / Rosenberger, Laura H.; Hranjec, Tjasa; Politano, Amani; Swenson, Brian R.; Metzger, Rosemarie; Bonatti, Hugo; Sawyer, Robert G.

In: Surgical Infections, Vol. 12, No. 5, 01.10.2011, p. 345-350.

Research output: Contribution to journalReview article

Rosenberger, Laura H. ; Hranjec, Tjasa ; Politano, Amani ; Swenson, Brian R. ; Metzger, Rosemarie ; Bonatti, Hugo ; Sawyer, Robert G. / Effective cohorting and "superisolation" in a single intensive care unit in response to an outbreak of diverse multi-drug-resistant organisms. In: Surgical Infections. 2011 ; Vol. 12, No. 5. pp. 345-350.
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abstract = "Background: Cohorting patients in dedicated hospital wards or wings during infection outbreaks reduces transmission of organisms, yet frequently, this may not be feasible because of inadequate capacity, especially in the intensive care unit (ICU). We hypothesized that cohorting isolation patients in one geographic location in a single ICU and using enhanced isolation procedures ({"}superisolation{"}) can prevent the further spread of highly multi-drug-resistant organisms (MDRO). Methods: Six patients dispersed throughout our Surgical Trauma Burn ICU had infections with carbapenem- resistant, non-clonal gram-negative MDRO, namely Klebsiella pneumoniae, Citrobacter freundii, Stenotrophomonas maltophilia, Aeromonas hydrophilia, Proteus mirabilis, Pseudomonas aeruginosa, and Providencia rettgeri. Five of the six patients also had simultaneous isolation of vancomycin-resistant enterococci (VRE). Under threat of unit closure and after all standard isolation procedures had been enacted, these six patients were moved to the front six beds of the unit, the front entrance was closed, and all traffic was redirected through the back entrance. Nursing staff were assigned to either two isolation or two non-isolation patients. In accordance with the practice of Semmelweis, rounds were conducted so as to end at the rooms of the patients with the most highly-resistant bacterial infections. Results: A few months after these interventions, all six patients had been discharged from the ICU (three alive and three dead), and no new cases of infection with any of their pathogens (based on species and antibiogram) or VRE occurred. The mean ICU stay and overall hospital length of stay for these six patients were 78.3 days and 117.2 days respectively, with a mortality rate of 50{\%}. Conclusion: Cohorting patients to one area and altering work routines to minimize contact with patients with MDRO (essentially designating a {"}high-risk{"} zone) may be beneficial in stopping patient-to-patient spread of highly resistant bacteria without the need for a dedicated isolation unit.",
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T1 - Effective cohorting and "superisolation" in a single intensive care unit in response to an outbreak of diverse multi-drug-resistant organisms

AU - Rosenberger, Laura H.

AU - Hranjec, Tjasa

AU - Politano, Amani

AU - Swenson, Brian R.

AU - Metzger, Rosemarie

AU - Bonatti, Hugo

AU - Sawyer, Robert G.

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N2 - Background: Cohorting patients in dedicated hospital wards or wings during infection outbreaks reduces transmission of organisms, yet frequently, this may not be feasible because of inadequate capacity, especially in the intensive care unit (ICU). We hypothesized that cohorting isolation patients in one geographic location in a single ICU and using enhanced isolation procedures ("superisolation") can prevent the further spread of highly multi-drug-resistant organisms (MDRO). Methods: Six patients dispersed throughout our Surgical Trauma Burn ICU had infections with carbapenem- resistant, non-clonal gram-negative MDRO, namely Klebsiella pneumoniae, Citrobacter freundii, Stenotrophomonas maltophilia, Aeromonas hydrophilia, Proteus mirabilis, Pseudomonas aeruginosa, and Providencia rettgeri. Five of the six patients also had simultaneous isolation of vancomycin-resistant enterococci (VRE). Under threat of unit closure and after all standard isolation procedures had been enacted, these six patients were moved to the front six beds of the unit, the front entrance was closed, and all traffic was redirected through the back entrance. Nursing staff were assigned to either two isolation or two non-isolation patients. In accordance with the practice of Semmelweis, rounds were conducted so as to end at the rooms of the patients with the most highly-resistant bacterial infections. Results: A few months after these interventions, all six patients had been discharged from the ICU (three alive and three dead), and no new cases of infection with any of their pathogens (based on species and antibiogram) or VRE occurred. The mean ICU stay and overall hospital length of stay for these six patients were 78.3 days and 117.2 days respectively, with a mortality rate of 50%. Conclusion: Cohorting patients to one area and altering work routines to minimize contact with patients with MDRO (essentially designating a "high-risk" zone) may be beneficial in stopping patient-to-patient spread of highly resistant bacteria without the need for a dedicated isolation unit.

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