Impact of Multidisciplinary Collaborative Intervention on Isolation Implementation in Prevention and Control of Multi-drug Resistance Infection

Abstract

Objective

Contact precautions, especially the initiation of isolation, are important measures to prevent and control multidrug-resistant organisms (MDROs). However, the implementation in clinical practice remains weak. This study aimed to analyze the impact of multidisciplinary collaborative intervention on isolation implementation in multidrug-resistant infection, and determine the factors that affect the implementation of isolation measures.

Methods

A multidisciplinary collaborative intervention related to isolation was conducted at a teaching tertiary hospital in central China on November 1, 2018. The information of 1338 patients with MDRO infection and colonization at 10 months before and after the intervention was collected. Then, the issuance of isolation orders was retrospectively analyzed. Univariate analysis and multivariate logistic regression analysis were performed to analyze the factors that affected the isolation implementation.

Results

The overall issuance rate of isolation orders was 61.21%, which increased from 33.12% to 75.88% (P<0.001) after the implementation of the multidisciplinary collaborative intervention. The intervention (P<0.001, OR=0.166) was a promoting factor for the issuance of isolation orders, in addition to the length of stay (P=0.004, OR=0.991), department (P=0.004), and microorganism (P=0.038).

Conclusion

The isolation implementation remains far lower than policy standards. Multidisciplinary collaborative interventions can effectively improve the compliance to isolation measures implemented by doctors, thereby promoting the standardized management of MDROs, and providing reference for further improving the quality of hospital infection management.

Keywords

multidisciplinary collaborative intervention / issuance of isolation orders / multidrug-resistant organism infection and colonization / isolation implementation rate

References

[1] López-MontesinosI, Domínguez-GuaschA, Gómez-ZorrillaS, et al.. Clinical and economic burden of community-onset multidrug-resistant infections requiring hospitalization. J Infect, 2020, 80(3): 271-278

[2] YamELY, HsuLY, YapEP, et al.. Antimicrobial Resistance in the Asia Pacific region: a meeting report. Antimicrob Resist Infect Control, 2019, 8: 202

[3] CerceoE, DeitelzweigSB, ShermanBM, et al.. Multidrug-Resistant Gram-Negative Bacterial Infections in the Hospital Setting: Overview, Implications for Clinical Practice, and Emerging Treatment Options. Microb Drug Resist, 2016, 22(5): 412-431

[4] SiegelJD, RhinehartE, JacksonM, et al.. Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control, 2007, 35(10Suppl2): S165-S193

[5] SiegelJD, RhinehartE, JacksonM, et al.. Health Care Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control, 2007, 35(10Suppl2): S65-S164

[6] SmithPW, BennettG, BradleyS, et al.. SHEA/APIC Guideline: Infection prevention and control in the long-term care facility. Am J Infect Control, 2008, 36(7): 504-535

[7] TacconelliE, CataldoMA, DancerSJ, et al.. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect, 2014, 20(Suppl1): 1-55

[8] LinkT. Guideline Implementation: Transmission-Based Precautions. AORN J, 2019, 110(6): 637-649

[9] CohenCC, CohenB, ShangJ. Effectiveness of contact precautions against multidrug-resistant organism transmission in acute care: a systematic review of the literature. J Hosp Infect, 2015, 90(4): 275-284

[10] DurandA, DupreC, RobriquetL. Should contact precautions for multidrug resistant organism transmission be used?. Reanimation, 2016, 25(3): 318-327

[11] GysinDV, CooksonB, SaenzH, et al.. Variability in contact precautions to control the nosocomial spread of multi-drug resistant organisms in the endemic setting: a multinational cross-sectional survey. Antimicrob Resist Infect Control, 2018, 7: 81

[12] ClockSA, CohenB, BehtaM, et al.. Contact precautions for multidrug-resistant organisms: Current recommendations and actual practice. Am J Infect Control, 2010, 38(2): 105-111

[13] AbdulrahmanGO. The effect of multidisciplinary team care on cancer management. Pan Afr Med J, 2011, 9: 20

[14] FleissigA, JenkinsV, CattS, et al.. Multidisciplinary teams in cancer care: are they effective in the UK?. Lancet Oncol, 2006, 7(11): 935-943

[15] WaqarS, NighK, SislerL, et al.. Multidisciplinary performance improvement team for reducing health care.associated Clostridium difficile infection. Am J Infect Control, 2016, 44(3): 352-354

[16] DavidsonPD, NewtonPJ, TankumpuanT, et al.. Multidisciplinary Management of Chronic Heart Failure: Principles and Future Trends. Clin Ther, 2015, 37(10): 2225-2233

[17] ZhangFF, WuXQ, LiaoSJ, et al.. Meta-analysis of the effect of multidisciplinary intervention on the prevention and control of multi-drug resistant bacteria infection. Zhongguo Shequ Yisheng (Chinese), 2019, 35(25): 41-43

[18] BoyceJM, Potter-BynoeG, ChenevertC, et al.. Environmental contamination due to methicillinresistant Staphylococcus aureus: possible infection control implications. Infect Control Hosp Epidemiol, 1997, 18(9): 622-627

[19] McConvilleTH, SullivanSB, Gomez-SimmondsA, et al.. Carbapenem-resistant Enterobacteriaceae colonization (CRE) and subsequent risk of infection and 90-day mortality in critically ill patients, an observational study. PLoS One, 2017, 12(10): e0186195

[20] SiegelJD, RhinehartE, JacksonM, et al.. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control, 2007, 35(10Suppl2): S165-S193

[21] HuangX, DengZD, NiYX, et al.. Chinese experts’ consensus on prevention and control of multidrug resistance organism healthcare-associated infection. Chin J Infect Control (Chinese), 2015, 14(1): 1-9

[22] XuC, XiongW, XuM, et al.. Effect of multidisciplinary team management on control of multidrug-resistant organism infections. Chin J Nosocomiol (Chinese), 2018, 28(18): 2834-2838

[23] LiangYF, LaiXQ, TanL, et al.. Application of Multidisciplinary Team Mode in the Management of Multidrug-resistant Organism Infection. Chin J Soc Med (Chinese), 2019, 36(04): 402-406

[24] CarolineL, LeonardoP, StephanH. Is patient isolation the single most important measure to prevent the spread of multidrug-resistant pathogens?. Virulence, 2013, 4(2): 163-171

[25] ChantalB, GeoffreyT, AnneS, et al.. An integrative review of infection prevention and control programs for multidrug-resistant organisms in acute care hospitals: a socio-ecological perspective. Am J Infect Control, 2011, 39(5): 368-378

[26] TacconelliE. Screening and isolation for infection control. J Hosp Infect, 2009, 73(4): 371-377

[27] CooperBS, StoneSP, KibblerCC, et al.. Isolation measures in the hospital management of methicillin resistant Staphylococcus aureus (MRSA): systematic review of the literature. BMJ, 2004, 329(7465): 533

[28] LiuQ, LiW, DuX, et al.. Risk and Prognostic Factors for Multidrug-Resistant Acinetobacter Baumannii Complex Bacteremia: A Retrospective Study in a Tertiary Hospital of West China. PLoS One, 2015, 10(6): e0130701

[29] GuoN, XueW, TangD, et al.. Risk factors and outcomes of hospitalized patients with blood infections caused by multidrug-resistant Acinetobacter baumannii complex in a hospital of Northern China. Am J Infect Control, 2016, 44(4): e37-e39

[30] JiaH, LiL, LiW, et al.. Impact of Healthcare-Associated Infections on Length of Stay: A Study in 68 Hospitals in China. Biomed Res Int, 2019, 2019: 2590563

[31] van LangeveldI, GagnonRC, ConradPF, et al.. Multiple-Drug Resistance in Burn Patients: A Retrospective Study on the Impact of Antibiotic Resistance on Survival and Length of Stay. J Burn Care Res, 2017, 38(2): 99-105

[32] World Health Organization.Antimicrobial Resistance Global Report on Surveillance, 2014, Geneva, World Health Organization

[33] BenetT, GirardR, Gerbier-ColombanS, et al.. Determinants of Implementation of Isolation Precautions Against Infections by Multidrug-Resistant Microorganisms: A Hospital-Based, Multicenter, Observational Study. Infect Control Hosp Epidemiol, 2017, 38(10): 1188-1195

[34] de KrakerME, JarlierV, MonenJC, et al.. The changing epidemiology of bacteraemias in Europe: trends from the European Antimicrobial Resistance Surveillance System. Clin Microbiol Infect, 2013, 19(9): 860-868

[35] SchwaberMJ, CarmeliY. Mortality and delay in effective therapy associated with extended-spectrum beta-lactamase production in Enterobacteriaceae bacteraemia: a systematic review and meta-analysis. J Antimicrob Chemother, 2007, 60(5): 913-920

[36] WangY, ZhangXP, LaiXQ, et al.Impact of Multidisciplinary Collaborative Intervention on Isolation Implementation in the Prevention and Control of Multidrug Resistance Infection—A Retrospective Study, 2020