scholarly journals Impact of multimodal strategies to reduce multidrug‐resistant organisms in surgical intensive care units: Knowledge, practices and transmission: A quasi‐experimental study

Nursing Open ◽  
2021 ◽  
Author(s):  
Nongyao Kasatpibal ◽  
Kaweesak Chittawatanarat ◽  
Nantana Nunngam ◽  
Daranee Kampeerapanya ◽  
Nongnut Duangsoy ◽  
...  
Keyword(s):  
Experimental Study ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Multidrug Resistant ◽  
Surgical Intensive Care ◽  
Knowledge Practices ◽  
Multidrug Resistant Organisms ◽  
Quasi Experimental

scholarly journals 528. Longitudinal Evaluation of Chlorhexidine Resistance Among Multidrug-Resistant Organisms in Relation to Intervention of Daily Chlorhexidine Bathing in Adult Intensive Care Units

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S254-S254
Author(s):  
Min Ja Kim ◽  
You Seung Chung ◽  
Hojin Lee ◽  
Jin Woong Suh ◽  
Yoojung Cheong ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Clinical Laboratory ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Microdilution Method ◽  
Broth Microdilution Method ◽  
Multidrug Resistant Organisms ◽  
Before And After ◽  
The Republic

Abstract Background Chlorhexidine digluconate (CHG), the most widely used antiseptic, has recently been applied to patient washing to decolonize the multidrug-resistant organisms (MDROs), but there are little data on susceptibilities of MDROs to CHG. The purpose of this study was to evaluate CHG resistance among MDROs before and after the intervention of daily CHG bathing in adult intensive care units (ICUs). Methods The intervention of daily body washing with 2% CHG cloths were taken in adult patients the medical or surgical ICU of 23-bed by a crossover manner for 6 months (MICU, July to December 2017; SICU, January to June 2018) in a 1,050-bed, university hospital in the Republic of Korea. Available MDRO isolates were randomly selected from clinical cultures of ICU patients within 6 months before, during and after the intervention, including MRSA, MR-CoNS, VRE, Carbapenem-resistant Pseudomonas aeruginosa (CR-PA), CR-Acinetobacter baumannii (CR-AB). Minimum inhibitory concentrations (MICs) were determined using the broth microdilution method set by the Clinical Laboratory Standards Institute. Determination of the minimum bactericidal concentrations (MBCs) was performed by subculturing 10 µL from each well without visible microbial growth. Cumulative amounts of CHG used in both ICUs was estimated across the study period from January 2008 to June 2018. Results The cumulative CHG consumption from both ICUs increased sharply from 27,503 g to 29,556 g after one-year intervention. The ranges of MICs and MBCs of CHG among MDRO clinical isolates selected by a 6-month phase are summarized in Table 1. Particularly, CR-PA and CR-AB isolates revealed four to eight times higher MICs and MBCs compared with the majority of Gram-positives excepting some VRE isolates. On the other hand, neither MICs and MBCs ranges of CHG from the MDRO isolates nor the monthly incidence of the MDROs from both ICUs were significantly increased before and after the intervention of daily CHG bathing. Conclusion This study indicates that some Gram-negative MDRO isolates with higher MICs and MBCs of CHG might be from longstanding exposure to CHG or efflux pumps. Although 2% daily CHG bathing uses over 1,000 times higher concentrations than the lethal concentration, it might be needed to monitor CHG resistance among MDROs. Disclosures All authors: No reported disclosures.

scholarly journals Preventing strategy of multidrug-resistant Acinetobacter baumanii susceptible only to colistin in cardiac surgical intensive care units

2008 ◽  
Vol 33 (6) ◽  
pp. 1086-1090 ◽  
Author(s):  
Aikaterini Mastoraki ◽  
Evangelia Douka ◽  
Ioannis Kriaras ◽  
Georgios Stravopodis ◽  
Georgios Saroglou ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Multidrug Resistant ◽  
Surgical Intensive Care ◽  
Acinetobacter Baumanii

Controlling the Diffusion of Multidrug-Resistant Organisms in Intensive Care Units

2019 ◽  
Vol 40 (04) ◽  
pp. 558-568 ◽  
Author(s):  
Solen Kernéis ◽  
Jean-Christophe Lucet
Keyword(s):  
Intensive Care ◽  
Hand Hygiene ◽  
Intensive Care Units ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Behavioral Approach ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Contact Precautions ◽  
Multidrug Resistant Organisms

AbstractThe prevalence of multidrug-resistant organisms (MDROs) in intensive care units (ICUs) is increasing worldwide, with very large variations across countries, microorganisms, and settings. Emerging MDR gram-negative bacteria and fungi raise particular concerns that require improved prevention and control strategies. Vertical approaches are mainly based on screening and contact precautions and/or decolonization of MDRO carriers. On the other hand, horizontal strategies are not pathogen-specific and include standard precautions (i.e., hand hygiene), universal decolonization, antimicrobial stewardship, and environmental cleaning. The impacts of the different strategies vary between MDROs and compliance with control measures, and are intermixed in most infection control programs. Based on historical data, hand hygiene remains the cornerstone to prevent transmission of MDROs in ICUs. In the context of high hand hygiene compliance, screening and contact precautions for carriers seem to have a limited additional effect, particularly for MDR gram-negative bacteria. Studies on skin decolonization with chlorhexidine bathing show conflicting results, impairing its widespread adoption. Selective oral and digestive decontaminations have shown positive impact on clinical outcomes in ICUs with low levels of antibiotic resistance, but raised ecological concerns in high-prevalence settings. Antibiotic stewardship programs have been associated with reductions in antimicrobial use, duration of stay, and costs with no negative impact on mortality and should be widely promoted in ICUs. Whatever the strategy, compliance with the recommended measures is of crucial importance and implementation should rely on behavioral approach and change in the institutional and safety culture.

scholarly journals Effect of guided imagery training on death anxiety of nurses at COVID-19 intensive care units: a quasi-experimental study

2020 ◽  
Vol 15 (3-4) ◽  
pp. 83-88
Author(s):  
Sedigheh Sanadgol ◽  
Mohammadreza Firouzkouhi ◽  
Mahin Badakhsh ◽  
Abdolghani Abdollahimohammad ◽  
Aziz Shahraki-vahed
Keyword(s):  
Experimental Study ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Death Anxiety ◽  
Guided Imagery ◽  
Imagery Training ◽  
Quasi Experimental

Multidrug-Resistant Pathogens and Pneumonia: Comparing the Trauma and Surgical Intensive Care Units

2011 ◽  
Vol 12 (4) ◽  
pp. 267-272 ◽  
Author(s):  
Robert D. Becher ◽  
J. Jason Hoth ◽  
Lucas P. Neff ◽  
Jerry J. Rebo ◽  
R. Shayn Martin ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Multidrug Resistant ◽  
Surgical Intensive Care ◽  
Multidrug Resistant Pathogens

scholarly journals Incidence of emerging multidrug-resistant organisms and its impact on the outcome in the pediatric intensive care

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Ahmed R. Rezk ◽  
Somaia Abdelhammed Bawady ◽  
Nashwa Naguib Omar
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Significant Risk ◽  
Pediatric Intensive Care ◽  
Multidrug Resistant ◽  
University Hospitals ◽  
Acinetobacter Species ◽  
Mortality And Morbidity ◽  
Multidrug Resistant Organisms

Abstract Background Healthcare-associated infections (HCAI) are a worldwide threat in intensive care units particularly in the pediatric intensive care units with a major cause of morbidity and mortality among this age group. The aim of the study is to determine the prevalence and risk factors predisposing to multidrug-resistant organisms (MDROs) infections among pediatric intensive care unit (PICU) patients at Ain Shams Pediatric University Hospitals as well as determining mortality and morbidity rates along with the length of stay at PICU. Results Culture results revealed that of the 282 patients evaluated, only 26 (9.2%) were MDROs (half of the affected patients had Acinetobacter species (50%) and the rest of them were free, 256 (90.8%). Our study revealed that the majority of MDROs were isolated from sputum in more than half of the patients 19/32 (59.3%) followed by whole blood in 10/32 (31.2%) and urine in 3/32 (9.4%). Pulmonary system was the most common affected site and was mainly colonized by MDR Acinetobacter (71.4%) followed by MDR Klebsiella (41.6%). Regarding MDR risk factors in our PICU, multivariate logistic regression analyses showed significant relationship between MDROs and age under 1 year (odds ratio [OR] 2.4554; 95% confidence interval [95% CI] (1.072–5.625); p = 0.043) and underlying pulmonary disease (OR 2.417; 95% CI (1.014–5.761); p = 0.592). A statistically significant higher mortality was detected in patients colonized with MDROs 9/26 (34.6%) versus MDROs non-colonized patients 32/256 (12.5%) [P=0.002]. Moreover, MDROs infection has negative significant risk with discharged patients ([OR] 0.269; [95% CI] (0.111–0.656); p = 0.002). Additionally, patients infected with MDROs did have significantly greater PICU stay than those non-infected [median (IQR), 16.5 (10.7–22), 5 (4–8), P=0.00] and have longer ventilation [median (IQR), 15.5 (10–18), 3 (2–10), P=0.00]. Conclusion Prevalence of MDROs (9.2%) was low among PICU cases at Ain Shams University Hospitals. Most common MDROs were Acinetobacter and Klebsiella followed by pseudomonas species. The frequency of gram-negative organisms is much more common than gram-positive organisms. An increasing rate of antimicrobial resistance with increasing mortality and morbidity among PICU patients is observed worldwide; even for new categories, so, strict infection control programs should be implemented.

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