Effect of Daily Chlorhexidine Bathing on Reducing Infections Caused by Multidrug-Resistant Organisms in Intensive Care Unit Patients: A Semi-Experimental Study with Parallel Controls

Abstract Background: A number of studies have shown that daily bathing by chlorhexidine (CHG) wipes in ICU can reduce healthcare-associated infections (HAIs) caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE). However, the impact of CHG bathing on carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Enterobacteriaceae (CRE) is not clear and remains controversial. Methods: A semi-experimental study which employs both pre-controls and a parallel control was conducted. In the intervention period (from July 1 to December 31, 2016), strengthened infection control measures and daily bathing with 2% CHG-impregnated wipes once daily was performed in the ICU. Fifty-seven non-ICU wards with the occurrence of multidrug-resistant organisms (MDRO) infections during the same time period were selected as parallel control group (only CHG bathing was not performed). The net effect of the 2% CHG daily bathing was evaluated by the difference in difference (DID) model.Results: The incidence of HAIs caused by CRPA in ICU was significantly decreased between the intervention and pre-intervention period (2.5, 95% confidence interval (CI) 1.6–3.8 vs. 4.6, 95% CI 3.3–6.3 cases /1,000 patient days, P = 0.02). Similarly, the incidence of HAIs caused by CRAB in intervention group was 19.75% lower than that in pre-intervention group (6.0, 95% CI 4.4–7.6 vs. 7.5, 95% CI 5.7–9.3 cases / 1,000 patient days, P = 0.24). The DID model analysis showed that CHG bathing reduced the incidence of CRAB- and CRPA-caused infections in ICU by 1.56 and 2.15 cases/1,000 patient days, respectively, P <0.01, and bathing of every 38 patients (95% CI, 21–268) and 39 patients (95% CI, 24–110) were able to prevent one case of HAIs of CRAB and CRPA, respectively. However, CHG bathing showed no effect on MRSA, VRE and CRE (P>0.05).Conclusion: Daily bathing with 2% CHG-impregnated wipes can reduce HAIs caused by CRAB and CRPA, while it is not effective for the prevalence of infections caused by MRSA, VRE, and CRE.

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Conceptualizing the Impact of MDRO Control Measures Directed at Carriers: A Capability Approach

Ethics and Drug Resistance: Collective Responsibility for Global Public Health - Public Health Ethics Analysis ◽

10.1007/978-3-030-27874-8_13 ◽

2020 ◽

pp. 203-224

Author(s):

Morten Fibieger Byskov ◽

Babette Olga Rump ◽

Marcel Verweij

Keyword(s):

Capability Approach ◽

Ethical Dilemmas ◽

Well Being ◽

Multidrug Resistant ◽

Control Measures ◽

Human Capabilities ◽

Multidrug Resistant Organisms ◽

The Impact ◽

Specific Control

Abstract Many countries have implemented specific control measures directed at carriers of multidrug-resistant organisms (MDRO) in order to prevent further introduction and transmission of resistant organisms into hospitals and other healthcare related settings. These control measures may in many ways affect the lives and well-being of carriers of MDRO, resulting in complex ethical dilemmas that often remain largely implicit in practice. In this chapter, we propose to conceptualize the impact of MDRO control measures on the well-being of individual carriers in terms of capabilities and functionings. A capabilitarian framework for the ethical treatment of MDRO carriers commits us to conceptualize the harm done to carriers in terms of the impact that MDRO control measures have on what they are able to do or be. Adopting and adapting Nussbaum’s list of ten central human capabilities, we present a taxonomy of capabilities and functionings that are normatively relevant for the design and evaluation of MDRO control measures.

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The Impact of a New Pedagogical Intervention on Nursing Students’ Knowledge Acquisition in Simulation-Based Learning: A Quasi-Experimental Study

Nursing Research and Practice ◽

10.1155/2018/7437386 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 4

Author(s):

Thor Arne Haukedal ◽

Inger Åse Reierson ◽

Hanne Hedeman ◽

Ida Torunn Bjørk

Keyword(s):

Experimental Study ◽

Nursing Students ◽

Intervention Group ◽

Control Group ◽

Theoretical Knowledge ◽

Knowledge Test ◽

Patient Deterioration ◽

Simulation Based ◽

Quasi Experimental ◽

The Impact

Simulation-based learning is an effective technique for teaching nursing students’ skills and knowledge related to patient deterioration. This study examined students’ acquisition of theoretical knowledge about symptoms, pathophysiology, and nursing actions after implementing an educational intervention during simulation-based learning. A quasi-experimental study compared theoretical knowledge among two groups of students before and after implementation of the intervention. The intervention introduced the following new components to the existing technique: a knowledge test prior to the simulation, video-recording of the performance, and introduction of a structured observation form used by students and facilitator during observation and debriefing. The intervention group had significantly higher scores on a knowledge test conducted after the simulations in comparison to the scores in the control group. In both groups scores were highest on knowledge of symptoms and lowest on knowledge of pathophysiology; the intervention group had significantly higher scores than the control group on both topics. Students’ theoretical knowledge of patient deterioration may be enhanced by improving the students’ prerequisites for learning and by strengthening debriefing after simulation.

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The management of NDM-β-lactamase-producing carbapenem-resistant Enterobacterales in Tuscany

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.703 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A Ninci ◽

M Grazzini ◽

D Paolini ◽

F Niccolini ◽

M T Mechi ◽

...

Keyword(s):

Prevention And Control ◽

Rectal Swab ◽

Task Force ◽

Hospital Setting ◽

Multidrug Resistant ◽

Control Measures ◽

Outbreak Management ◽

Carbapenem Resistant ◽

Multidrug Resistant Organisms ◽

And Control

Abstract Issue An important outbreak of New Delhi metallo-β-beta-lactamase (NDM)-producing carbapenem-resistant Enterobacterales (CRE) has been reported from north-western of Tuscany since November 2018. NDM is a metallo-β-lactamase able to hydrolyze most β-lactames (including carbapenems) with limited treatment options. Description of the Problem From November 2018 to May 2019, 7 Tuscan hospitals notified a total of 350 infected or colonized cases. This outbreak was described in a risk assessment edited by the European Centre for Disease Prevention and Control (ECDC) in June 2019. The Ministry of Health and the Tuscany Region promptly adopted infection prevention control measures. Results Since July 2019, a regional task force, composed by experts in infectivology, microbiology and public health, coordinated the following actions: Publication of Regional Resolutions which have established practical guidelines for the outbreak management. These measures included:(I) the introduction of screening test for CRE by rectal swab for hospitalized patients; (II) the implementation of microbiological rapid molecular tests and genotyping of rectal swab; (III) the enhancement of standard and transmission-based precautions; (iv) the strengthening of handover between hospital setting and primary healthcare; (v) the implementation of a regional data-base for outbreak surveillance.Monthly regional meetings with the infection control teams of each hospital.Site visits (n. 44) performed by a group of experts in all healthcare facilities. After the implementation of these measures, a trend for decrease in positive blood cultures of NDM was registered. Lessons The spread of NDM in Tuscany has been the opportunity to standardize and improve the approach to Multidrug-Resistant Organisms (MDROs) prevention and control. Key messages The spread of NDM in Tuscany has been the opportunity to standardize and improve the approach to Multidrug-Resistant Organisms (MDROs) prevention and control. The cooperation among stakeholders and the standardization of precaution measures and healthcare workers’ behavior allows to effectively face the MDROs diffusion.

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Multidrug-resistant organisms (MDROs) in patients with subarachnoid hemorrhage (SAH)

Scientific Reports ◽

10.1038/s41598-021-87863-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ha-Young Rhim ◽

Sae-Yeon Won ◽

Sepide Kashefiolasl ◽

Nina Brawanski ◽

Elke Hattingen ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Negative Impact ◽

Delayed Cerebral Ischemia ◽

Multidrug Resistant ◽

Favorable Outcome ◽

Matched Pair ◽

Intracerebral Hematoma ◽

Control Group ◽

Multidrug Resistant Organisms ◽

The Impact

AbstractPatient care in a neurointensive care unit (neuro-ICU) is challenging. Multidrug-resistant organisms (MDROs) are increasingly common in the routine clinical practice. We evaluated the impact of infection with MDROs on outcomes in patients with subarachnoid hemorrhage (SAH). A single-center retrospective analysis of SAH cases involving patients treated in the neuro-ICU was performed. The outcome was assessed 6 months after SAH using the modified Rankin Scale [mRS, favorable (0–2) and unfavorable (3–6)]. Data were compared by matched-pair analysis. Patient characteristics were well matched in the MDRO (n = 61) and control (n = 61) groups. In this center, one nurse was assigned to a two-bed room. If a MDRO was detected, the patient was isolated, and the nurse was assigned to the patient infected with the MDRO. In the MDRO group, 29 patients (48%) had a favorable outcome, while 25 patients (41%) in the control group had a favorable outcome; the difference was not significant (p > 0.05). Independent prognostic factors for unfavorable outcomes were worse status at admission (OR = 3.1), concomitant intracerebral hematoma (ICH) (OR = 3.7), and delayed cerebral ischemia (DCI) (OR = 6.8). Infection with MRDOs did not have a negative impact on the outcome in SAH patients. Slightly better outcomes were observed in SAH patients infected with MDROs, suggesting the benefit of individual care.

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Awareness among French healthcare workers of the transmission of multidrug resistant organisms: a large cross-sectional survey

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-019-0625-0 ◽

2019 ◽

Vol 8 (1) ◽

Author(s):

L. Vaillant ◽

◽

G. Birgand ◽

M. Esposito-Farese ◽

P. Astagneau ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Hand Hygiene ◽

Healthcare Workers ◽

Knowledge Score ◽

Multidrug Resistant ◽

Control Measures ◽

Professional Status ◽

Cross Sectional ◽

Multidrug Resistant Organisms ◽

The Impact

Abstract Background Much effort has been made over the last two decades to educate and train healthcare professionals working on antimicrobial resistance in French hospitals. However, little has been done in France to assess perceptions, attitudes and knowledge regarding multidrug resistant organisms (MDROs) and, more globally, these have never been evaluated in a large-scale population of medical and non-medical healthcare workers (HCWs). Our aim was to explore awareness among HCWs by evaluating their knowledge of MDROs and the associated control measures, by comparing perceptions between professional categories and by studying the impact of training and health beliefs. Methods A multicentre cross-sectional study was conducted in 58 randomly selected French healthcare facilities with questionnaires including professional and demographic characteristics, and knowledge and perception of MDRO transmission and control. A knowledge score was calculated and used in a logistic regression analysis to identify factors associated with higher knowledge of MDROs, and the association between knowledge and perception. Results Between June 2014 and March 2016, 8716/11,753 (participation rate, 74%) questionnaires were completed. The mean knowledge score was 4.7/8 (SD: 1.3) and 3.6/8 (SD: 1.4) in medical and non-medical HCWs, respectively. Five variables were positively associated with higher knowledge: working in a university hospital (adjusted odds ratio, 1.41, 95% CI 1.16–1.70); age classes 26–35 years (1.43, 1.23–1.6) and 36–45 years (1.19, 1.01–1.40); medical professional status (3.7, 3.09–4.44), working in an intensive care unit (1.28, 1.06–1.55), and having been trained on control of antimicrobial resistance (1.31, 1.16–1.48). After adjustment for these variables, greater knowledge was significantly associated with four cognitive factors: perceived susceptibility, attitude toward hand hygiene, self-efficacy, and motivation. Conclusions We found a low level of MDRO awareness and knowledge of associated control measures among French HCWs. Training on hand hygiene and measures to control MDRO spread may be helpful in shaping beliefs and perceptions on MDRO control among other possible associated factors. Messages should be tailored to professional status and their perception. Other approaches should be designed, with more effective methods of training and cognitive interventions. Trial registration Clinical Trials.gov NCT02265471. Registered 16 October 2014 - Retrospectively registered.

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Impact of permagarden intervention on improving fruit and vegetable intake among vulnerable groups. A quasi-experimental study conducted in seven cities of Ethiopia

10.1101/563965 ◽

2019 ◽

Author(s):

Fikralem Alemu ◽

Medhanit Mecha ◽

Girmaye Medhin

Keyword(s):

Experimental Study ◽

Nutrient Intake ◽

Vegetable Consumption ◽

Intervention Group ◽

Control Group ◽

Control Groups ◽

Percentage Difference ◽

Vulnerable Families ◽

Quasi Experimental ◽

The Impact

AbstractBackgroundIncreasing nutrient intake through home gardening is a sustainable strategy that can address multiple micronutrient deficiencies in developing countries. This study investigated the impact of permagarden intervention in increasing the frequency and diversity of vegetable and fruit consumption among vulnerable families.MethodA quasi-experimental study was conducted from August 10 to September 30, 2015. A total of 884 care givers (427 from intervention and 457 control) participated in the study. Data was collected through face to face interview with caregivers of highly vulnerable children. Propensity score matching (PSM) was conducted using STATA software, and the program impact on the frequency and diversity of household’s vegetable consumption between intervention and control groups was assessed using chi square test.ResultIntervention participants had a 13% greater increase frequency of one-week vegetables and fruits consumption compared with control participants (p<0.01). The diversity (consumption of 2 and more groups of vegetable and fruit) is higher among intervention groups than control groups (percentage difference=9, p-value<0.05). A significant higher percentage of participants in the intervention group reported getting the one-week vegetable and fruits mainly from their own garden (percentage difference 58.3, p<0.05). A significantly larger proportion of participants in the intervention group compared to the control group reported “high likelihood” on intention to grow vegetable in the future (percentage difference = 30%, and P<0.01). Perceived importance to include vegetables in every day meal is higher among intervention groups than control groups (percentage difference = 11.5%, P<0.01).ConclusionsThe observed higher frequency and diversity of household vegetable consumption among intervention group compared to control group suggests that nutrition and health programs need to promote household vegetable gardening as the means for address improve micro nutrient intake for vulnerable societies in least and middle developed countries.

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A Hope Intervention Compared to Friendly Visitors as a Technique to Reduce Depression among Older Nursing Home Residents

Nursing Research and Practice ◽

10.1155/2010/676351 ◽

2010 ◽

Vol 2010 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Donna M. Wilson ◽

Alexandra Marin ◽

Param Bhardwaj ◽

Bonnie Lichlyter ◽

Amy Thurston ◽

...

Keyword(s):

Experimental Study ◽

Nursing Home ◽

Pilot Study ◽

Older Persons ◽

Intervention Group ◽

Nursing Home Residents ◽

Control Group ◽

Control Subjects ◽

Hope Intervention ◽

The Impact

Depression is common among older persons. An experimental study was undertaken to test the impact of a four-week hope program on depressed nursing home residents. Residents aged 65 or older, who met the criteria for this pilot study and agreed to participate, were randomly assigned to (a) an intervention group, and provided with weekday hope interventions mainly involving positive messages and pictures or (b) a modified control group, and provided with a friendly weekday greeting. The structured hope intervention was not proven effective for reducing depression or raising hope. Instead, a significant reduction in depression among the control subjects was found, as well as a nonsignificant increase in their level of hope. Although these findings suggest friendly visitors may be a more efficacious nonpharmacological approach for reducing depression, further investigations are needed to confirm this and to explore the impact of other hope interventions.

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The effect of educational intervention based on BASNEF model for reducing internet addiction among female students: a quasi-experimental study

Italian Journal of Pediatrics ◽

10.1186/s13052-019-0761-4 ◽

2019 ◽

Vol 45 (1) ◽

Cited By ~ 2

Author(s):

Batol Gholamian ◽

Hossein Shahnazi ◽

Akbar Hassanzadeh

Keyword(s):

Experimental Study ◽

Educational Intervention ◽

Internet Addiction ◽

Intervention Group ◽

Female Students ◽

T Test ◽

The Internet ◽

Control Group ◽

Quasi Experimental ◽

The Impact

Abstract Background Adolescents and students are encountered with a challenge so-called “internet Addiction”. This issue affects both their physical and mental health, as well as their academic, social, and family performance. The aim of the current research is to determine the impact of educational intervention. To achieve this aim, BASNEF is utilized to reduce the excessive use of the internet by students. Methods This quasi-experimental study was implemented on 120 high school female students in Shahrekord (west of Iran), which were addicted to the internet. Paticipants was randomly divided into two groups of control and intervention. For data collection before and after the intervention, the standard Yang internet Addiction Questionnaire and BASNEF researcher-developed Questionnaire were used. Educational intervention for mothers was conducted in one session (as the most important subjective norm) and for students in two sessions. This method was based on BASNEF construct. Then, data were analyzed using SPSS-20 and chi-square test, Mann-Whitney test, independent t-test, and paired t-test. Results After the education intervention, the mean scores of knowledge, attitude, subjective norms, perceived behavioral control and enabling factors in the intervention group were significantly different from the control group (p < 0.001). In Post-test assessment, the intervention group revealed a significant decrease, in terms of using the internet (based on the time). (p < 0.001). Conclusions The results of this study revealed that BASNEF and its related constructs was a suitable framework to design the educational interventions in order to reduce the extreme use of internet in students. Applying of this model can be a cognitive and intellectual framework that affects students’ internet use behavior.

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Colonization with multidrug-resistant organisms is associated with in increased mortality in liver transplant candidates

PLoS ONE ◽

10.1371/journal.pone.0245091 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245091

Author(s):

Philip G. Ferstl ◽

Natalie Filmann ◽

Eva-Maria Heilgenthal ◽

Andreas A. Schnitzbauer ◽

Wolf O. Bechstein ◽

...

Keyword(s):

Liver Transplant ◽

Multidrug Resistant ◽

Waiting List ◽

Gram Negative Bacteria ◽

Gram Negative ◽

Carbapenem Resistant ◽

Multidrug Resistant Organisms ◽

Transplant Candidates ◽

The Impact

Objectives Rising prevalence of multidrug-resistant organisms (MDRO) is a major health problem in patients with liver cirrhosis. The impact of MDRO colonization in liver transplantation (LT) candidates and recipients on mortality has not been determined in detail. Methods Patients consecutively evaluated and listed for LT in a tertiary German liver transplant center from 2008 to 2018 underwent screening for MDRO colonization including methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant gram-negative bacteria (MDRGN), and vancomycin-resistant enterococci (VRE). MDRO colonization and infection status were obtained at LT evaluation, planned and unplanned hospitalization, three months upon graft allocation, or at last follow-up on the waiting list. Results In total, 351 patients were listed for LT, of whom 164 (47%) underwent LT after a median of 249 (range 0–1662) days. Incidence of MDRO colonization increased during waiting time for LT, and MRDO colonization was associated with increased mortality on the waiting list (HR = 2.57, p<0.0001. One patients was colonized with a carbapenem-resistant strain at listing, 9 patients acquired carbapenem-resistant gram-negative bacteria (CRGN) on the waiting list, and 4 more after LT. In total, 10 of these 14 patients died. Conclusions Colonization with MDRO is associated with increased mortality on the waiting list, but not in short-term follow-up after LT. Moreover, colonization with CRGN seems associated with high mortality in liver transplant candidates and recipients.

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Contact precautions for colonisation with multidrug-resistant organisms and haemodialysis patient quality of life and mood: a pilot case-control study

Renal Society of Australasia Journal ◽

10.33235/rsaj.15.1.19-25 ◽

2019 ◽

pp. 19-25 ◽

Cited By ~ 1

Author(s):

Rathika Krishnasamy

Keyword(s):

Quality Of Life ◽

Qualitative Interviews ◽

Social Function ◽

Multidrug Resistant ◽

Contact Precautions ◽

Dialysis Vintage ◽

Multidrug Resistant Organisms ◽

And Gender ◽

The Impact

Background: The rate of multidrug-resistant organisms (MDRO) colonisation in dialysis populations has increased over time. This study aimed to assess the effect of contact precautions and isolation on quality of life and mood for haemodialysis (HD) patients colonised with MDRO. Methods: Patients undergoing facility HD completed the Kidney Disease Quality of Life (KDQOL–SFTM), Beck Depression Inventory (BDI) and Personal Wellbeing-Index Adult (PWI-A). Patients colonised with MDRO were case-matched by age and gender with patients not colonised. Results: A total of 16 MDRO-colonised patients were matched with 16 controls. Groups were well matched for demographics and co-morbidities, other than a trend for older dialysis vintage in the MDRO group [7.2 years (interquartile range 4.6–10.0) compared to 3.2 (1.4–7.6) years, p=0.05]. Comparing MDRO-positive with negative patients, physical (30.5±10.7 vs. 34.6±7.3; p=0.2) and mental (46.5±11.2 vs. 48.5±12.5; p = 0.6) composite scores were not different between groups. The MDRO group reported poorer sleep quality (p=0.01) and sleep patterns (p=0.05), and lower social function (p=0.02). BDI scores were similar (MDRO-positive 10(3.5–21.0) vs. MDRO-negative 12(6.5–16.0), p=0.6). PWI-A scores were also similar in both groups; however, MDRO patients reported lower scores for “feeling safe”, p=0.03. Conclusion: While overall scores of quality of life and depression were similar between groups, the MDRO group reported poorer outcomes in sleep and social function. A larger cohort and qualitative interviews may give more detail of the impact of contact precautions and isolation on HD patients. The necessity for contact precautions for different MDRO needs consideration.

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