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Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study.

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Title: Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study.
Authors: Cepeda, Jorge A, Whitehouse, Tony, Cooper, Ben, Hails, Janeane, Jones, Karen, Kwaku, Felicia, Taylor, Lee, Hayman, Samantha, Cookson, Barry, Shaw, Steve, Kibbler, Chris, Singer, Mervyn, Bellingan, Geoffrey, Wilson, A. Peter R.
Source: Lancet. 1/22/2005, Vol. 365 Issue 9456, p295-304. 10p. 5 Charts, 2 Graphs.
Subjects: Staphylococcus aureus infections, Critical care medicine, Infection prevention, Health of patients, Hospital sanitation, Infectious disease transmission
Abstract: Summary Background Hospital-acquired infection due to meticillin-resistant Staphylococcus aureus (MRSA) is common within intensive-care units. Single room or cohort isolation of infected or colonised patients is used to reduce spread, but its benefit over and above other contact precautions is not known. We aimed to assess the effectiveness of moving versus not moving infected or colonised patients in intensive-care units to prevent transmission of MRSA. Methods We undertook a prospective 1-year study in the intensive-care units of two teaching hospitals. Admission and weekly screens were used to ascertain the incidence of MRSA colonisation. In the middle 6 months, MRSA-positive patients were not moved to a single room or cohort nursed unless they were carrying other multiresistant or notifiable pathogens.Standard precautions were practised throughout. Hand hygiene was encouraged and compliance audited. Findings Patients' characteristics and MRSA acquisition rates were similar in the periods when patients were moved and not moved. The crude (unadjusted) Cox proportional-hazards model showed no evidence of increasedtransmission during the non-move phase (0·73 [95%CI 0 ·49 --1·10 ],p=0·94 one-sided). There were no changes in transmission of any particular strain of MRSA nor in hand washing frequency between management phases. Interpretation Moving MRSA-positive patients into single rooms or cohorted bays does not reduce cross infection. Because transfer and isolation of critically ill patients in single rooms carries potential risks, our findings suggest that re-evaluation of isolation policies is required in intensive-care units where MRSA is endemic, and that more effective means of preventing spread of MRSA in such settings need to be found. [ABSTRACT FROM AUTHOR]
Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: <searchLink fieldCode="DE" term="%22Staphylococcus+aureus+infections%22">Staphylococcus aureus infections</searchLink><br /><searchLink fieldCode="DE" term="%22Critical+care+medicine%22">Critical care medicine</searchLink><br /><searchLink fieldCode="DE" term="%22Infection+prevention%22">Infection prevention</searchLink><br /><searchLink fieldCode="DE" term="%22Health+of+patients%22">Health of patients</searchLink><br /><searchLink fieldCode="DE" term="%22Hospital+sanitation%22">Hospital sanitation</searchLink><br /><searchLink fieldCode="DE" term="%22Infectious+disease+transmission%22">Infectious disease transmission</searchLink>
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  Data: Summary Background Hospital-acquired infection due to meticillin-resistant Staphylococcus aureus (MRSA) is common within intensive-care units. Single room or cohort isolation of infected or colonised patients is used to reduce spread, but its benefit over and above other contact precautions is not known. We aimed to assess the effectiveness of moving versus not moving infected or colonised patients in intensive-care units to prevent transmission of MRSA. Methods We undertook a prospective 1-year study in the intensive-care units of two teaching hospitals. Admission and weekly screens were used to ascertain the incidence of MRSA colonisation. In the middle 6 months, MRSA-positive patients were not moved to a single room or cohort nursed unless they were carrying other multiresistant or notifiable pathogens.Standard precautions were practised throughout. Hand hygiene was encouraged and compliance audited. Findings Patients' characteristics and MRSA acquisition rates were similar in the periods when patients were moved and not moved. The crude (unadjusted) Cox proportional-hazards model showed no evidence of increasedtransmission during the non-move phase (0·73 [95%CI 0 ·49 --1·10 ],p=0·94 one-sided). There were no changes in transmission of any particular strain of MRSA nor in hand washing frequency between management phases. Interpretation Moving MRSA-positive patients into single rooms or cohorted bays does not reduce cross infection. Because transfer and isolation of critically ill patients in single rooms carries potential risks, our findings suggest that re-evaluation of isolation policies is required in intensive-care units where MRSA is endemic, and that more effective means of preventing spread of MRSA in such settings need to be found. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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