3児の親さん薬剤師のブログ

とある薬剤師です。感染症治療を考える素材をちょこっと提供。noteもあります https://note.com/twin1980

Time-Series Analysis of Health Care-Associated Infections in a New Hospital With All Private Rooms.

 JAMA Inter Med に報告された、「院内感染の発症予防に個室管理が有効か」という題材の論文。このトピック最近流行っていますね。

抄読会で呼吸器内科の先生が取り上げてくれました。

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2747870

 

抄読会での主な討論


・全室個室化以外の因子、(新しい施設で換気もしっかりし、配管等もむき出しでない状況)が交絡因子としては挙げられそう。
飛沫感染であり、医療者側の振る舞い、服装なども院内感染では大きく影響しそうだ。
・全ケベック州CDIが減っているのは何が原因なのだろうか。
・似たような報告が確かオランダで最近出ており、それでは個室の有意差なしで出ているので、それとも比較したい。
・オランダなど、抗生剤選択が慎重に行われ、感染予防が徹底的に行われ、耐性菌もおきにくく、院内感染が少なくコントロールされている場所では個室でなくても予防できているということかもしれない。

 

f:id:akinohanayuki:20191224055810j:plain

 

Key Points


Question Are 100% single-patient hospital rooms associated with reductions in the acquisition of common multidrug-resistant organisms and nosocomial infections compared with ward-type rooms?

Finding In this time-series analysis of a move from a 417-bed hospital with ward-type rooms to a 350-bed facility with solely private rooms, the move was associated with reductions in the incidence of nosocomial vancomycin-resistant Enterococcus and methicillin-resistant Staphylococcus aureus colonization and vancomycin-resistant Enterococcus infection. However, no change in nosocomial Clostridioides difficile or methicillin-resistant Staphylococcus aureus infections was noted.

Meaning Single-patient rooms may help prevent nosocomial multidrug-resistant organism colonization, but the extent to which single-patient rooms may be associated with infection rates likely owes to community colonization rates and factors associated with the transition from colonization to infection.

 

Abstract

 

Importance

 

Health care–associated infections are often caused by multidrug-resistant organisms and substantially factor into hospital costs and avoidable iatrogenic harm. Although it is recommended that new facilities be built with single-room, low-acuity beds, this process is costly and evidence of reductions in health care–associated infections is weak.

 

Objective

 

To examine whether single-patient rooms are associated with decreased rates of common multidrug-resistant organism transmissions and health care–associated infections.

 

Design, Setting, and Participants

 

A time-series analysis comparing institution-level rates of new multidrug-resistant organism colonization and health care–associated infections before (January 1, 2013-March 31, 2015) and after (April 1, 2015-March 31, 2018) the move to the hospital with 100% single-patient rooms. In the largest hospital move in Canadian history, inpatients in an older, tertiary care, 417-bed hospital in Montréal, Canada, that consisted of mainly mixed 3- and 4-person ward-type rooms were moved to a new 350-bed facility with all private rooms.

Exposures A synchronized move of all patients on April 26, 2015, to a new hospital with 100% single-patient rooms equipped with individual toilets and showers and easy access to sinks for hand washing.

 

Main Outcomes and Measures

 

Rates of nosocomial vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) colonization, VRE and MRSA infection, and Clostridioides difficile (formerly known as Clostridium difficile) infection (CDI) per 10 000 patient-days.

 

Results

 

Compared with the 27 months before, during the 36 months after the hospital move, an immediate and sustained reduction in nosocomial VRE colonization (from 766 to 209 colonizations; incidence rate ratio [IRR], 0.25; 95% CI, 0.19-0.34) and MRSA colonization (from 129 to 112 colonizations; IRR, 0.57; 95% CI, 0.33-0.96) was noted, as well as VRE infection (from 55 to 14 infections; IRR, 0.30, 95% CI, 0.12-0.75). Rates of CDI (from 236 to 223 infections; IRR, 0.95; 95% CI, 0.51-1.76) and MRSA infection (from 27 to 37 infections; IRR, 0.89, 95% CI, 0.34-2.29) did not decrease.

 

 

Conclusion and Relevance

 

The move to a new hospital with exclusively single-patient rooms appeared to be associated with a sustained decrease in the rates of new MRSA and VRE colonization and VRE infection; however, the move was not associated with a reduction in CDI or MRSA infection. These findings may have important implications for the role of hospital construction in facilitating infection control.

 

 

 

J-IDEO (ジェイ・イデオ) Vol.2 No.5

J-IDEO (ジェイ・イデオ) Vol.2 No.5

  • 作者: 
  • 出版社/メーカー: 中外医学社
  • 発売日: 2018/09/10
  • メディア: 単行本(ソフトカバー)