Effects of Discontinuing Contact Precaution on Control of Extended-Spectrum β-lactamase-producing Enterobacteriaceae Nosocomial Acquisition: An Interrupted Time Series Analysis

Abstract

Background: Interest of contact precautions (CP) to prevent cross-transmission in addition to standard precautions (SP) is actually debated in the literature for some microorganisms, like extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBLE). We took advantage of the decision to stop CP for ESBLE in our hospital to study in real life if this discontinuing has an impact on the ESBLE acquisition rate. Methods: An interrupted time series (ITS) was performed in 3 wards and the week was used as the temporal unit. The ESBLE acquisition and importation incidence density (ID) and potential risks factors (colonization and selective pressure, Alcohol-Based hand rub solution consumption rates, demographic patients data) were collected between two periods: the pre-intervention (July 2018 to June 2019) when patients infected or colonized by ESBLE were cared with PC and SP and the post-intervention (September 2019 to March 2020) when patients were cared with SP only. Results: ESBLE acquisition ID were of 1.32 ± 1.36 and 1.17 ± 1.25 cases per 1000 patient-days for the pre- and post-intervention period respectively with no significant change in slope (p = 0.15). The only confounding variable significant (p = 0.04) in ITS was the antibiotics consumption, with a positive increasing trend. Conclusion: This study showed that the SP alone in order to control the ESBLE nosocomial did not lead to increasing the ESBLE nosocomial cross-transmission.