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

Cepeda, Jorge; Whitehouse, Tony; Cooper, Ben; Hails, J; Jones, Karen; Kwaku, F; Taylor, L; Hayman, Samantha; Cookson, Barry; Shaw, Steve; Kibbler, C; Singer, Mervyn; Bellingan, Geoffrey; Wilson, A.P.R.

doi:10.1016/s0140-6736(05)17783-6

Cited by 247 publications

(190 citation statements)

References 44 publications

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“…In the present study, we loaded 10% teicoplanin within CS pellets for local osteomyelitis treatment and compared the effectiveness of TCS to that of standard, systemically administered teicoplanin. The dosing regimen for teicoplanin employed in this study was clinically relevant (Targocid prescribing information; Gruppo Lepetit S.p.A, December 2006) and comparable to dosing regimens used in other studies of experimental rabbit models of MRSA infection (3,6,13,29). As evidenced in the in vivo experiment, the best therapeutic effect was observed in animals treated with TCS pellets, resulting in a significantly lower radiological and histological score and a lower positive rate of MRSA culture and bacterial load than in those treated by CS alone or i.v.…”

Section: Figsupporting

confidence: 65%

“…Furthermore, vancomycin-resistant Enterococcus faecium (VRE) exhibiting a VanB, VanC, VanE, or VanG phenotype also remains sensitive to teicoplanin (5,12). The efficacy of parenterally administered teicoplanin has been reported (3,8,13,16); however, there are few studies evaluating the use of this antibiotic delivered locally via biodegradable materials against MRSA osteomyelitis.…”

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confidence: 99%

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In Vitro and In Vivo Efficacies of Teicoplanin-Loaded Calcium Sulfate for Treatment of Chronic Methicillin-Resistant Staphylococcus aureus Osteomyelitis

Jia

Luo

Zhang

et al. 2010

Antimicrob Agents Chemother

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The in vitro and in vivo therapeutic efficacies of teicoplanin-loaded calcium sulfate (TCS; 10% [wt] teicoplanin) were investigated in a rabbit model of chronic methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis. The in vitro elution characteristics of teicoplanin from TCS pellets were realized by carrying out an evaluation of the release kinetics, recovery rate, and antibacterial activity of the released teicoplanin. Chronic osteomyelitis was induced by inoculating 10 7 CFU of a MRSA strain into the tibial cavity of rabbits. After 3 weeks, the animals were treated by debridement followed by implantation of TCS pellets in group 1, calcium sulfate (CS) pellets alone in group 2, and intravenous (i.v.) teicoplanin (6 mg/kg of body weight every 12 h for three doses and then every 24 h up to 4 weeks) in group 3. Animals in group 4 were left untreated. After 6 weeks, the efficacy of the osteomyelitis treatment was evaluated by hematological, radiological, microbiological, and histological examinations. In vitro elution studies showed sustained release of teicoplanin at a therapeutic level over a time period of 3 weeks. The released teicoplanin maintained its antibacterial activity. In vivo, the best therapeutic effect was observed in animals treated with TCS pellets, resulting in significantly lower radiological and histological scores, lower positive rates of MRSA culture and bacterial load, and excellent bone regeneration compared with those treated by CS alone or i.v. teicoplanin, without any local or systemic adverse effects. TCS pellets are an effective alternative to i.v. teicoplanin for the treatment of chronic MRSA osteomyelitis, particularly because teicoplanin is delivered locally while the TCS pellets simultaneously promote bone defect repair.

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Section: Figsupporting

confidence: 65%

mentioning

confidence: 99%

In Vitro and In Vivo Efficacies of Teicoplanin-Loaded Calcium Sulfate for Treatment of Chronic Methicillin-Resistant Staphylococcus aureus Osteomyelitis

Jia

Luo

Zhang

et al. 2010

Antimicrob Agents Chemother

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“…It is not clear, however, why this might be the case and whether single rooms were directly causal or some other disruptions to work patterns may have been the cause. Finally, Cepeda et al 154 show that moving MRSA-positive patients into single rooms or bays does not reduce cross-infection. Moreover, because transfer and isolation of critically ill patients in single rooms carries potential risks, they argue that the findings suggest that re-evaluation of isolation policies is required in ICUs where MRSA is endemic.…”

Section: Infection Controlmentioning

confidence: 99%

Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

Maben

Griffiths

Penfold

et al. 2015

Health Services and Delivery Research

177

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BackgroundNew hospital design includes more single room accommodation but there is scant and ambiguous evidence relating to the impact on patient safety and staff and patient experiences.ObjectivesTo explore the impact of the move to a newly built acute hospital with all single rooms on care delivery, working practices, staff and patient experience, safety outcomes and costs.Design(1) Mixed-methods study to inform a pre-/post-‘move’ comparison within a single hospital, (2) quasi-experimental study in two control hospitals and (3) analysis of capital and operational costs associated with single rooms.SettingFour nested case study wards [postnatal, acute admissions unit (AAU), general surgery and older people’s] within a new hospital with all single rooms. Matched wards in two control hospitals formed the comparator group.Data sourcesTwenty-one stakeholder interviews; 250 hours of observation, 24 staff interviews, 32 patient interviews, staff survey (n = 55) and staff pedometer data (n = 56) in the four case study wards; routinely collected data at ward level in the control hospitals (e.g. infection rates) and costs associated with hospital design (e.g. cleaning and staffing) in the new hospital.Results(1) There was no significant change to the proportion of time spent by nursing staff on different activities. Staff perceived improvements (patient comfort and confidentiality), but thought the new accommodation worse for visibility and surveillance, teamwork, monitoring, safeguarding and remaining close to patients. Giving sufficient time and attention to each patient, locating other staff and discussing care with colleagues proved difficult. Two-thirds of patients expressed a clear preference for single rooms, with the benefits of comfort and control outweighing any disadvantages. Some patients experienced care as task-driven and functional, and interaction with other patients was absent, leading to a sense of isolation. Staff walking distances increased significantly after the move. (2) A temporary increase in falls and medication errors within the AAU was likely to be associated with the need to adjust work patterns rather than associated with single rooms, although staff perceived the loss of panoptic surveillance as the key to increases in falls. Because of the fall in infection rates nationally and the low incidence at our study site and comparator hospitals, it is difficult to conclude from our data that it is the ‘single room’ factor that prevents infection. (3) Building an all single room hospital can cost 5% more but the difference is marginal over time. Housekeeping and cleaning costs are higher.ConclusionsThe nature of tasks undertaken by nurses did not change, but staff needed to adapt their working practices significantly and felt ill prepared for the new ways of working, with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. There was no strong evidence that single rooms had any impact on patient safety but housekeeping and cleaning costs are higher. In terms of future work, patient experience and preferences in hospitals with different proportions of single rooms/designs need to be explored with a larger patient sample. The long-term impact of single room working on the nature of teamwork and informal learning and on clinical/care outcomes should also be explored.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Only well-designed trials combined with appropriate statistical analyses can help us in quantifying the effects of interventions to prevent the spread of multiple resistant bacteria. There are some good samples of such studies that, unfortunately, failed to demonstrate effectiveness of such interventions [10,11]. Nevertheless, we are far better off with such studies than with oversimplified analyses reporting positive findings but neglecting the effects of colonization pressure.…”

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confidence: 99%

Colonization pressure: a critical parameter in the epidemiology of antibiotic-resistant bacteria

Bonten

2012

Crit Care

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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

Cited by 247 publications

References 44 publications

In Vitro and In Vivo Efficacies of Teicoplanin-Loaded Calcium Sulfate for Treatment of Chronic Methicillin-Resistant Staphylococcus aureus Osteomyelitis

In Vitro and In Vivo Efficacies of Teicoplanin-Loaded Calcium Sulfate for Treatment of Chronic Methicillin-Resistant Staphylococcus aureus Osteomyelitis

Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

Colonization pressure: a critical parameter in the epidemiology of antibiotic-resistant bacteria

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