The order of ward rounds influences nosocomial infection. A 2-year study in gastroenterologic surgery patients

Abstract

We studied the effect of the order of ward rounds on nosocomial infection in gastroenterologic surgery patients. The subjects were patients with gastrointestinal diseases admitted between September 1992 and August 1994. During the 1st year, the round proceeded indiscriminately among recovery rooms and rooms with stable patients and isolated patients with methicillin-resistant Staphylococcus aureus (MRSA). In the subsequent year, the round started in the recovery rooms and moved into the general rooms with stable patients and finally into the isolation rooms. Against the time course, piecewise linear regression analyses were made with the number of culture-positive patients and the quantities of antibiotics and disinfectants used. Of a total of 1894 strains from 264 patients, isolates of MRSA (n = 200) decreased from 150 in the 1st year to 50 in the 2nd year. The number of MRSA-positive patients showed the point of inflexion in the analysis at the change of round order, with a later decrease. The trend was similar for Candida (n = 99) and Enterococcal (n = 225) species. The amount of antibiotics was unchanged while the amount of disinfectants used decreased in the 2nd year. Thus, the round re-ordering appeared to help prevent nosocomial infection. Ward rounds for patients who have had gastroenterologic surgery should proceed from compromised hosts to stable patients, and then isolated patients.

Systematic review of isolation policies in the hospital management of methicillin-resistant Staphylococcus aureus: a review of the literature with epidemiological and economic modelling

“…57,84,92,95 Five were prospective twophase ITS. 55,97,102,107,120 One was a prospective cohort study with historical controls, 114 one a prospective cohort crossover study 110 and one a prospective ITS. 93 There were four prospective single-phase observational studies.…”

“…Five studies 90,95,102,110,112 lasted <1 year (range: 1-9 months); 12 lasted between 1 and 4 years 55,57,78,84,93,97,[106][107][108][109]114,120 one lasted 4 years 4 months 56 and one study described 9 years' experience of MRSA.…”

“…Changes in antibiotic use were part of the intervention in five studies and so cannot be considered a confounder, 56,[75][76][77][78] although a detailed record of consumption was presented only in two. 56,75 Details of antibiotic use were reported in four other studies 55,[79][80][81] and unquantified changes were alluded to in two studies. 82,83 In one study 82 we considered changes in antibiotic use to provide a plausible alternative explanation for the outcome of the study.…”

“…90 One studied patients with gastrointestinal diseases on two surgical wards. 55 One study was based on a systematically collected questionnaire survey of all reported index cases of MRSA in Dutch hospitals. …”

“…93,107,120 The interventions here were changes to other aspects of MRSA control such as the criteria for isolation, 110,120 change in screening policy, 93 ward closure, cleaning and alert systems, 107 eradication, screening and handhygiene education, 95 a change of soap, 57 use of mupirocin for all patients irrespective of MRSA status 114 or leaving MRSA patients until last on ward rounds. 55 In the study by Jernigan and colleagues, 95 although the intervention was not a change to patient isolation, the data were reported and analysed in sufficient detail to allow an assessment of the contribution of the isolation to control.…”