1194 infection control & hospital epidemiology october 2017, vol. 38, no. 10
in hospitalized patients with detected or suspected MDRO infection or carriage, to limit nosocomial spread.21 Moreover, errors or omission of medical prescription are frequent at hospital admission22 or during hospital stay,23,24 and these may be associatedwith increased risk of various adverse events, such as pressure ulcers.25 Other independent factors of IP absence are the medium age
category of patients with better practices in younger and older populations. In acute or intensive care, the incidence of MRDO infections is high, but IP practices are good. However, units with lower risk of MDRO infections, namely, extended-stay facilities, nursing homes, and psychiatric facilities may have poorer practices. Particular attention must be given to specialties that are less aware of MDRO but are at risk of outbreaks.26,27 Moreover, significant heterogeneity was observed between hospitals, even when all settings followed the same protocols and recommenda- tions for IPs. This heterogeneity might be related more to local screening practices and IPs than to the type of study population. In addition, the probability of being isolated was greater in infected than in colonized patients, and their risk of transmissionmight be also higher. This study had some limitations. First, screened patients with
only positive nasal or rectal tests were excluded, while some of them might have needed contact
precautions.However, patients withMRSAnasal carriage did not necessitate contact precautions according to our protocol. Second, although the study was prospective, there was a time lag between the identification of MDRO cases and investigation. Thus, some patients were already discharged at inclusion, and information was less reliable than direct observation. Third, although multivariate models were used to control for main cofounding variables, residual confounding (eg, change in staff who are eligible to write prescriptions for isolation or in training on isolation prescriptions between 2013 and 2015) might persist because such data were not prospectively collected. The study’smain strengths were its multicenter design, which increased external validity, and the standardization of data collection. In conclusion, MRSA and 3GCR-E infections and/or
colonizations are frequent in French healthcare settings. Isolation precautions are implemented in most cases. When they are lacking, the main causative factor is the absence of medical prescription for IPs. Despite recurring discussions on the importance of IPs to control the spread of MRDO infections, their utility is demonstrated in both outbreak and nonoutbreak situations. Continuous monitoring with real-time advice from the infection control team and the microbiological laboratory should be promoted and evaluated.
acknowledgments
The authors thank all infection control nurses and practitioners who partici- pated in the study as well as the nursing staff from University of Lyon hospitals. We also thank Ovid Da Silva for her assistance in editing the manuscript. Financial support. No financial support was provided relevant to this article. Potential conflicts of interest. All authors report no conflicts of interest relevant to this article.
Address correspondence to Thomas Bénet, MD, PhD, Service d’Hygiène,
Epidémiologie et Prévention, Hôpital Edouard Herriot, 5 place d’Arsonval, 69437 Lyon Cedex 03, France (
thomas.benet@
chu-lyon.fr).
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