166 Table 1. Distribution of Antimicrobial Curtains and Standard Curtains by Patient Types and Specialties in 10 Hospitals
Antimicrobial Curtain A
For the rooms of patients with known MDROs MRSA (N=1), medical, SH MRPA (N=1), medical, TMH MDRA (N=4), medical, TPH
MRSA (N=4), MDRA (N=2), medical, YCH Total For cubicles
Medical (7-bed & 8-bed, AHNH; 8-bed, CMC; 6-bed, PYNEH; 5-bed, TMH; 2 corner beds of a 4-bed cubicle & 1 corner bed of a 6-bed cubicle, SH; 1 corner bed of a 8-bed cubicle, TPH)
Surgical (4-bed, UCH)
Neurosurgical (6-bed, PWH; 6-bed, QEH) Orthopedics (7-bed, AHNH)
Total 22
4 7 5
38 14
0 0 0
14 199
23 13 3
238
Note. MDROs, multidrug-resistant organisms; MRSA, methicillin-resistant Staphylococcus aureus; MRPA, multidrug-resistant Pseudomonas aeruginosa; MDRA, multidrug-resistant Acinetobacter species, TMH, Tuen Mun Hospital; YCH, Yan Chai Hospital; AHNH, Alice Ho Miu Ling Nethersole Hospital; CMC, Caritas Medical Centre; PYNEH, Pamela Youde Nethersole Eastern Hospital; SH, Shatin Hospital; TPH, Tai Po Hospital; UCH, United Christian Hospital; PWH, Prince of Wales Hospital; QEH, Queen Elizabeth Hospital.
MRSA count>100 CFU/cm2, median day 29 (N=5); pre-
sence of MDRA, median day 45 (N=3); grossly soiled, median day 67.5 (N=2); miscommunication, median day 25 (N=2). Also, 1 piece of antimicrobial curtain B was removed: grossly soiled, median day 131. The median hanging time of anti- microbial curtain A was 60 days; the median hanging time of antimicrobial curtain B was 173 days, and the median hanging time of the standard curtain was 15 days. In total, 3,029 curtain surfaces were sampled: 923 anti-
microbial curtain A surfaces, 580 antimicrobial curtain B surfaces, and 1,526 standard curtain surfaces; by clinical settings, 257 surfaces next to the rooms of patients with MDROs and 2,772 surfaces in cubicles. The bioburden, in terms of CFU/100cm2 of TAC, MRSA, CRA, and MDRA, and the percentages of MDROs contamination, are presented in Table 2. Compared with the standard curtain, the bioburden and percentages of MDROs contamination on antimicrobial curtain B were significantly reduced, and the bioburden and percentages of MDROs con- tamination on antimicrobial curtain A were higher. In total, 1,290 (42.6%) cultures were collected on the cur-
tain surfaces next to patients having history of MDROs within the previous 12 months. The corresponding percentages of MDROs contamination on curtain surfaces for antimicrobial curtain A and standard curtain were higher if the residing patients had the same type of MDROs within the previous 12 months. For antimicrobial curtain A,MRSA contamination was found on 137 of 267 samples (51.3%). For CRA, 14 of 34 samples (41.2%) were contaminated. For MDRA, 7 of 29 samples (24.1%) were contaminated. On standard curtain surfaces, MRSA was found on 204 of 507 samples (40.2%); CRA was found on 13 of 31 samples (41.9%); and MDRA was found on 8 of 31 samples (25.8%). The differences in percen- tages of MDRO contamination between antimicrobial curtain B and antimicrobial curtain A were significant: MRSA difference, 50.7%
(95% CI, 44.2%–56.7%) (P<.001); CRA difference, 41.2% (95% CI, 24.4%–57.8%) (P<.001); and MDRA difference, 24.1% (95% CI, 0.5%–42.1%) (P=.047). The differences in percentages of MDRO contamination between antimicrobial curtain B and standard curtain were also significant:MRSA difference, 39.7% (95% CI, 34.8%–44.0%) (P <.001); CRA difference, 41.9% (95% CI, 24.5%–59.2%) (P<.001); and MDRA difference, 25.8% (95% CI, 1.1%–43.2%) (P=.038). The increases in percentages ofMDROs contamination of standard curtain surfaces next to patients with history ofMDROs within past 12months were also significant, when compared to curtain surfaces next to patients without such history:MRSA increase, 26.4% (95% CI, 21.6%– 31.2%) (P<.001); CRA increase, 21.5% (95% CI, 5.8%–38.9%) (P=.004); and MDRA increase, 13.3% (95% CI, 1.1%–30.8%) (P=.028) (Fig. 1). Among the contaminated curtains, the median time to first
MDRO contamination of antimicrobial curtains A was 4 days (interquartile range [IQR], 1–12.8 days), the median time to first MDRO contamination of antimicrobial curtains B was 138 days (IQR, 99.5–159 days), and the median time to first MDRO contamination of standard curtains was 5 days (IQR, 2–7 days). The differences between antimicrobial curtains B and antimicrobial curtains A (134 days; 95% CI, 46–155; P<.001) were statistically significant, and those between antimicrobial curtain B and the standard curtain (133 days; 95% CI, 46–157; P=.001) were also statistically significant. The time to first MDRO contamination of each curtain type in cubicles was graphed using nonparametric maximum likelihood estimator (NPMLE) censoring after curtain removal or study completion (log-rank P<.001) (Fig. 2). Using an 8-bed MRSA cohort cubicle in an acute medical ward
as a template, the direct cost of new purchase and the indirect cost of time of replacement, staff wage, revenue loss and laundering were compared among antimicrobial curtain A, antimicrobial curtain B and standard curtain (Table 3).
1 1 1 5
Antimicrobial Curtain B
0 0 0 0
80
Standard Curtain
1 6 4
12 23
Shik Luk et al
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