Reduction of Nosocomial Blood Stream Infections (BSI) and Nosocomial Vancomycin-Resistant Enterococcus faecium (VRE) Colonisation on an Intensive Care Unit (ICU) after the Introduction of Antiseptic (Octenidine-based) Bathing: An Interrupted Time Series Analysis
Methods: Between 1/2012 and 4/2014 ICU patients were screened for VRE at admission and twice weekly. Patients with a negative admission screening and a subsequent detection of VRE were defined as nosocomial cases. Intervention started 5/2013 and was implemented 8/2013. Octenidine based body washes were standardised by the use of new wash clothes for each body region and engaged hand disinfection before contacts at aseptic sites. Active surveillance for BSI and VRE infection and colonisation was performed, and VRE infections were determined according to the Centers for Disease Control and Prevention (CDC) criteria. Positive blood cultures taken after 3 days of admission were defined as nosocomial BSI. In case of skin commensals only the repeated detection in two independent blood cultures was taken as BSI. VRE were typed by PFGE. One-sided Permutation test was used to test the pre- and the post-intervention periods for significance (open source program "R" used).
Results: During the pre-intervention period 100 admitted (61% vanA, 39% vanB) and 113 nosocomial (60% vanA, 40% vanB) VRE cases were detected resulting in mean incidence densities (ID) of admitted and nosocomial cases of 6.6 and 7.53/1000 patient days, respectively. PFGE analysis revealed three vanA and four vanB clusters with partially differing hyl and esp profiles, as well as unique strains. Post-interventionally, 30 admitted (65% vanA, 35% vanB) and 19 nosocomial (63 % vanA, 37% vanB) cases occurred resulting in mean IDs of 4.13 and 2.61 (p<0.001), respectively. PFGE analysis showed two vanA and one vanB cluster, as well as unique strains. Nosocomial VRE infections were 10 in the pre- and one in the post-intervention period. Incidence densities of BSI pre- and post-intervention were 2.98 and 2.06, respectively (p = 0.147).
Conclusion: At admission to surgical ICU a high VRE prevalence was detected. The implementation of universal decolonisation using octenidine in combination with a standardised washing regimen led to a significant reduction of nosocomial VRE and a trend in reduction of BSI.
F. Wappler, None
G. Werner, None
U. Ligges, None
S. Sakka, None
S. Messler, None