A systematic review of the effectiveness of cohorting to reduce transmission of healthcare-associatedC. difficileand multidrug-resistant organisms

Abstract

Background:Cohorting of patients and staff is a control strategy often used to prevent the spread of infection in healthcare institutions. However, a comprehensive evaluation of cohorting as a prevention approach is lacking.Methods:We performed a systematic review of studies that used cohorting as part of an infection control strategy to reduce hospital-acquired infections. We included studies published between 1966 and November 30, 2019, on adult populations hospitalized in acute-care hospitals.Results:In total, 87 studies met inclusion criteria. Study types were quasi-experimental “before and after” (n = 35), retrospective (n = 49), and prospective (n = 3). Case-control analysis was performed in 7 studies. Cohorting was performed with other infection control strategies in the setting of methicillin-resistant Staphylococcus aureus (MRSA, n = 22), Clostridioides difficile infection (CDI, n = 6), vancomycin-resistant Enterococcus (VRE, n = 17), carbapenem-resistant Enterobacteriaceae infections (CRE, n = 22), A. baumannii (n = 15), and other gram-negative infections (n = 5). Cohorting was performed either simultaneously (56 of 87, 64.4%) or in phases (31 of 87, 35.6%) to help contain transmission. In 60 studies, both patients and staff were cohorted. Most studies (77 of 87, 88.5%) showed a decline in infection or colonization rates after a multifaceted approach that included cohorting as part of the intervention bundle. Hand hygiene compliance improved in approximately half of the studies (8 of 15) during the respective intervention.Conclusion:Cohorting of staff, patients, or both is a frequently used and reasonable component of an enhanced infection control strategy. However, determining the effectiveness of cohorting as a strategy to reduce transmission of MDRO and C. difficile infections is difficult, particularly in endemic situations.

Early experience with COVID-19 patients in a private tertiary hospital in the Philippines: Implications on surge capacity, healthcare systems response, and clinical care

“…Our staff were also reshuffled and assigned to patients in COVID-19 units to limit cross-contamination. This method of patient and staff cohorting is often used to curtail outbreaks of multi-drug resistant organisms 25 , 26 and emerging infections. 26 However, isolation and cohorting are difficult to sustain because of higher cost and increased workload for the healthcare team.…”

Occupational Health and Safety Measures in Healthcare Settings during COVID-19: Strategies for Protecting Staff, Patients and Visitors

“…According to Su et al [35], administrative control measures can be effective in reducing the transmission of infections if they are well implemented, adequately enforced and continually monitored to better facilitate staff, patients and visitors compliance. Several studies have reported that administrative control measures such as triage procedures at main entrances of the facility, limiting the number of patients and visitors to the facility, cohorting of patients and healthcare workers and physical distancing practices are all effective measures of preventing or limiting the spread of SARS-CoV-2 infection in hospitals [32,[35][36][37][38][39][40][43][44][45][46][47][49][50][51][52][53][54][55][56][57][58][59]61]. According to Lu et al [40] the establishment of infection control strategies such as material preparation and distribution, training on infection prevention measures, a triage strategy, limiting traffic into the hospital, reorganization of hospital departments to minimize the number of people present at any particular time and keeping the environment sanitized are very effective strategies to contain the spread of the SARS-CoV-2.…”

“…They concluded that there are multiple pathways of transmission and formulating healthcare teams can potentially prevent the transfer of SARS-CoV-2 to non-COVID-19 patients and staff. In a systematic review by Abad et al [46], they reported that cohorting patients and healthcare workers is an effective strategy to reduce intra-hospital transmission of infectious diseases. They observed that about 88.5% of studies have reported a significant reduction in the spread of infection when cohorting healthcare workers was implemented with other infectious disease measures such as cohorting patients and good hand hygiene practices.…”

Effectiveness of infection prevention and control interventions, excluding personal protective equipment, to prevent nosocomial transmission of SARS-CoV-2: a systematic review and call for action

“…Evidence of intervention strategies for other types of hospital-acquired infections can also be informative. A review ( 48 ) of the effectiveness of cohorting in reducing transmission of C. difficile and multi-drug organisms found limited evidence in its effectiveness despite its widespread use.…”