Prospective evaluation of hospital isolation room capacity

Wigglesworth, Neil; Wilcox, Mark H.

doi:10.1016/j.jhin.2006.02.008

Cited by 34 publications

(21 citation statements)

References 13 publications

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“…The efficacy of these approaches as a control mechanism for CDI remains unproven. By contrast, the results of the present study do justify the use of single rooms for patients with suspected or proven CDI, even when such resources are limited [8]. In particular, we believe our findings underscore the importance of early patient isolation, as soon as possible after the onset of diarrhea and before laboratory diagnosis of CDI is confirmed.…”

Section: Discussioncontrasting

confidence: 61%

The Potential for Airborne Dispersal ofClostridium difficilefrom Symptomatic Patients

et al. 2010

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BACKGROUND. The high transmissibility and widespread environmental contamination by Clostridium difficile suggests the possibility of airborne dissemination of spores. We measured airborne and environmental C. difficile adjacent to patients with symptomatic C. difficile infection (CDI). METHODS. We conducted air sampling adjacent to 63 patients with CDI for 180 h in total and for 101 h in control settings. Environmental samples were obtained from surfaces adjacent to the patient and from communal areas of the ward. C. difficile isolates were characterized by ribotyping and multilocus variable-number tandem-repeat analysis to determine relatedness. RESULTS. Of the first 50 patients examined (each for 1 h), only 12% had positive air samples, most frequently those with active symptoms of CDI (10%, vs 2% for those with no symptoms). We intensively sampled the air around 10 patients with CDI symptoms, each for 10 h over 2 days, as well as a total of 346 surface sites. C. difficile was isolated from the air in the majority of these cases (7 of 10 patients tested) and from the surfaces around 9 of the patients; 60% of patients had both air and surface environments that were positive for C. difficile. Molecular characterization confirmed an epidemiological link between airborne dispersal, environmental contamination, and CDI cases. CONCLUSIONS. Aerosolization of C. difficile occurs commonly but sporadically in patients with symptomatic CDI. This may explain the widespread dissemination of epidemic strains. Our results emphasize the importance of single-room isolation as soon as possible after the onset of diarrhea to limit the dissemination of C. difficile.

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Section: Discussioncontrasting

confidence: 61%

The Potential for Airborne Dispersal ofClostridium difficilefrom Symptomatic Patients

et al. 2010

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“…However, although this approached may be proactive and provides a safe environment of care for other patients, the benefits of single room isolation of patients colonized in their respiratory tract or their cohorting for reducing the spread of MDRO are discussed controversially [8]. Wigglesworth et al [10] concluded that either isolation capacity needs to be increased or evidence-based risk assessment shall be applied in situations where isolation demands exceed availability.…”

Section: Resultsmentioning

confidence: 99%

The strength of coughing may forecast the likelihood of spread of multi-drug resistant microorganisms from the respiratory tract of colonized patients

Diab-Elschahawi

Lusignani

Starzengrüber

et al. 2014

Antimicrob Resist Infect Control

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BackgroundCurrent recommendations indicate that patients who are coughing and have multidrug resistant microorganisms (MDROs) in their sputum are considered to be shedders and should be cared for in single room isolation at least until symptoms resolve. Airborne spread and subsequent contamination of surfaces adjacent to patients may contribute to transmission. Hence, isolation measures for patients colonized or infected with MDRO at their respiratory tract are intended to interrupt such transmission. However, the potential for microbial shedding in patients with MDRO-positive microbiological reports from their respiratory tract and factors justifying the need for single room isolation are viewed controversially.MethodsCough aerosol produced by patients colonized with MDROs was measured for viable counts. Descriptive analysis together with logistic regression analysis was performed to assess the impact of strength of cough on growth of MDRO on culture plates.ResultsIn 18% (23/128) MDRO were transmitted. Multivariate analysis revealed that strength of cough significantly predicts the yield of MDRO on culture plates (P = 0.012).ConclusionBased on these results it can be concluded that risk stratification for decision of single room isolation of patients colonized or infected with MDROs at their respiratory tract may also take the severity of cough into consideration. However, more work is required in order to assess the severity of cough objectively.

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“…No limit was set on isolation capacity and it was assumed that all identified carriers were isolated, with corresponding isolation costs. However, this ideal policy will not always be realized [29]. Failure to isolate will reduce the total isolation effectiveness, but will also reduce costs.…”

Section: Discussionmentioning

confidence: 99%

Modelling the Costs and Effects of Selective and Universal Hospital Admission Screening for Methicillin-Resistant Staphylococcus aureus

et al. 2011

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BackgroundScreening at hospital admission for carriage of methicillin-resistant Staphylococcus aureus (MRSA) has been proposed as a strategy to reduce nosocomial infections. The objective of this study was to determine the long-term costs and health benefits of selective and universal screening for MRSA at hospital admission, using both PCR-based and chromogenic media-based tests in various settings.Methodology/Principal FindingsA simulation model of MRSA transmission was used to determine costs and effects over 15 years from a US healthcare perspective. We compared admission screening together with isolation of identified carriers against a baseline policy without screening or isolation. Strategies included selective screening of high risk patients or universal admission screening, with PCR-based or chromogenic media-based tests, in medium (5%) or high nosocomial prevalence (15%) settings. The costs of screening and isolation per averted MRSA infection were lowest using selective chromogenic-based screening in high and medium prevalence settings, at $4,100 and $10,300, respectively. Replacing the chromogenic-based test with a PCR-based test costs $13,000 and $36,200 per additional infection averted, and subsequent extension to universal screening with PCR would cost $131,000 and $232,700 per additional infection averted, in high and medium prevalence settings respectively. Assuming $17,645 benefit per infection averted, the most cost-saving strategies in high and medium prevalence settings were selective screening with PCR and selective screening with chromogenic, respectively.Conclusions/SignificanceAdmission screening costs $4,100–$21,200 per infection averted, depending on strategy and setting. Including financial benefits from averted infections, screening could well be cost saving.

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Prospective evaluation of hospital isolation room capacity

Cited by 34 publications

References 13 publications

The Potential for Airborne Dispersal ofClostridium difficilefrom Symptomatic Patients

The Potential for Airborne Dispersal ofClostridium difficilefrom Symptomatic Patients

The strength of coughing may forecast the likelihood of spread of multi-drug resistant microorganisms from the respiratory tract of colonized patients

Modelling the Costs and Effects of Selective and Universal Hospital Admission Screening for Methicillin-Resistant Staphylococcus aureus

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