The Impact of a Single Ward for Cohorting Patients with Infection due to Multidrug-Resistant Organisms

Abstract

Multidrug-resistant organisms (MDROs) are emerging and disseminating around the globe. The guidelines for the management of MDROs support the use of various interventions to reduce the burden of MDROs. We conducted a study to assess the impact of the creation of a unit for cohorting of patients with infection due to MDROs.Hospital de Clínicas de Porto Alegre, a 795-bed university, public hospital, is located in the city of Porto Alegre in southern Brazil. In a quasi-experimental study, we assessed the impact of the creation of an MDRO unit for patient cohorting on the overall hospital incidence of infection due to MDROs.The 34 beds of the unit were located in 16 rooms for adult MDRO-infected patients and 2 additional rooms for respiratory isolation. Patients were transferred to the unit when they were identified as infected or colonized with MDROs. The unit staff was trained for MDRO-infected patient care; unit staff, patients, and families attended weekly meetings for education about MDROs with a multidisciplinary team (doctors, nurses, pharmacists, and social assistants).

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

“…Most were retrospective studies (n = 49) or quasiexperimental "before and after" studies (n = 35). 3,4,10,20,21,23,24,26,28,29,[31][32][33][34]38,40,42,43,46,51,52,55,[57][58][59]62,68,76,77,80,83,85,86,89,97 The remaining 3 were prospective studies. 8,25,41 Case-control analysis was done in 7 studies.…”

“…6,10,20,21,24,26,30,32,35,37,38,40,41,43,44,51,54,62,65,70,77,[83][84][85]89,92,95 Potential adverse effects from cohorting were discussed in 12 studies. 8,19,25,28,33,34,44,59,61,78,86,89 These adverse effects included increased anxiety or feeling of isolation, 28,34 increased workload for the healthcare team, 61,78 higher cost, 19,33 disruption of patient care, 59,61 potentially less time spent with the healthcare team, 28 increase in other MDROs, 25 or no adverse effects. 8 In 1 study,…”

“…8,19,25,28,33,34,44,59,61,78,86,89 These adverse effects included increased anxiety or feeling of isolation, 28,34 increased workload for the healthcare team, 61,78 higher cost, 19,33 disruption of patient care, 59,61 potentially less time spent with the healthcare team, 28 increase in other MDROs, 25 or no adverse effects. 8 In 1 study, 86 the researchers used surrogate markers, such as falls and pressure ulcers, to evaluate adverse events from contact precautions, and none was observed. In contrast, in 2 studies, 44,89 cohorting led to increased time spent with patients 89 and decreased cost.…”

Estresse psicossocial e resiliência: um estudo em profissionais da enfermagem

“…Por ser um problema relativamente novo no cenário nacional, as instituições de saúde ainda estão buscando formas de organizar o trabalho para o atendimento desta clientela, de modo a manter todas as medidas de barreira epidemiológica preconizadas, preservando a segurança de todos os pacientes e poucas instituições possuem um setor específico para internação e tratamento de pacientes portadores de GMR. [10][11] Uma instituição pública da região sul do Brasil apostou na implantação de uma unidade de internação específica para o atendimento de pacientes clínicos e cirúrgicos com GMR. Os resultados demonstraram um decréscimo importante na incidência de bactérias resistentes, principalmente nas infecções causadas pelo Enterococcus spp resistente à vancomicina e Pseudomonas aeruginosa resistente aos carbapenêmicos.…”

“…Os resultados demonstraram um decréscimo importante na incidência de bactérias resistentes, principalmente nas infecções causadas pelo Enterococcus spp resistente à vancomicina e Pseudomonas aeruginosa resistente aos carbapenêmicos. 10 Entretanto, observa-se que o atendimento dos pacientes com GMR acarreta sobrecarga no trabalho dos profissionais da enfermagem, pois o tratamento requer a execução de um número elevado de atividades no seu turno de trabalho.…”