1. Objective of study The purpose of this study was to investigate whether the active surveillance and preemptive isolation of multidrug-resistant Gram-negative bacteria in the intensive care unit affected the reduction of the rate of acquisition of multidrug- resistant Gram-negative bacteria (MDRGNB). 2. Background Treatment option for MDRGNB (Carbapenem-resistant P. aeruginosa, Carbapenem-resistant A. baumannii, Carbapenem-resistant Enterobacteriaceae) is limited. Development of infection due to MDRGNB is common in ICU. Strategy to prevent transmission of MDRGNB is needed, and there is two approaches; First, antimicrobial stewardship program, and second, infection control strategy.The investigators aimed to figure out the role of active surveillance test and preemptive isolation of MDRGNB in reduction of acquisition rate of MDRGNB. 3. Methods Pragmatic cluster randomized, crossover, controlled trial During first period (6 months), intervention group (randomized 3 ICUs) perform daily chlorhexidine bathing, active surveillance test and preemptive isolation and contact precaution. Control group (randomized 3 ICUs) perform standard precaution with daily chlorhexidine bathing, and start contact precaution when clinical isolates reveals MDRGNB. After 1 month washout period, intervention group and control group cross over for next 6 months.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
2,500
Active surveillance test and preemptive isolation is performed. If MDRO is isolated in surveillance test, contact precaution is needed.
No active surveillance and preemptive isolation. If clinical isolates are positive for MDRGNB, start contact precaution
Asan Medical Center
Seoul, South Korea
RECRUITINGThe number of patients who acquired MDRGNB in ICU per 1000 patient-days
The number of patients who acquired MDRGNB in ICU per 1000 patient-days
Time frame: through study completion, an average 6 months
Rate of bloodstream infection due to MDRGNB
Rate of bloodstream infection due to MDRGNB
Time frame: through study completion, an average 6 months
Hand hygiene compliance rates (%) of healthcare workers
number of Hand hygiene compliance/number of opportunicities for hand hygiene of healthcare workers \*100
Time frame: through study completion, an average 1 year
Days of ICU stay
Days of ICU stay
Time frame: through study completion, an average 6 months
28-day mortality rate
28-day mortality rate
Time frame: 28-days
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