Nosocomial Infections Clinical Trial
Official title:
Evaluation of Two Protocols to Prevent the Acquisition of Methicillin-Resistant Staphylococcus Aureus in Intensive Care Units.
Nosocomial infections is a major problem in intensive care units due to both growing incidence and pathogens implicated which become increasingly resistant to antibiotics. According to the Center for Disease Control (USA), Staphylococcus aureus is responsible for approximately 10% of cases. In Europe, 79% of the S.aureus strains are resistant to methicillin, a routinely used antibiotic. Recommendations for the prevention of transmission of these resistant bacteria are rarely based on controlled trials. Therefore the aim of our study is to evaluate two protocols to prevent the acquisition of methicillin-resistant S. Aureus in intensive care units: either a reinforced isolation precautions protocol or a standard precautions protocol.
Recommendations for the prevention of transmission of resistant bacteria in intensive care
units (ICU) are rarely based on controlled trials. For this reason, we compared a reinforced
isolation precautions protocol (RIPP) with a standard precautions protocol (SPP) for the
acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in 2 intensive care units.
Evaluation: the risk for MRSA carriage was defined on admission if 1 of 3 criteria were met:
hospitalization in the past year, transfer with prior length of stay ≥2 days, prior history
of MRSA in the 5 past years.
Intervention: Randomization 1/1 of a total of 500 patients to either protocol; MRSA
screening was performed at the sites of carriage and colonization at inclusion, every week
and at ICU discharge in all patients; the results were given to the clinicians only for the
patients of the RIPP group.
Protocols: the SPP was consistent with the CDC recommendations and included
transmission-based isolation precautions to patients with clinical samples involving
resistant bacteria (including MRSA) or highly transmissible organisms. The RIPP included the
extension of isolation precautions (1) to patients at risk for MRSA on admission until
screening results proved negative and (2) to MRSA-positive patients on screening or clinical
samples until further negative samples, in whom nasal mupirocin decontamination was added.
Compliance with the recommendations of each protocol was controlled by an audit.
The efficacy is assessed on the proportion of patients who acquired MRSA at any site.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention
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