Effectiveness of contact isolation in the control of multiresistant bacteria in an intensive care service

AIM. To describe the frequency, characteristics and progression of critically ill patients admitted to the ICU, for whom isolation is indicated due to detection of multiresistant pathogenic bacteria, and to study the effectiveness of precautionary measures to avoid dissemination of these microorganisms. PATIENTS AND METHODS. Prospective, observational, cohort study performed by a specially created working group of four nurses and an ICU specialist. The study included 55 patients in whom contact isolation was indicated (isolation rate, 15.2 per 100 patients), collected over a 16-month period. RESULTS. The multiresistant bacteria responsible for isolation of the patients were: Pseudomonas aeruginosa (17 cases), Staphylococcus aureus (17 cases), Stenotrophomonas maltophilia (15 cases), Acinetobacter baumannii (4 cases) and extended-spectrum beta-lactamase (ESBL)- producing Enterobacteria (2 cases). Vancomycin-resistant Enterococcus spp. was not identified in any case. The mean duration of ICU isolation was 17.6 ± 5.1 days (range 1-75). Multiresistant bacteria were classified as intra-ICU nosocomial in 39 cases (70.9%), extra-ICU nosocomial in 10 cases (18.2%) and community-acquired in 6 (10.9%). During the study period, no epidemic outbreak due to any of the controlled bacteria was detected. The multiresistant bacteria presented in the form of colonization in 41 cases (74.5%). The reasons for discontinuing isolation were death of the patient in 18 cases, transferal to a hospital ward (discharge from the ICU) in 19 cases, and eradication of the bacteria in 18 cases. Of the 55 patients with multiresistant bacteria, 35 (63.6%) died during hospitalization, and 23 of these (41.8%) during their stay in the ICU. CONCLUSIONS. The implementation of a working team for early detection of multiresistant pathogenic bacteria resulted in application of contact isolation in 15.2% of patients admitted. Surveillance to fulfill isolation precautions in a medical-surgical ICU achieved an absence of epidemic outbreaks due to these bacteria during the study period.