Table 4:
Summary of Study Outcomes by Pathogen and Endemicity
| Pathogen | Cohorting | Pre intervention | Post-intervention | Risk ratio | Outcome |
|---|---|---|---|---|---|
| C. difficile | |||||
| Outbreak | |||||
| Struelens 1991 | G | 1.47/1000 admissions 1.5/10,000 patient days [PD] |
0.39/1000 0.34/10,000 |
0.26 (0.46–0.87) 0.23 (NR) | Decrease |
| Cherifi 2006 | SU | 99 /100,000 [PD] | 31/100,000 | 0.31 (0.13–0.77), p=0.013 | Decrease |
| Debast 2009 | SU | 45 | 0 | NA | Decrease |
| Islam 2013 | SU | 5/110 | 21/138 | 3.34 (1.3–8.6) p= 0.021 | Increase |
| Endemic | |||||
| Price 2010 | SU | 1.3/1000 bed days [BD] | 0.6/1000 | 0.46 (NR) | Decrease |
| Garcia-Lecona 2018 | SU | 7/91 recurrences | 14/85 | 2.14 (0.91–5.05), p= 0.08 | No change |
| MRSA | |||||
| Outbreak | |||||
| Selkon 1980 | SU | 6.5 /1000 patients | 0.527/1000 | 0.08 (NR), p=0.05 | Decrease |
| Arnow 1982 | G | 2.5 /100 PD | 0/100 PD | 0 | Decrease |
| Duckworth 1988 | SU | 169 | 67 | Decrease | |
| Murray-Leisure 1990 | SU | 16 / month Colonization: 6/53 (11.3%) |
1–3/month 0/39 (0) | NA 0 |
Decrease |
| Cox 1995 | SU | 35/month | 1–2/month | NA | Decrease |
| Mayall 1996 | SU | Colonization: 19% | 6.4% | 0.34 (NR) | Decrease |
| Meier 1996 | SU | 6 | 0 | Decrease | |
| Cohen 1991 | G | 3.5/1000 discharges | 1.5/1000 | 0.29 (NR) | Decrease |
| Faoagali 1992 | G | 11/40131 admissions | 720/48818 | 49 (NR) | Increase |
| Farrington 1998 | G | 29% (# cases/# infections) | 14% | 0.48 (NR) | Decrease |
| Curran 2006 | G | 1–7/month | 0–2/month | P<0.0005 | Decrease |
| Khan 2009 | G | 9 | 0 | NA | Decrease |
| Batra 2010 | G | 1.06 (1.03–1.08) | A 1.12 (0.632.01) B 0.71 (0.182.88)^ C 3.85 (0.818.59) |
NR | No change |
| Barbut 2013 | G | 7.22/1000 PD | 0.77/1000 | P<00001 | Decrease |
| Endemic | |||||
| Fitzpatrick 2000 | SU | NR NR |
26/88 (27%) infected 23/88 (23%) decolonized | NA | Not reported |
| Cepeda 2005 | G | Hospital A 20.6/1000 PD Hospital B 28.2/1000 PD |
15.5/1000 22.2/1000 |
A: 0.72[0.44–1.17], p=0.91 B: 0.76[0.37–1.58], p=0.77 (HR) |
No change |
| G | Acquisition 45.6% | 9.9% | 0.22 (NR), p<0.001 | ||
| Singh 2006 | Infection 40.4 (19/47) | 4.1 (4/97) | p<0.001 | Decrease | |
| Bacteremia 25.5 (12/47) | 4.1 (4/97) | p<0.01 | |||
| Raineri 2007 | G | 3.5/1000 PD | 1.7/1000 (p2) 0.7/1000 (p3) |
P= 0.0023 P=0.048 |
Decrease |
| Gilroy 2009 | SU | 0.66/1000 PD | 0.43/1000 0.23/1000 |
0.65 (NR) 0.53 (NR) |
|
| Kusachi 2010 | G | 34/833 (4.1%) | D 40/1807 (2.2) E 5/1302 (0.4) |
0.18 (NR), p<0.002 | Decrease |
| G | Infection 0.26/1000 PD (0.18–0.34) | 0.11/1000 (0.07–0.19) |
0.42 | Decrease | |
| Fisher 2013 | Acquisition 10% | 5 | 0.5 (NR) | Decrease | |
| Hand hygiene compliance 47% (44–49) | 69% (68–71) | 14.6 (NR) | Improved | ||
| Marshall 2013 | G | 18.5/ 1000 risk days Hand hygiene compliance: Glove use 698/795 (87.8%) |
7.9/1000 12–34% 622/722 (86.2) |
HR 0.39 (0.24–0.62) NA P=0.3 |
Improved No change No change |
| VRE | |||||
| Outbreak | |||||
| Karanfil 1992 | G | 6 | 0 | NA | Decrease |
| Lai 1998 | G | 24/month Hand hygiene: 51% |
2–7/month 100% |
NA | Decrease Increase |
| 49 | 0 | NA | Outbreak | ||
| Bartley 2001 | G | MRSA incidence : 10.9/mo | 19/mo | p=0.013 | control 4 mos Increase |
| Ridwan 2002 | G | 43 | NR | NA | Partial control 4 mos |
| Sample 2002 | G | 3.5/1000 PD | 0.8/1000 | 0.22 (NR) p=0.001 | Decrease; outbreak control 5 mos |
| Timmers 2002 | G | 24 | 0 | Outbreak control week 44 | |
| Christiansen 2004 | SU | 169 | 0 | Outbreak control in 6 mos | |
| Mascini 2006 | G | P1 NR Hand hygiene: 31% |
PII 0.67 (0.41–1.1) PIII 0.02 (0.002–0.6) 275% |
Outbreak control in 3 yrs Increase | |
| Lucet 2007 | SU | 37 | 0 | Outbreak control 4 wks | |
| Schmidt-Heiber 2007 | SU | 33 | 0 | Outbreak control 33 wks | |
| Kurup 2008 | SU | 29/254 (11.4%) | 6/142 (4.2) | Outbreak control 3 mos | |
| Servais 2009 | SU | 14 | 0 | Outbreak control 2 mos | |
| Moretti 2010 | SU | 75.8/1000 PD | 0.45/1000 | P<0.001 | Decrease |
| Endemic | |||||
| Jochimsen 1999 | SU | 0.28/100 admissions Infection control compliance: 5/23 (21%) |
0.09/100 36/41 (88%) |
0.32 (0.69–15.85), p=0.2 p<0.001 |
No change Decrease |
| Montecalvo 1999 | G | Infection 2.1/1000 PD | 0.45/1000 | 0.22 (0.05–0.92), p=0.04 | Decrease |
| Colonization 20.7/1000 PD | 10.3/10000 | 0.5 (0.33–0.75), p <0.001 | Decrease | ||
| G | Colonization 1.96/10,000 BD (2001) | 4.98/10,000 (2006) 3.18/10,000 (2007) |
P<0.01 (2006 vs 2007) | Decrease | |
| Morris-Downes 2010 |
BSI 0.091 (2001) |
0.78 (2005) | P < 0.001 | Increase | |
| Hand hygiene 28% (20050 | 88 (67–93) [2008] | NR | Increase | ||
| Chotiprasitsakul 2016 | G | 26 | 0 | Outbreak control 33 wks | |
| A. baumannii | |||||
| Endemic | |||||
| Apisarnarnthanarak | Colonization/Infection | P2 1.2/1000 | P<0.001 | Decrease | |
| 2008 | 3.6/1000 PD | P3 0.85/1000 | |||
| G | Hand hygiene−0.31 +/− 0.7 | P2 0.75 +/− 0.8 P3 0.54 +/− 0.1 |
NR | No change | |
| Infection rates | P2 1.74/1000 | p<0.001 | Decrease | ||
| P1 11.1/1000 PD | P3 0.69/1000 | p<0.001 | |||
| Apisnarnthanarak 2014 |
G | Surveillance | P2 2.11/1000 | p<0.001 | Decrease |
| P1 12.15/1000PD | P3 0.98/1000 | p<0.001 | |||
| Hand hygiene | P2/P3 | NS | No change | ||
| Infection rates | 0.46/1000 | P=0.96 (2010) | No change | ||
| 0.35/1000 PD (2007) | 0.06/1000 | P<0.001 (2012) | Decrease | ||
| Cho 2014 | SU | ||||
| Hand hygiene: 5.6L/1000 PD | 7.5/1000 11.9/1000 |
P<0.001 (2012) | Decrease | ||
| Gavalda 2015 | SU | 10.78/1000 PD (2011) | 5.87/1000 1.74/1000 0.69/1000 |
0.54 (0.41–0.73) (2012) 0.3 (0.18–0.48) (2013) 0.4 (0.18–0.89) (2014), p<0.02 |
Decrease |
| Outbreak | |||||
| Podnos 2001 | G | 52 | 0 | Outbreak control 13 mos | |
| Longo 2005 | G | 14 | 0 | Outbreak control i 2 mos | |
| Kohlenberg 2009 | G | 32 | 0 | Outbreak control 10 mos | |
| Palmore 2011 | G | Total 63 1st outbreak 29 2nd oubreak 22 |
0 0 |
Control in 6 mos 3 mos | |
| Ayraud-Thevenot | 1st outbreak = 20 | 2nd outbreak= | Outbreak | ||
| 2012 | G | 7 | control 152 days vs. 25 days | ||
| Landelle 2013 | SU | 38 | 0 | Outbreak control 18 mos | |
| Alfandari 2014 | SU | 8 | 0 | Outbreak control 9 mos | |
| Gray 2015 | SU | 29 | 0 | Outbreak control 20 mos | |
| Molter 2015 | G | 10 | 0 | Outbreak control 1 mo | |
| Gagnaire 2017 | G | 5 | 0 | Outbreak control 37 days | |
| VAP 10.19/1000 PD | 3.645/1000 | P=0.198 | No change | ||
| CLABSI 14.33 | 12.90/1000 | P=1 | No change | ||
| Metan 2019 | G | CAUTI 11.05 | 6.858/1000 | P=0.27 | No change |
| Hand hygiene 58% | 62% | p=0.38 | No change | ||
| Enterobacteriaceae | |||||
| Ohana 2006 | G | 2.36/1000 PD (2000–2002) | 0/1000 (2003) | 0 | Decrease |
| Laurent 2008 | SU | 11.57/1000 PD | 0.08/1000 | 0.11 (NS) | Decrease |
| Kochar 2008 | G | 9.7/1000 PD | 3.7/1000 | 0.38 p<0.001 | Decrease |
| Langer 2009 | G | 8.6/1000 PD | 0 | Decrease | |
| Carbonne 2010 | G | 13 | 0 | Outbreak control in 1 mo | |
| 26 | 0 | Outbreak control in 7 mos | |||
| Gregory 2010 | SU |
Hand hygiene (no baseline)
Contact precaution (no baseline) |
108/225 (48%) 139/225 (62%) |
Not indicated | |
| Kassis 2010 | G | 8 | 0 | Outbreak | |
| control after 1 yr | |||||
| Munoz-price 2010 | G | 10 | 0 | Outbreak control in 7 mos | |
| Agodi 2011 | G | 16 | 0 | Outbreak control in 4 mos | |
| Ciobotaro 2011 | SU | 3.4/10000 – 8.2/10000 PD | 0.5/10000 | 0.91 (0.85–0.97), p<0.001 | Decrease |
| 30/1000 hospital beds | P2 13.4 | p<0.001 | Decrease | ||
| P3 8.3 | p =0.76 | No change | |||
| Cohen 2011 | G | P4 4.3 | p=0.27 | No change | |
| Compliance w/ cohorting | 71 +/− 20 | Not reported | |||
| w/ active surveillance | 43 +/− 10 | ||||
| Schwaber 2011 | SU | 55.5/100,000 PD | 11.7 | 0.21 (NR) p<0.001 | Decrease |
| Palmore 2013 | G | 8 then 15 | 0 | Outbreak control 1 yr | |
| Hand hygiene: 84–88% | Close to 100% | Increase | |||
| Sisirak 2013 | G | 78 | 0 | Outbreak control 1 yr | |
| Vergara-Lopez 2013 | G | 1.91/100 PD | 1.24/100 P2 0.82/100 P3 | NR | Decrease |
| Kim 2014 | G | 5.49 to 9.81/100,000 PD | 1.61/100,000 | 0.88 (NR) p<0.001 | Decrease |
| Hand hygiene: 35.2 | 78% | Increase | |||
| Nouvenne 2014 | SU | 18–23/ month (13.2–16.9% incidence) |
3–13
(8/month, 1.2%) |
P=0.04 | Decrease |
| Infection rate : 36.6% | 22.5% | P= 0.07 | No change | ||
| Viale 2014 | CRE BSI 1.05 (0.99 – 1.11) p 0.09 | IRR 0.96 (0.92–0.99), p=0.03 | Decrease | ||
| G | CRE Colonization NR | 0.96 (0.95–0.97), p<0.0001 |
Decrease | ||
| Hussein 2017 | G | CRE incidence186.6 /100,000 HD | 23.4/100,000 | p<0.05 | Decrease |
| CRE BSI 25.5/100,000 HD | 3.7–4.4/100,000 | p<0.05 | Decrease | ||
| E. coli 0.15 (0.04–0.67) | 0.02 (0–0.14) | p<0.001 | Decrease | ||
| Decraene 2018 | SU | KPN 0.19 (0.04–0.82) | 0.27 (0.090.78) | p=0.015 | Decrease |
| Pirs 2018 | G | 42 | 0 | Outbreak control 6 mos | |
| Reeme 2019 | SU | 8 | 0 | Outbreak control 9 mos | |
| Other MDRO | |||||
| Outbreak | |||||
| Rosenberger 2011 | G | 6 | 0 | Outbreak control 2 mos | |
| Endemic | |||||
| Landrum 2008 | G | VAP 60.6/1000 PD | 11.1/1000 | 0.18 (NR), p=0.029 | Decrease |
| Stumpfs 2013 | SU | MDRO incidence: 0.65 VRE 0.69 |
−1.04 −1.04 |
p<0.01 p<0.01 |
Decrease Decrease |
| SU | Hand hygiene 54% | 66% | p<0.05 | Increase | |
| Wongchaoren 2013 | Gloves 16.7% | 37.2% | p<0.05 | Increase | |
| Environmental cleaning 90% | 90% | NR | No change | ||
| Arruda 2019 | SU | 2/1000 PD | 2.8/1000 PD | IDR 1.35 (1.01–1.810, p=0.04 | Decrease |
G- geographic, SU- special or dedicated unit; NR – Not reported, RR Risk ratio, IDR – incidence density ratio Bolded- cohorting intervention