Table 1.
Characteristics and infection control practices of hospital sites included in study.
| Hospital network | Hospital code | Hospital description | No. of inpatient bedsa | High-risk wards | MDRO screening practices during study period and changes during study | Management of patients colonised or infection with MDRO |
|---|---|---|---|---|---|---|
| A | A1 | Tertiary referral center, including ICU, solid-organ and bone marrow transplant | 560 | ICU, Haematology/BMT and Oncology , Renal Transplant & Liver Transplant (Spinal ward and respiratory ward added during study) |
vanA VRE and MRGN screening: ICU, on admission and twice weekly; haematology/oncology, renal and liver transplant wards screened on admission and weekly. Additional MRSA screening in ICU (on admission and twice weekly). Biannual point-prevalence survey for vanA VRE and MRGN. MRSA screening before critical surgeries (prosthetic joint, spinal and cardiac). Change during study: Added spinal ward and respiratory ward (ventilator support service) to high-risk wards for regular MDRO screening (October 2018) |
MRSA: patients only isolated in certain circumstances, e.g. highly exudative wound; single room, disposable apron, gloves. vanA VRE: single room with own bathroom, full gown, gloves; sometimes cohortedb with other vanA VRE-colonised patients. ESBL-Ec and ESBL-Kp (multidrug-resistant)c: single room, own bathroom, disposable apron |
| A2 | Subacute hospital, aged care and rehabilitation services | 150 | None | Biannual point-prevalence survey for vanA VRE and MRGN | ||
| A3 | Subacute hospital, rehabilitation services | 60 | None | Biannual point-prevalence survey for vanA VRE and MRGN | ||
| B | B1 | Tertiary referral center, including ICU and solid-organ transplant and specialist pediatric hospital (including neonatal ICU) | 640 | ICU, Renal Transplant | ICU and renal ward screened for vanA VRE and carbapenem-resistant Gram negatives (CRGN) on admission and weekly. MRSA screening before cardiac surgery. Changes during study: Stopped routine screening of renal ward for VRE (June 2018). Network-wide changes in cleaning practices to from microfibre/steam cleaning to bleach cleaning (September 2018) |
MRSA: single room, gloves and short-sleeved gown. vanA VRE: single room, own bathroom, occasional cohortingb with other vanA VRE-colonised patients; gloves and short-sleeved gown. Additional measures if diarrhoea (full gown). ESBL-Ec: no specific management measures. ESBL-Kp: single room, own bathroom, gloves and short-sleeve gown |
| B2 | Tertiary referral center, including ICU, trauma and some aged care & rehabilitation services | 573 | ICU | ICU patients screened for vanA VRE and carbapenem-resistant Gram negatives (CRGN) on admission and weekly. Changes during study: Cleaning protocol changes as above |
||
| C | C1 | Tertiary referral center, including ICU, solid-organ and bone marrow transplant | 571 | ICU, Haematology/BMT | ICU and haematology ward screened on admission and weekly for vanA VRE and MRGN | MRSA: single room only in certain situations, e.g. highly exudative wound. vanA VRE: single room, own bathroom, gloves and full gown. ESBL-Ec (multidrug-resistant)c and ESBL-Kp: single room, own bathroom, gloves and full gown |
| C2 | Subacute hospital, aged care and rehabilitation services | 150 | None | None | ||
| D | D1 | Specialized cancer care center. Located adjacent to Hospital C1 (ICU patients cared for at C1 before transfer back to hospital D1) |
96 | Haematology | Haematology ward patients screened on admission and weekly for vanA VRE and MRGN | MRSA: single room when possible; if open wounds, gown and gloves; if respiratory, mask and gloves. vanA VRE: single room, own bathroom, gloves and full gown. ESBL-Ec and ESBL-Kp: single room, own bathroom, no extra PPE but additional cleaning if incontinent or discharging wounds |
ICU, intensive care unit; MRGN, multi-resistant Gram negatives (includes ESBL and carbapenem-resistant phenotypes); CRGN, carbapenem-resistant Gram negatives; BMT, bone marrow transplant (allogeneic); PPE, personal protective equipment; VRE, vancomycin-resistant Enterococcus; ESBL-Ec, extended-spectrum beta-lactamase Escherichia coli; ESBL-Kp, extended-spectrum beta-lactamase Klebsiella pneumoniae; MRSA, methicillin-resistant Staphylococcus aureus.
a
Inpatient beds, excludes day cases, hospital-in-the-home and mental health.
b
Cohorting, practice of patients colonised with the same MDRO sharing a room.
c
Multidrug-resistant ESBL, ESBL isolates with additional resistance aminoglycosides, fluoroquinolones and trimethoprim-sulfamethoxazole (at least two classes).