Multidrug Resistant Bacteria in an Intensive Care Unit: relationship between excessive workload and increasing requirement of contact isolation

Introduction

Multidrug resistant bacteria (MRB) transmission occurs frequently as a result of inadequate compliance to handwashing practices in ICUs. Decreasing rates of handwashing compliance are related to work overload. Little is known about the relationship between excessive work and recovery of selected mul-tidrug resistant bacteria.

Objective

to establish a relationship between workload in an intensive care unit and the rate of isolation of selected MRB requiring the institution of contact precautions.

Methods

The study was conducted in a 24-bed-medical-surgical ICU. Routine surveillance of selected MRB is conducted every monday and contact isolation is indicated upon the isolation of epidemiological important bacteria (methicilin Resistant S. aureus, Acinetobacter, Gram-negative bacteria resistant to carbapenens/ ceftazidime and vancomycin resistant Enterococcus). The ratio of patient/month and the number of multidisciplinary health staff working in the same month was used as an index of workload.

Results

The figure bellow shows an endemic curve of MRB, considering a two-year-period of routine surveillance. As shown, there is a clear relationship between work overload and peaks of isolation of MRB above the upper limit in the endemic curve.

Figure

Conclusion

Excessive workload in this ICU is related to an increasing rate of recovery of MRB, probably due to inadequate compliance to handwashing.