Infection control and prevention measures to reduce the spread of vancomycin-resistant enterococci in hospitalized patients: A systematic review and meta-analysis

Giulia De Angelis, Maria Adriana Cataldo, Chiara DeWaure, Silvia Venturiello, Giuseppe La Torre, Roberto Cauda, Yehuda Carmeli, Evelina Tacconelli

Research output: Contribution to journalArticle

Abstract

Objectives: Vancomycin-resistant enterococci (VRE) represent a major problem in healthcare settings worldwide. It is still unclear which is the most effective infection control and prevention (ICP) measure to reduce the spread of hospital-acquired VRE. Methods: Cochrane databases, MEDLINE, EMBASE and CINAHL were searched until June 2012 to find studies comparing wards/hospitals where ICP measures to prevent VRE transmission were investigated. In the absence of heterogeneity, a fixed-effects model was used to estimate the pooled risk ratio (RR). Study quality was assessed according to Cochrane Effective Practice and Organisation of Care (EPOC) criteria. Results: The search strategy retrieved 549 studies and 9 studies (1 randomized clinical trial, 3 controlled clinical trials and 5 interrupted time series) with 30949 participants were included. The overall study quality was low. Implementation of hand hygiene was associated with a 47% decrease in the VRE acquisition rate (pooled RR 0.53, 95% CI 0.39-0.73, I2 26%) while contact precautions did not significantly reduce the VRE acquisition rate (pooled RR 1.08, 95% CI 0.63-1.83, I2 0%). Due to the low number of studies, meta-analysis was not applied for surveillance screening, environmental cleaning and antibiotic formulary interventions. No studies were available on the effectiveness of isolation and cohorting of patients and staff. Conclusions: Available evidence on the ICP measures to reduce VRE spread in adult hospitalized patients is poor. This systematic review suggests a significant role for the implementation of hand hygiene. Further studies with appropriate study design are urgently needed to define ICP measures able to reduce the acquisition of VRE among hospitalized patients.

Original languageEnglish
Article numberdkt525
Pages (from-to)1185-1192
Number of pages8
JournalJournal of Antimicrobial Chemotherapy
Volume69
Issue number5
DOIs
Publication statusPublished - 2014

Fingerprint

Infection Control
Meta-Analysis
Hand Hygiene
Odds Ratio
Patient Isolation
Formularies
Environmental Monitoring
Controlled Clinical Trials
Cross Infection
Vancomycin-Resistant Enterococci
MEDLINE
Randomized Controlled Trials
Databases
Anti-Bacterial Agents
Delivery of Health Care

Keywords

  • Contact precaution
  • Hand hygiene
  • Screening

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases
  • Medicine(all)

Cite this

Infection control and prevention measures to reduce the spread of vancomycin-resistant enterococci in hospitalized patients : A systematic review and meta-analysis. / Angelis, Giulia De; Cataldo, Maria Adriana; DeWaure, Chiara; Venturiello, Silvia; La Torre, Giuseppe; Cauda, Roberto; Carmeli, Yehuda; Tacconelli, Evelina.

In: Journal of Antimicrobial Chemotherapy, Vol. 69, No. 5, dkt525, 2014, p. 1185-1192.

Research output: Contribution to journalArticle

Angelis, Giulia De ; Cataldo, Maria Adriana ; DeWaure, Chiara ; Venturiello, Silvia ; La Torre, Giuseppe ; Cauda, Roberto ; Carmeli, Yehuda ; Tacconelli, Evelina. / Infection control and prevention measures to reduce the spread of vancomycin-resistant enterococci in hospitalized patients : A systematic review and meta-analysis. In: Journal of Antimicrobial Chemotherapy. 2014 ; Vol. 69, No. 5. pp. 1185-1192.
@article{7ad3a29ffe51473e90c4a7bf9ca59b46,
title = "Infection control and prevention measures to reduce the spread of vancomycin-resistant enterococci in hospitalized patients: A systematic review and meta-analysis",
abstract = "Objectives: Vancomycin-resistant enterococci (VRE) represent a major problem in healthcare settings worldwide. It is still unclear which is the most effective infection control and prevention (ICP) measure to reduce the spread of hospital-acquired VRE. Methods: Cochrane databases, MEDLINE, EMBASE and CINAHL were searched until June 2012 to find studies comparing wards/hospitals where ICP measures to prevent VRE transmission were investigated. In the absence of heterogeneity, a fixed-effects model was used to estimate the pooled risk ratio (RR). Study quality was assessed according to Cochrane Effective Practice and Organisation of Care (EPOC) criteria. Results: The search strategy retrieved 549 studies and 9 studies (1 randomized clinical trial, 3 controlled clinical trials and 5 interrupted time series) with 30949 participants were included. The overall study quality was low. Implementation of hand hygiene was associated with a 47{\%} decrease in the VRE acquisition rate (pooled RR 0.53, 95{\%} CI 0.39-0.73, I2 26{\%}) while contact precautions did not significantly reduce the VRE acquisition rate (pooled RR 1.08, 95{\%} CI 0.63-1.83, I2 0{\%}). Due to the low number of studies, meta-analysis was not applied for surveillance screening, environmental cleaning and antibiotic formulary interventions. No studies were available on the effectiveness of isolation and cohorting of patients and staff. Conclusions: Available evidence on the ICP measures to reduce VRE spread in adult hospitalized patients is poor. This systematic review suggests a significant role for the implementation of hand hygiene. Further studies with appropriate study design are urgently needed to define ICP measures able to reduce the acquisition of VRE among hospitalized patients.",
keywords = "Contact precaution, Hand hygiene, Screening",
author = "Angelis, {Giulia De} and Cataldo, {Maria Adriana} and Chiara DeWaure and Silvia Venturiello and {La Torre}, Giuseppe and Roberto Cauda and Yehuda Carmeli and Evelina Tacconelli",
year = "2014",
doi = "10.1093/jac/dkt525",
language = "English",
volume = "69",
pages = "1185--1192",
journal = "Journal of Antimicrobial Chemotherapy",
issn = "0305-7453",
publisher = "Oxford University Press",
number = "5",

}

TY - JOUR

T1 - Infection control and prevention measures to reduce the spread of vancomycin-resistant enterococci in hospitalized patients

T2 - A systematic review and meta-analysis

AU - Angelis, Giulia De

AU - Cataldo, Maria Adriana

AU - DeWaure, Chiara

AU - Venturiello, Silvia

AU - La Torre, Giuseppe

AU - Cauda, Roberto

AU - Carmeli, Yehuda

AU - Tacconelli, Evelina

PY - 2014

Y1 - 2014

N2 - Objectives: Vancomycin-resistant enterococci (VRE) represent a major problem in healthcare settings worldwide. It is still unclear which is the most effective infection control and prevention (ICP) measure to reduce the spread of hospital-acquired VRE. Methods: Cochrane databases, MEDLINE, EMBASE and CINAHL were searched until June 2012 to find studies comparing wards/hospitals where ICP measures to prevent VRE transmission were investigated. In the absence of heterogeneity, a fixed-effects model was used to estimate the pooled risk ratio (RR). Study quality was assessed according to Cochrane Effective Practice and Organisation of Care (EPOC) criteria. Results: The search strategy retrieved 549 studies and 9 studies (1 randomized clinical trial, 3 controlled clinical trials and 5 interrupted time series) with 30949 participants were included. The overall study quality was low. Implementation of hand hygiene was associated with a 47% decrease in the VRE acquisition rate (pooled RR 0.53, 95% CI 0.39-0.73, I2 26%) while contact precautions did not significantly reduce the VRE acquisition rate (pooled RR 1.08, 95% CI 0.63-1.83, I2 0%). Due to the low number of studies, meta-analysis was not applied for surveillance screening, environmental cleaning and antibiotic formulary interventions. No studies were available on the effectiveness of isolation and cohorting of patients and staff. Conclusions: Available evidence on the ICP measures to reduce VRE spread in adult hospitalized patients is poor. This systematic review suggests a significant role for the implementation of hand hygiene. Further studies with appropriate study design are urgently needed to define ICP measures able to reduce the acquisition of VRE among hospitalized patients.

AB - Objectives: Vancomycin-resistant enterococci (VRE) represent a major problem in healthcare settings worldwide. It is still unclear which is the most effective infection control and prevention (ICP) measure to reduce the spread of hospital-acquired VRE. Methods: Cochrane databases, MEDLINE, EMBASE and CINAHL were searched until June 2012 to find studies comparing wards/hospitals where ICP measures to prevent VRE transmission were investigated. In the absence of heterogeneity, a fixed-effects model was used to estimate the pooled risk ratio (RR). Study quality was assessed according to Cochrane Effective Practice and Organisation of Care (EPOC) criteria. Results: The search strategy retrieved 549 studies and 9 studies (1 randomized clinical trial, 3 controlled clinical trials and 5 interrupted time series) with 30949 participants were included. The overall study quality was low. Implementation of hand hygiene was associated with a 47% decrease in the VRE acquisition rate (pooled RR 0.53, 95% CI 0.39-0.73, I2 26%) while contact precautions did not significantly reduce the VRE acquisition rate (pooled RR 1.08, 95% CI 0.63-1.83, I2 0%). Due to the low number of studies, meta-analysis was not applied for surveillance screening, environmental cleaning and antibiotic formulary interventions. No studies were available on the effectiveness of isolation and cohorting of patients and staff. Conclusions: Available evidence on the ICP measures to reduce VRE spread in adult hospitalized patients is poor. This systematic review suggests a significant role for the implementation of hand hygiene. Further studies with appropriate study design are urgently needed to define ICP measures able to reduce the acquisition of VRE among hospitalized patients.

KW - Contact precaution

KW - Hand hygiene

KW - Screening

UR - http://www.scopus.com/inward/record.url?scp=84898430287&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84898430287&partnerID=8YFLogxK

U2 - 10.1093/jac/dkt525

DO - 10.1093/jac/dkt525

M3 - Article

C2 - 24458513

AN - SCOPUS:84898430287

VL - 69

SP - 1185

EP - 1192

JO - Journal of Antimicrobial Chemotherapy

JF - Journal of Antimicrobial Chemotherapy

SN - 0305-7453

IS - 5

M1 - dkt525

ER -