PREVENTION OF TRANSMISSION OF EXTENDED-SPECTRUM BETA-LACTAMASES ENTEROBACTERIACEAE (ESBLE) IN SURGICAL ICV BY NURSING REORGANIZATION

A preliminary control study performed in our digestive intensive care unit (11 beds) from June to August 1992 pointed out a ESBLE digestive colonization rate of 70 %. In order to decrease this rate, nursing procedures were then intensified or modified : hand washing, single use equipment, use of specific gowns and plastic gloves for all septic procedures, immediate removal of septic materials. To test the efficacy of these procedures, 64 patients were screened for digestive acquisition of ESBLE at the admission and weekly from September 1992 to March 1993. ESBLE colonization rate significantly dropped to 39 % (p < 0.001). Five patients were colonized at their admission, but all these patients were previously hospitalized in the SICU. Twenty patients (31,2 %) nosocomially acquired a digestive ESBLE. The mean time for acquiring ESBLE was 24.3 +/- 13.7 days and rate of ESBLE acquisition significantly increased with length of hospital stay. Each patient was colonized with either 1, 2 or 3 ESBLE (Klebsiella pneumoniae, Escherichia coli, Enterobacter aerogenes). Baseline characteristics of the 39 non-colonized patients and the 20 colonized patients (age, sex, SAPS, previous hospital stay) were not different (Student's t-test, p > 0.05). However, the heaviness of the nursing care as estimated by Omega index was greater in the colonized group (p < 0.001). The strict observance of nursing procedures can significantly reduce ESBLE nosocomial acquisition in a high risk surgical unit.