Study: Single-Bed Rooms Preferred to Control Certain Bacteria

An isolation strategy of contact precautions in multiple-bed rooms was non-inferior to contact precautions in a single-bed room for preventing transmission of ESBL-producing Enterobacteriaceae, a recent study found.

“Non-inferiority of the multiple-bed room strategy might change the current single-bed room preference for isolation of patients with ESBL-producing Enterobacteriaceae and, thus, broaden infection-control options for ESBL-producing Enterobacteriaceae in daily clinical practice,” wrote Marjolein F. Q. Kluytmans-van den Bergh, MD, PhD, with the Department of Infection Control at Amphia Hospital in Breda, Netherlands, in a recent Lancet Infectious Diseasesarticle.

Use of single-bed rooms for control of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae is under debate because the added value when applying contact precautions has not been shown, Kluytmans-van den Bergh wrote.

The researchers conducted a cluster-randomized, crossover, non-inferiority study on medical and surgical wards of 16 Dutch hospitals. During two consecutive study periods, either contact precautions in a single-bed room or contact precautions in a multiple-bed room were applied as the preferred isolation strategy for patients with ESBL-producing Enterobacteriaceae cultured from a routine clinical sample.

Eligible index patients were 18 years or older, had no strict indication for barrier precautions in a single-bed room, had a culture result reported within 7 days of culture and before discharge, and had no wardmate known to be colonized or infected with an ESBL-producing Enterobacteriaceae isolate of the same bacterial species with a similar antibiogram.

A total of 693 index patients and 9,527 wardmates were enrolled in the study and 463 index patients and 7,093 wardmates were included in the per-protocol population.

The primary outcome was transmission of ESBL-producing Enterobacteriaceae to wardmates, which was defined as rectal carriage of an ESBL-producing Enterobacteriaceae isolate that was clonally related to the index patient's isolate in at least one wardmate. The primary analysis was done in the per-protocol population, which included patients who were adherent to the assigned room type.

Then, the 16 hospitals were randomized, eight to each sequence of isolation strategies. All hospitals randomized to the sequence single-bed room then multiple-bed room and five of eight hospitals randomized to the sequence multiple-bed room then single-bed room completed both study periods and were analyzed.

Transmission of ESBL-producing Enterobacteriaceae to at least one wardmate was identified in 4 percent of 275 index patients during the single-bed room strategy period and for 7 percent of 188 index patients during the multiple-bed room strategy period.

The study was funded by the Netherlands Organisation for Health Research and Development.