PREVENTION OF TRANSMISSION OF EXTENDED-SP ECTRUM 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 pro cedures were then intensified or modified : hand washing, single use e quipment, use of specific gowns and plastic gloves for all septic proc edures, 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 199 3. ESBLE colonization rate significantly dropped to 39 % (p < 0.001). Five patients were colonized at their admission, but all these patient s were previously hospitalized in the SICU. Twenty patients (31,2 %) n osocomially acquired a digestive ESBLE. The mean time for acquiring ES BLE was 24.3 +/- 13.7 days and rate of ESBLE acquisition significantly increased with length of hospital stay. Each patient was colonized wi th either 1, 2 or 3 ESBLE (Klebsiella pneumoniae, Escherichia coli, En terobacter aerogenes). Baseline characteristics of the 39 non-colonize d patients and the 20 colonized patients (age, sex, SAPS, previous hos pital stay) were not different (Student's t-test, p > 0.05). However, the heaviness of the nursing care as estimated by Omega index was grea ter in the colonized group (p < 0.001). The strict observance of nursi ng procedures can significantly reduce ESBLE nosocomial acquisition in a high risk surgical unit.