Experience of an "isolation" units for patients infected with multiresistant bacteria: retrospective study of 49 patients

OBJECTIVES: Perform a retrospective analysis of care in a hospital <<isolat ion unit>> for patients infected with multiresistant bacteria (MRB), i.e. m eticillin-resistant staphylococcus aureus (SAMR), broad spectrum beta-lacta mase secreting enterobacteria. (BLSE). PATIENTS AND METHODS: Forty-nine patients infected with MRB were cared for in our hospital isolation unit between January 1, 1996 and January 1, 1997. Each patient was in a separate room equipped with a sink and soap distribu tor, single-use towels, and individual material for patient care (stethosco pe, mobile equipment writing material, etc). The personnel were given speci al training in the prevention of nosocomial infections. At admission, and i n all patients, bacteriological samples to search for SAMR were acquired fr om nasal discharge, urine, perineal swabs, wounds and bed sores. Wound, uri ne and fecal samples were also taken to search for BLSE. Search for other s ites of infection depended on the clinical situation. The management protoc ol in the isolation unit included. isolation, daily antiseptic baths, topic al application of antibiotics or antiseptics on all bacteriologically prove n sites of SAMR infection, selective decontamination of the digestive tract for patients with BLSE positive stools. Systemic antibiotics were given ca se by case. RESULTS: Mean duration of stay in the isolation unit was 17 days for SAMR i nfections and 14 days for BLSE infections. Mean delay to sterilization of t he infected sites varied depending on the localization: 2.3 days for blood and 19.4 days for stools. Seven patients died. After leaving the isolation unit the bacteriological course was followed in 23 patients: there were 7 c ases of recurrence at least one site within a mean delay of 34.5 days. CONCLUSION: Use of isolation units provides an interesting solution for hea lth care centers to control spread of multiresistant bacteria. Considering the endemic state of multiresistant bacteria infections in French hospitals , each health care unit should have correctly equipped facilities for isola ting infected patients.