According to the Centre for Disease Control and Prevention (CDC), additional consideration should be given to patients with Multiple Drug Resistant Organisms (MDROs) in ICUs using measures that include single room isolation and dedicated specific staff to provide the bulk of the patient’s care rather than all staff available.
If single rooms are not available to isolate MDRO positive patients then the use of cohorting is advised, meaning that these patients should be grouped with others who have cultured positive with the same organism(s).
But, Isolation and cohorting is not always feasible to achieve.
So. When MDRO positive ICU patient isolation and cohorting is not feasible, what comes next?
Seems like strict contact precaution may be the other alternative until the optimal isolation is available.
I agree with you.
Is there published literature on this?
I couldn't found any recommendation on when isolation and cohorting is not feasible strict contact precautions to be used...
There may be little literature on this subject, especially that it belongs to the non standard of care.
Difficulties on achieving Isolation and cohorting are very common in daily practice.
I'm wandering why, it does not get the proper scientific attention?
This could be literally life saving...
I agree that cohorting is practiced, especially for some common disease like RSV in children, and this is in accordance to the guidelines.
However, MDRO cohorting as an actual practice may deserve to be reported as cohort observational study..
Despite differences in study design and methodology, and acknowledging the high transmission dynamics in the ICU, the following three papers may give some answers: the ESCMID guidelines on IC measures to reduce MDR-GNB transmission which are presented separately for each type of pathogen ( https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)60007-0/fulltext); a technical report by the ECDC on CRE (see syst.review #2 that supports specific measures as the most effective) ( https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/110913_Risk_assessment_resistant_CPE.pdf); and a recent Dutch study which showed the non-inferiority of contact precautions in multiple-bed rooms compared to single-bed (isolation) rooms for ESBL (https://www.sciencedirect.com/science/article/abs/pii/S1473309919302622).
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