Active surveillance and contact precautions
infection, CRPA
INFECTION
In the intervention period, stool or perirectal swabs for CRPA, CRAB, and CRE surveillance cultures and sputum, or endotracheal cultures for CRPA or CRAB, were obtained from patients within 2 days of their admission to the ICU and weekly thereafter. In the intervention period, preemptive isolation and contact precautions were implemented at admission, and if the initial surveillance test was negative, contact precautions were ceased, and standard precautions were continued. If the initial surveillance test or subsequent surveillances or clinical culture tests were positive for CRGNB, isolation and contact precautions were continued until 3 negative consecutive test results were obtained. In the control period, surveillance testing was not performed, and if clinical specimens were positive for CRGNB, contact precautions were implemented. During both the intervention and control periods, daily chlorhexidine-bathing was performed in all ICUs, and contact precautions were required in patients with MRSA and VRE colonization or infection. In period 2 (from April to June 2020), universal use of personal protective equipment (PPE) (gown, glove, KF94 mask, and face shield or goggle) was implemented for response to COVID-19 pandemic when caring patients in ICUs. During the whole study period, hand hygiene compliance was observed 4 times by a year by the infection control team staff, and the results by units were disclosed to all hospital staffs. Promotions for improving the compliance of hand hygiene included frequent monitoring and real-time feedback by infection control leader in ICU nursing team, and hospital-wide rewards given to the units with high hand hygiene compliance.If outbreaks of CRGNB occurred, surveillance and post-outbreak surveillance in the control period were permitted.