Effectiveness of contact precautions against multidrug-resistant organism transmission in acute care: a systematic review of the literature.
Effectiveness of contact precautions against multidrug-resistant organism transmission in acute care: a systematic review of the literature.
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DOI：
10.1016/j.jhin.2015.05.003
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发表时间：
2015-08
期刊：
影响因子：
--
通讯作者：
Shang J
中科院分区：
文献类型：
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作者：
Cohen CC;Cohen B;Shang J
广泛建议采取接触预防措施，以防止耐多药微生物（MDRO）传播。然而，关于它们的有效性存在相互矛盾的数据。先前的系统审查将接触预防措施作为更大的捆绑方法的一部分进行审查，限制了了解其有效性的能力。本综述的目的是描述单独的接触预防措施对成人急性护理患者中任何MDRO传播的有效性。在系统评价和meta分析首选报告项目的指导下，对2004年1月至2014年6月期间发表的英文研究进行了四个电子科学文献数据库的综合检索。研究纳入介入性、原创性研究，评估接触隔离预防住院患者间MDRO传播的措施。搜索结果为284项研究，其中6项纳入了综述。这些研究测量了四种不同的mdro，其中一项研究显示传播减少。虽然在结果操作化和统计分析方面的研究质量很高，但由于干预描述、人群特征和潜在的偏差较差，总体质量为中等至低。当测量依从性时（N = 4），它对有效性构成威胁，因为它包括干预的选定部分，范围从21%到87%，并且在研究阶段之间存在显着差异（N = 2）。关于这一主题的证据质量较差，继续限制了对这些数据的解释。因此，这些相互矛盾的文献并不能构成支持或反对接触预防措施的证据。我们建议研究人员在设计关于该主题的未来研究时考虑功率计算、依从性监测、非等效并发控制。
Contact precautions are widely recommended to prevent multidrug-resistant organism (MDRO) transmission. However, conflicting data exist regarding their effectiveness. Prior systematic reviews examined contact precautions as part of a larger bundled approach, limiting ability to understand their effectiveness. The aim of this review was to characterize the effectiveness of contact precautions alone against transmission of any MDRO among adult acute care patients. Directed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, comprehensive searches of four electronic scientific literature databases were conducted for studies published in English from January 2004 to June 2014. Studies were included if interventional, original research, evaluating contact isolation precautions against MDRO transmission among inpatients. Searches returned 284 studies, six of which were included in the review. These studies measured four different MDROs with one study showing a reduction in transmission. Whereas studies were of high quality regarding outcome operationalization and statistical analyses, overall quality was moderate to low due to poor intervention description, population characterization and potential biases. Where compliance was measured (N = 4), it presented a threat to validity because it included select parts of the intervention, ranged from 21% to 87%, and was significantly different across study phases (N = 2). The poor quality of evidence on this topic continues to limit interpretation of these data. Hence, this conflicting body of literature does not constitute evidence for or against contact precautions. We recommend that researchers consider power calculation, compliance monitoring, non-equivalent concurrent controls when designing future studies on this topic.