Assignment: Infection Control Interventions

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Assignment: Infection Control Interventions

Assignment: Infection Control Interventions

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We con- ducted a systematic review to determine which, if any, infection control interventions are effective in re- ducing the incidence of ESBL-E among hospitalized patients in the nonoutbreak setting.


We searched MEDLINE, CINAHL, EMBASE, and the Cochrane Library for studies published from January 1985 to April 2010. The search terms used included terms to identify the organism (eg, Enterobacteriaceae),

the Department of Medicine, University of Toronto, Toronto, daa; and Division of Infectious Diseases, St. Michael’s Hospital, to, Canada.b

ess correspondence to Matthew P. Muller, MD, PhD, FRCPC, ichael’s Hospital, 30 Bond St, 4CC wing, room 4-178, Toronto, M5B 1W8, Canada. E-mail:

icts of interest: None to report.

the mechanism of resistance (eg, ESBL), and the inter- vention (eg, contact precautions). The complete search strategy is available from the authors on request.

Studies were included if the study was designed as a randomized controlled trial (RCT), time series analysis, or quasi-experimental study; if they included an infection control intervention designed to reduce the person-to-person transmission of ESBL-E; and if they reported total or nosocomial ESBL-E incidence as an outcome. Studies were excluded if third-generation cephalosporin resistance was not confirmed to be due to ESBL production; if the intervention was con- ducted during a defined clonal outbreak; if the inter- vention focused on antibiotic stewardship or digestive tract decolonization; or if the study was not published in a peer-reviewed journal or not published in English.

Articles were reviewed independently by both au- thors to determine eligibility; differences of opinion were resolved through consensus. Studies were not ex- cluded because of poor quality if the inclusion criteria were met. Instead, the strength of the study design was assessed using a guidelines for the evaluation of quasi- experimental studies of infection control interventions (no RCT were identified).2


Our search strategy identified 995 articles: 10 were considered eligible on initial review, but 6 were


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