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develop colonization following hospitalization because in-hospital interventions can only influence the latter group.

develop colonization following hospitalization because in-hospital interventions can only influence the latter group.

develop colonization following hospitalization because in-hospital interventions can only influence the latter group.
Assignment: Improve Hand Hygiene

rather than on routine practices that are already required (eg, hand hygiene).

The intervention should be described in sufficient detail as to be reproducible.

Preintervention infection control strategies for ESBL-E should be clearly described.

Cointerventions Cointerventions with the potential to impact ESBL-E incidence (eg, initiation of an antibiotic stewardship program,

intervention to improve hand hygiene) should be avoided; if cointerventions occur, they should be described and their

impact assessed (eg, report change in antimicrobial usage patterns, change in hand hygiene compliance over study period).

Outcome measures Nosocomial ESBL-E incidence per patient day or per admission should be the preferred outcome.

Surveillance cultures on admission should be used to help distinguish patients with colonization at admission from those who

develop colonization following hospitalization because in-hospital interventions can only influence the latter group.

ESBL-E production should be confirmed using standard phenotypic methods; additional molecular data should be presented

to exclude both clonal and plasmid outbreaks (eg, PFGE, plasmid typing).

Confounding factors Potential confounding factors including changes in the incidence risk factors for ESBL-E acquisition should be monitored (eg,

antibiotic use, length of hospital or ICU stay, hand hygiene compliance, severity of illness).

ESBL-E, extended-spectrum b-lactamase (ESBL)-producing Enterobacteriaceae; ICU, intensive care unit; PFGE, pulsed-field gel electrophoresis.

600 Goddard and Muller American Journal of Infection Control September 2011

excluded following full review because ESBL-E inci- dence was not measured at baseline (n 5 2),3,4 no in- tervention was studied (n 5 2),5,6 the study was conducted during an ESBL-E outbreak (n 5 1),7 or the study intervention involved antibiotic stewardship (n 5 1).8 Therefore, 4 studies were included in our systematic review.9-12

All 4 studies were conducted retrospectively. One was an interrupted time series analysis of methicillin- resistant Staphylococcus aureus incidence that exam- ined ESBL incidence in a post hoc analysis.10 The other 3 studies were uncontrolled pretest-post-test studies.9-11,12 There were no RCT or controlled trials of any type identified. No study reported obtaining ap- proval from a Research Ethics Board.

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