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BMC Infectious Diseases

, 17:539

Healthcare-associated infection control

Abstract

BackgroundRandomized controlled trials RCTs of behavior-based interventions are particularly vulnerable to post-randomization changes between study arms. We assess the impact of such a change in a large, multicenter study of universal contact precautions to prevent infection transmission in intensive care units.

MethodsWe construct a stochastic mathematical model of methicillin-resistant Staphylococcus aureus MRSA acquisition in a simulated 18-bed intensive care unit ICU. Using parameters from a recent study of contact precautions that reported a post-randomization change in contact rates, with fewer visits observed in the treatment arm, we explore the impact of several possible interpretations of this change on MRSA acquisition rates.

ResultsScenarios where contact precautions resulted in less patient visitation resulted in a mean decrease in MRSA acquisition rate of 37%, accounting for much of the effect reported in the trial.

ConclusionsBehavior changes that impact the contact rate have the potential to drastically alter the results of RCTs in infection control settings. Careful monitoring for these changes, and an assessment of which changes will likely have the greatest impact on the study before the study begins are both recommended.

KeywordsMRSA Hospital epidemiology Healthcare-associated infections Contact precautions Mathematical modeling AbbreviationsABCApproximate Bayesian Computation

CDCCenters for Disease Control and Prevention

CIConfidence Interval

HCWHealthcare worker

ICUIntensive care unit

IDRIncidence Density Ratio

ITTIntent-to-Treat

MRSAMethicillin-resistant Staphylococcus aureus

RCTRandomized controlled trial

SDStandard deviation

Electronic supplementary materialThe online version of this article doi:10.1186-s12879-017-2632-1 contains supplementary material, which is available to authorized users.

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Author: Eric T. Lofgren

Source: https://link.springer.com/







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