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Table 5 Summary table for accepted studies—other and multiple/mixed systems with combination of colonization and infection

From: Use of ward closure to control outbreaks among hospitalized patients in acute care settings: a systematic review

Study Setting (beds); country Definition of ward closure (length) Other measures Inpatient outcomes (includes index case(s))a Controlled (Y, N, NA) Due tob
Acinetobacter baumannii
Alfandari et al. [97] ICU (16) and infectious diseases unit at a general hospital (400); France Second outbreak: no new admissions Stage 1: 8
Stage 2: 2
20 in total: 15 infected (75 %), 6 died (30 %) Y Multiple, particularly equipment disinfection
Ayraud-Thévenot et al. [69] Surgical (15), medical (12), and intermediate care units (6) at a teaching hospital (1500); France First outbreak: undefined partial and complete closure (1 m)
Second outbreak: no new admissions
First outbreak: 7
Second outbreak: 3
First outbreak: 20 in total: 16 (80 %) asymptomatic, 4 (20 %) infected, 1 (5 %) died
Second outbreak: 7 in total: 3 (43 %) asymptomatic, 4 (57 %) infected
Y Closure
Enoch et al. [102] Neurosciences critical care unit (21) and general ICU (14) at a teaching hospital (1100); UK Phase 2: limited transfers (16d) Phase 1: 5 19 in total (16, 3): 8 (42 %) died; 9 (47 %) positive; 10 (53 %) infected Y All
Phase 2: 6
Phase 3: 5
Koeleman et al. [76] Surgical ward at a teaching hospital; The Netherlands Stage 3: no new admissions (12d) Stage 1: 2 13 in total: 8 (62 %) infected, 5 (38 %) colonized Y Closure for disinfection
Stage 2: 3
Stage 3: 2
Landelle et al. [77] 5 ICUs: 4 surgical and 1 medical (95 total) at a teaching hospital (860); France No new admissions Phase 1: 5 86 in total Y Multiple excluding closure
Phase 2: 2
Phase 3: 3
Phase 4: 1
Phase 5: 4
Simor et al. [92] Burn unit (14) at a teaching hospital; Canada No new admissions (1w) 8 31/247 in total: 18 (58 %) infected; 7 (23 %) died Y Multiple
Wagenvoort et al. [100] ICU in a specialty hospital; The Netherlands Limited admissions 3 66 in total Y All
Coxsackie virus
Konjajev et al. [110] Neonatal unit, Yugoslavia Unspecified closure 2 6 in total Y Closure
Enterobacter aerogenes
Piagnerelli et al. [109] Geriatric acute unit (30); Belgium Unspecified (20d) 4 12 in total Y Closure
Enterococcus faecium
Bartley et al. [70] Renal unit (30), infectious diseases unit at a teaching hospital (800); Australia No new admissions (pre- and during outbreak) Prior to outbreak: 5 47 in total Y Multiple
Outbreak: 11
Ergaz et al. [73] NICU (16); Israel No new admissions (1m) 6 11/18 in total: 3 (27 %) infections; 8 (73 %) positive Y Multiple
Liu et al. [80] Surgical (15) and emergency (10) ICUs at a teaching hospital (1500); China No new admission area (2w) 5 8 in total Y All
Moretti et al. [83] Gastroenterology clinic and several units at a teaching hospital; Brazil No new admissions (15d) Phase 1: 5 321 in total: 16 (5 %) infected N: significant (p < 0.001) reduction in cases Multiple
Phase 2: 3
Sample et al. [95] Hematology–oncology unit (32) at a teaching hospital (1100); Canada Stage 1: limited admissions 5 16 in total: 3 (23 %) died Y All
Stage 2: no new admissions
Enterobacter cloacae
Donkers et al. [72] NICU at a teaching hospital; Holland No new admissions (<1m) 5 26 in total: 2 (8 %) died Y Dedicated and disposable equipment
Modi et al. [81] NICU at a maternity hospital; England No new admissions 3 12 in total: 6 (50 %) positive; 6 (50 %); 2 (17 %) died Y All
van den Berg et al. [94] NICU(15) at a tertiary hospital (950); The Netherlands No new admissions Stage 1: 5 32 in total: 2 (6 %) infected Y Mainly equipment disinfection
Stage 2: 5
Escherichia coli
Moissenet et al. [82] Neonatal ward (30) at a children’s teaching hospital; France Phase 2: no new admissions (1w ≥ 2w)
Phase 3: no new admissions (1w ≥ 2w)
Phase 1: 5 26/59 in total Y Ward closure
Phase 2: 3
Phase 4: 4
Quinet et al. [85] Neonatal unit (30); France Limiting admissions to infants born at the hospital; no new admissions (6w) 6 27/59 neonatal patients affected Y Closure
Klebsiella pneumoniae
Carbonne et al. [101] Seven hospitals; France All 7 hospitals: limited transfers 7 13 in total: 4 (31 %) infected; 9 (69 %) positive Y All
Grogan et al. [103] Pediatric intensive care; Ireland No new admissions; limited discharges (1w) 10 3 in total Y Multiple
Kassis-Chikhani et al. [104] Abdominal surgery care center (81) in a teaching hospital (716); France Limited new admissions; limited transfers First 7m: 5 8 in total (6, 2); 4 (50 %) died Y Multiple
Next 4.5m: 6
Laurent et al. [105] 4 ICUs (6, 6, 8, 1) at a teaching hospital (858); Belgium Limited transfers, no new admissions 11 30 in total: 9 (30 %) infected; 3 (10 %) died Y All
Macrae et al. [106] Intensive care section (8) and special care section (15) at a neonatal unit; UK Stage 1: limited transfers (10d)
Stage 2: no new admissions (39d)
Stage 1: 5
Stage 2: 11
22 in total: 15 (68 %) positive; 1 (14 %) died Y Temporary ward opened so infected ward could be closed for disinfection
McKee Jr. et al. [75] Intensive care nursery (30) at a teaching children’s hospital; USA No new admissions (2w) 6 26/232 in total: 21 (81 %) positive; 5 (19 %) infected; 1 (4 %) died Y All
Reish et al. [89] NICU at a tertiary care center; Israel No new admissions 3 8 in total: 5 (63 %) infected; 3 (37 %) positive; 3 (37 %) died Y All
Ritter et al. [90] Surgical ward in a specialty hospital; The Netherlands No new admission 4 11 (10 %) infected; 4 (36 %) died Y Disinfection during closure
Parvovirus
Pillay et al. [99] General pediatric ward; England Limited admissions 5 9 in total: 2 (22 %) patients infected Y All
Seng et al. [91] Adult surgical unit (28); England No new admissions 3 3/6 in total: 3 (50 %) positive; 3 (50 %) infected Y Author does not know
Salmonella  
Newman [98] NICU (18) at a teaching hospital; Ghana Limited admissions 3 21/72 in total Y Aseptic measures and closure
Serratia marcescens
Assadian et al. [68] NICU (8) at a teaching hospital (2168); Austria No new admissions (10d) First outbreak: 4 8 in total: 5 (63 %) infected; 3 (37 %) positive N: 2 of different isolates after 41d NA
Second outbreak: 2
Lewis et al. [78] Neonatal; England No new admissions (7w) 9 13/24 in total: 2 (15 %) died Y Closure
Maragakis et al. [79] NICU (36) at a tertiary care hospital (926); USA No new admissions 9 18 in total Y Closing beds to enable cohorting
Staphylococcus aureus
Boyce et al. [107] Burn unit (4) at a teaching hospital (580); USA Stage 1: restricted admissions (3 occasions) 5 245 in total: 151 infections; 40 (26 %) deaths N: new cases until permanent closure Permanent closure
Stage 2: permanently closed
Danchivijitr et al. [96] Burn unit; Thailand Phase 1: No new admission (2m) Phase 1: 3 19/29 in total: 14 (74 %) infected; 5 (26 %) positive; 5 (26 %) died N NA
Phase 2: 2
Hill and Ferguson [74] Special baby care unit (24) at a university hospital; UK Stage 1: no new admissions (2 occasions: 10d, 2w) 9 35/315 in total: 2 (6 %) infected; 1 (3 %) died N NA
Kluytmans et al. [108] Hematology unit and surgical unit at a teaching hospital; The Netherlands Undefined closure Outbreak 1: 5 27 in total: 24 (89 %) infected; 5 (19 %) died Y Mainly external cohort isolation
Outbreak 2: 4
Price et al. [84] Neonatal medical and surgical unit; England No new admissions 13 11 in total: 2 (18 %) infected; 1 (9 %) died Y All
Rampling et al. [87] Male surgical (37) and female surgical (32) wards; UK Closure of one bay at a time; no new admissions Phase 1: 7 69 in total (66, 3) Y Closure and environmental disinfection
Phase 2: 5
Rashid et al. [88] Burn unit (12) at a regional hospital; Ireland No new admissions (2w) 7 18/ 176 in total: 3 (17 %) infected Y All
Teare et al. [93] Burn unit (20) and plastics unit (84); England No new admission Stage 1: 1 19 in total Y Treatment for HCW
Stage 2: 2
Stage 3: 3
Stage 4: 5
Streptococcus
Deutscher et al. [71] Long-term acute care hospital; USA No new admissions (26d) 9 19 in total: 8 (42 %) positive; 3 (16 %) assumed; 8 (42 %) asymptomatic; 2 (15 %) died Y All
Ramage et al. [86] Medical unit (24) at a community hospital (235); Canada No new admissions 6 3/25 in total: 3 (100 %) died Y HCW treatment and infected inpatient deaths
  1. d days, w weeks, m months, y years
  2. aIncludes deaths directly, indirectly, and attributable to infection
  3. bMultiple includes ward closure