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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