Introduction: Cohorting patients in dedicated hospital wards or wings during infectious outbreaks has been shown to reduce the transmission of infection, yet this may not be feasible in a hospital frequently over capacity, especially in the Intensive Care Units (ICU). Hypothesis: Cohorting isolation patients in one geographic location in a single ICU and using enhanced isolation procedures for infected patients (“superisolation”) can prevent the further spread of highly resistant multi-drug resistant bacterial organisms (MDRO).

Materials and methods: At one moment in time in a twelve-bed Surgical Trauma Burn Intensive Care Unit (STBICU), six patients had active infections with carbapenem-resistant, non-clonal Gram negative MDRO, including Klebsiella pneumoniae (KPC), Citrobacter freundii, Stenotrophomonas maltophilia, Aeromonas hydrophilia, Proteus mirabilis, Pseudomonas aeruginosa, and Providencia rettgeri. All six were colonized with VRE. Three were admitted to the ICU following complications from liver transplantation, one with 55% total body surface area burns, one after the development of multiple enterocutaneous fistulae, and one following a shotgun wound to the chest & abdomen. Initially the six patients were interspersed throughout the unit, many of whom had a nurse also providing care for a non-isolation patient. Under threat of unit closure and after all standard isolation procedures were enacted, the patients with multi-drug resistant bacteria were cohorted into the front six beds of the unit. The main front entrance was closed and all traffic was redirected through the back entrance of the unit. Nursing staff was assigned to either two isolation or two non-isolation patients. Per Semmelweis, rounds were conducted so as to end at the patients’ rooms cohorted to the front of the unit with the most highly-resistant bacterial infections. Procedures and diagnostics were performed at the bedside (without transporting out of the unit) unless absolutely necessary.

Results: Two months after these interventions, all six patients have been discharged from the ICU (three alive and three dead). No new cases of infection with any of the previously isolated pathogens (based on species and antibiogram) or VRE have occurred.

Conclusion: Cohorting patients to one area and altering work routines to minimize contact with patients with MDRO (essentially designating a high-risk zone) may be beneficial in stopping patient to patient spread of highly resistant bacteria without the need for a dedicated isolation unit.