Advertisement

Control of a two-decade endemic situation with carbapenem-resistant Acinetobacter baumannii: Electronic dissemination of a bundle of interventions

      Background

      Our institution continued to experience a hyperendemic situation with carbapenem-resistant Acinetobacter baumannii despite a bundle of interventions. We aim to describe the effect of the subsequent implementation of electronic dissemination of the weekly findings of a bundle of interventions.

      Methods

      This was a quasiexperimental study performed at a 1,500-bed, public, teaching hospital. From January 2011 to March 2012, weekly electronic communications were sent to the hospital leadership and intensive care units (ICUs). These communications aimed to describe, interpret, and package the findings of the previous week’s active surveillance cultures, environmental cultures, environmental disinfection, and hand cultures. Additionally, action plans based on these findings were shared with recipients.

      Results

      During 42 months and 1,103,900 patient-days, we detected 438 new acquisitions of carbapenem-resistant A baumannii. Hospital wide, the rate of acquisition decreased from 5.13 ± 0.39 to 1.93 ± 0.23 per 10,000 patient-days, during the baseline and postintervention periods, respectively (P < .0001). This effect was also observed in the medical and trauma ICUs, with decreased rates from 67.15 ± 10.56 to 17.4 ± 4.6 (P < .0001) and from 55.9 ± 8.95 to 14.71 ± 4.45 (P = .0004), respectively.

      Conclusion

      Weekly and systematic dissemination of the findings of a bundle of interventions was successful in decreasing the rates of carbapenem-resistant A baumannii across a large public hospital.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kallen A.J.
        • Hidron A.I.
        • Patel J.
        • Srinivasan A.
        Multidrug resistance among gram-negative pathogens that caused healthcare-associated infections reported to the National Healthcare Safety Network, 2006-2008.
        Infect Control Hosp Epidemiol. 2010; 31: 528-531
        • Munoz-Price L.S.
        • Weinstein R.A.
        Acinetobacter infection.
        N Engl J Med. 2008; 358: 1271-1281
        • Thom K.A.
        • Maragakis L.L.
        • Richards K.
        • Johnson J.K.
        • Roup B.
        • Lawson P.
        • et al.
        Assessing the burden of Acinetobacter baumannii in Maryland: a statewide cross-sectional period prevalence survey.
        Infect Control Hosp Epidemiol. 2012; 33: 883-888
        • Peleg A.Y.
        • Seifert H.
        • Paterson D.L.
        Acinetobacter baumannii: emergence of a successful pathogen.
        Clin Microbiol Rev. 2008; 21: 538-582
        • Jawad A.
        • Seifert H.
        • Snelling A.M.
        • Heritage J.
        • Hawkey P.M.
        Survival of Acinetobacter baumannii on dry surfaces: comparison of outbreak and sporadic isolates.
        J Clin Microbiol. 1998; 36: 1938-1941
        • Maragakis L.L.
        • Perl T.M.
        Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options.
        Clin Infect Dis. 2008; 46: 1254-1263
        • Villegas M.V.
        • Hartstein A.I.
        Acinetobacter outbreaks, 1977-2000.
        Infect Control Hosp Epidemiol. 2003; 24: 284-295
        • Munoz-Price L.S.
        • Arheart K.
        • Nordmann P.
        • Boulanger A.E.
        • Cleary T.
        • Alvarez R.
        • et al.
        Eighteen years of experience with Acinetobacter baumannii in a tertiary care hospital.
        Crit Care Med. 2013; 41: 2733-2742
        • Munoz-Price L.S.
        • Namias N.
        • Doi Y.
        • Response to Chao
        • et al.
        Environmental source, except air, need to be investigated first.
        Crit Care Med. 2013; 41: e480-e481
        • Silvia Munoz-Price L.
        • Namias N.
        • Cleary T.
        • Fajardo-Aquino Y.
        • Depascale D.
        • Arheart K.L.
        • et al.
        Acinetobacter baumannii: association between environmental contamination of patient rooms and occupant status.
        Infect Control Hosp Epidemiol. 2013; 34: 517-520
        • Munoz-Price L.S.
        • Ariza-Heredia E.
        • Adams S.
        • Olivier M.
        • Francois L.
        • Socarras M.
        • et al.
        Use of UV powder for surveillance to improve environmental cleaning.
        Infect Control Hosp Epidemiol. 2011; 32: 283-285
        • Munoz-Price L.S.
        • Fajardo-Aquino Y.
        • Arheart K.L.
        Ultraviolet powder versus ultraviolet gel for assessing environmental cleaning.
        Infect Control Hosp Epidemiol. 2012; 33: 192-195
        • Munoz-Price L.S.
        • Arheart K.L.
        • Mills J.P.
        • Cleary T.
        • Depascale D.
        • Jimenez A.
        • et al.
        Associations between bacterial contamination of health care workers’ hands and contamination of white coats and scrubs.
        Am J Infect Control. 2012; 40: e245-e248
        • Harris A.D.
        • McGregor J.C.
        • Furuno J.P.
        What infection control interventions should be undertaken to control multidrug-resistant gram-negative bacteria?.
        Clin Infect Dis. 2006; 43: S57-S61
        • Munoz-Price L.S.
        • Quinn J.P.
        Deconstructing the infection control bundles for the containment of carbapenem-resistant Enterobacteriaceae.
        Curr Opin Infect Dis. 2013; 26: 378-387
        • CDC
        Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities.
        MMWR Morb Mortal Wkly Rep. 2009; 58: 256-260
        • Rodríguez-Baño J.
        • García L.
        • Ramírez E.
        • Martínez-Martínez L.
        • Muniain M.A.
        • Fernández-Cuenca F.
        • et al.
        Long-term control of hospital-wide, endemic multidrug-resistant Acinetobacter baumannii through a comprehensive “bundle” approach.
        Am J Infect Control. 2009; 37: 715-722
        • McGrath E.J.
        • Chopra T.
        • Abdel-Haq N.
        • Preney K.
        • Koo W.
        • Asmar B.I.
        • et al.
        An outbreak of carbapenem-resistant Acinetobacter baumannii infection in a neonatal intensive care unit: investigation and control.
        Infect Control Hosp Epidemiol. 2011; 32: 34-41
        • Doidge M.
        • Allworth A.M.
        • Woods M.
        • Marshall P.
        • Terry M.
        • O'Brien K.
        • et al.
        Control of an outbreak of carbapenem-resistant Acinetobacter baumannii in Australia after introduction of environmental cleaning with a commercial oxidizing disinfectant.
        Infect Control Hosp Epidemiol. 2010; 31: 418-420
        • Bourigault C.
        • Corvec S.
        • Bretonniére C.
        • Guillouzouic A.
        • Crémet L.
        • Marraillac J.
        • et al.
        Investigation and management of multidrug-resistant Acinetobacter baumannii spread in a French medical intensive care unit: one outbreak may hide another.
        Am J Infect Control. 2013; 41: 652-653
        • Consales G.
        • Gramigni E.
        • Zamidei L.
        • Bettocchi D.
        • De Gaudio A.R.
        A multidrug-resistant Acinetobacter baumannii outbreak in intensive care unit: antimicrobial and organizational strategies.
        J Crit Care. 2011; 26: 453-459
        • Palmore T.N.
        • Michelin A.V.
        • Bordner M.
        • Odom R.T.
        • Stock F.
        • Sinaii N.
        • et al.
        Use of adherence monitors as part of a team approach to control clonal spread of multidrug-resistant Acinetobacter baumannii in a research hospital.
        Infect Control Hosp Epidemiol. 2011; 32: 1166-1172
        • Ayraud-Thévenot S.
        • Huart C.
        • Mimoz O.
        • Taouqi M.
        • Laland C.
        • Bousseau A.
        • et al.
        Control of multi-drug-resistant Acinetobacter baumannii outbreaks in an intensive care unit: feasibility and economic impact of rapid unit closure.
        J Hosp Infect. 2012; 82: 290-292
        • Chmielarczyk A.
        • Higgins P.G.
        • Wojkowska-Mach J.
        • Synowiec E.
        • Zander E.
        • Romaniszyn D.
        • et al.
        Control of an outbreak of Acinetobacter baumannii infections using vaporized hydrogen peroxide.
        J Hosp Infect. 2012; 81: 239-245
        • Ray A.
        • Perez F.
        • Beltramini A.M.
        • Jakubowycz M.
        • Dimick P.
        • Jacobs M.R.
        • et al.
        Use of vaporized hydrogen peroxide decontamination during an outbreak of multidrug-resistant Acinetobacter baumannii infection at a long-term acute care hospital.
        Infect Control Hosp Epidemiol. 2010; 31: 1236-1241
        • Otter J.A.
        • Yezli S.
        • Schouten M.A.
        • van Zanten A.R.
        • Houmes-Zielman G.
        • Nohlmans-Paulssen M.K.
        Hydrogen peroxide vapor decontamination of an intensive care unit to remove environmental reservoirs of multidrug-resistant gram-negative rods during an outbreak.
        Am J Infect Control. 2010; 38: 754-756
        • La F.C.
        • Franke J.
        • Hacek D.M.
        • Thomson Jr., R.B.
        • Robicsek A.
        • Peterson L.R.
        Management of a multidrug-resistant Acinetobacter baumannii outbreak in an intensive care unit using novel environmental disinfection: a 38-month report.
        Am J Infect Control. 2010; 38: 259-263
        • Landman D.
        • Babu E.
        • Shah N.
        • Kelly P.
        • Olawole O.
        • Bäcker M.
        • et al.
        Transmission of carbapenem-resistant pathogens in New York City hospitals: progress and frustration.
        J Antimicrob Chemother. 2012; 67: 1427-1431