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Outbreak of imipenem-resistant Acinetobacter baumannii in different wards at a regional hospital related to untrained bedside caregivers

  • Ching-Hsun Wang
    Affiliations
    Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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  • Jin-Feng Li
    Affiliations
    Infection Control Room, Tri-Service General Hospital Penghu Branch, Penghu, Taiwan, ROC
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  • Li-Yueh Huang
    Affiliations
    Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan, ROC
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  • Fu-Mei Lin
    Affiliations
    Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan, ROC
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  • Ya-Sung Yang
    Affiliations
    Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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  • L. Kristopher Siu
    Affiliations
    Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC

    Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan, ROC

    Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan, ROC
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  • Feng-Yee Chang
    Affiliations
    Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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  • Jung-Chung Lin
    Correspondence
    Address correspondence to Jung-Chung Lin, MD, PhD, Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No 325, Section 2, Cheng-Kung Rd, Neihu 114, Taipei, Taiwan. (J.-C. Lin).
    Affiliations
    Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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      Highlights

      • An outbreak caused by imipenem-resistant Acinetobacter baumannii occurred and disseminated to our 2 general wards.
      • The outbreak may be possibly transmitted through the hands of untrained bedside caregivers.
      • A computer-assisted alert messaging system to notify case patients with imipenem-resistant A baumannii helped to control the outbreak.
      • The importance of adherence to hand hygiene by all health care workers cannot be overemphasized.

      Background

      This study describes an outbreak caused by imipenem-resistant Acinetobacter baumannii (IRAB) involving 2 general wards at the Penghu branch of Tri-Service General Hospital.

      Methods

      Clinical data obtained from the patients with IRAB during an outbreak from May 2014-October 2014 were reviewed. Microbiologic sampling from the environment and the hands of health care workers (HCWs) was performed. Clinical isolates from case patients were genotyped using pulsed-field gel electrophoresis (PFGE).

      Results

      During the outbreak period, 12 patients were colonized or infected with IRAB. The hospital room environments of the case patients were contaminated with IRAB. Hands of nurses and physicians were not colonized with IRAB, but the hands of 2 bedside caregivers of case patients were colonized with IRAB. The PFGE analysis revealed that at least 2 major genetically distinct strains disseminated between 2 different wards. After implementation of infection control measures with a cohort of nursing patients, hand hygiene education for caregivers who had not received instructions before the outbreak, and a critical value alert system to notify case patients, the outbreak was controlled successfully.

      Conclusions

      This outbreak study highlights the importance of adherence to hand hygiene by all HCWs to prevent the dissemination of multidrug-resistant organisms.

      Key Words

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