PURPOSE: To describe infection Control interventions that were successful in eradicating an outbreak of drug resistant acinetobacter baumannii (DRAB) in a medical-surgical adult ICU (MSICU).
METHODS: Between December 2009 and March 2010 seven patients were identified in our 16 bed MSICU with isolates of DRAB. Prior to that our hospital has never seen any DRAB. After the identification of the first patient with this isolate we conducted the following interventions: 1- all patients placed on contact isolation. 2- we conducted active education for all health care workers in the ICU, patients and their families on the importance, transmission and prevention of DRAB. 3- we actively observed compliance of team members with IC policies. This resulted in the identification of a respiratory therapist that repeatedly violated the IC policy despite repeated verbal warnings. This individual was suspended for three days and was not allowed to return to ICU. 4- we revised the IC policies to clearly assign responsibility of equipment cleaning to environmental services. 5- then we used stabilized H202 agent with 24-hour persistence to clean all high touch areas in all the ICU rooms. 6- finally, we used of Ultra Violet Light to aide in the cleaning of all rooms in the ICU. This included the clean and soiled utility room, equipment rooms (and equipment), all ICU common areas, OR holding, and OR rooms where patients with DRAB received incision and drainage for their wounds. Strain relatedness was determined by colony appearance and antibiotic susceptibility analysis. No molecular work up was done. All patient medical records were reviewed, the significance of isolates as true infection vs. colonization was determined by the infection control team.
RESULTS: 1-The index case introduced the organism from a chronic ventilator facility. 2-All patients had one of two apparently related isolate. 3-Two of the patients were determined as true infection; five were considered to have hospital acquired colonization. 4-The active transmission lasted about 3 months. After the application of stringent environmental cleaning and sterilization using the ultra violate machine, no further transmissions were since April 2010 to this date.
CONCLUSIONS: It is possible to terminate an outbreak of DRAB in an ICU by using aggressive multifaceted IC program that specifically pays attention to environmental cleaning.
CLINICAL IMPLICATIONS: The use of ultra violate light may be useful in eradicating DRAB outbreaks when combined with other IC efforts.
DISCLOSURE: The following authors have nothing to disclose: Deb Paul-Cheadle, Mujaheda Abbas
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