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Intervention to reduce carbapenem-resistant Acinetobacter baumannii in a neonatal intensive care unit

Published online by Cambridge University Press:  05 March 2020

Anucha Thatrimontrichai Open the ORCID record for Anucha Thatrimontrichai [Opens in a new window] ,
Pia S. Pannaraj ,
Waricha Janjindamai ,
Supaporn Dissaneevate ,
Gunlawadee Maneenil  and
Anucha Apisarnthanarak
Anucha Thatrimontrichai
Affiliation:
Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
Pia S. Pannaraj
Affiliation:
Division of Infectious Diseases, Children’s Hospital Los Angeles, Los Angeles, California, United States Department of Pediatrics and Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
Waricha Janjindamai
Affiliation:
Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
Supaporn Dissaneevate
Affiliation:
Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
Gunlawadee Maneenil
Affiliation:
Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
Anucha Apisarnthanarak*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Thammasat University Hospital, Pratumthani, Thailand
*
Author for correspondence: Anucha Apisarnthanarak, E-mail: anapisarn@yahoo.com
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Abstract

Objective:

To investigate the effects of environmental cleaning and the installation of heat and moisture exchangers (HMEs) to reduce neonatal carbapenem-resistant Acinetobacter baumannii (CRAB) sepsis and colonization as well as antimicrobial use.

Design:

We conducted a 7-year, quasi-experimental study.

Setting and patients:

All neonates admitted to a neonatal intensive care unit (NICU).

Methods:

We compared the trends for CRAB sepsis and colonization before (period 1, 2011–2013) and after (period 3, 2015–2017) a 12-month intervention period in 2014 (period 2) to incorporate a combination of HME use and sodium hypochlorite cleaning (5,000 ppm in the NICU and 500 ppm in the neonatal environment) using interrupted time series analysis with segmented regression.

Results:

During the 7-year study period, 3,367 neonates were admitted to the NICU; the prevalence rates of CRAB sepsis and endotracheal CRAB colonization were 0.5 per 1,000 patient days, and 19.4 per 1,000 ventilator days. A comparison of period 1 to period 3 showed significant decreases in the percentages of both CRAB of A. baumannii sepsis (100% versus 11%) and endotracheal colonization (76% vs 52%) following the introduction of disposable HMEs and sodium hypochlorite cleaning (both P < .001). In period 3, compared with period 1, segmented regression analysis showed significant reductions in endotracheal CRAB colonization per 1,000 ventilator days (ie, change in level) and both carbapenem and colistin use (changes in both level and slope) (P < .001).

Conclusions:

Interventions featuring environmental cleaning and use of HMEs led to a sustainable reduction of CRAB colonization coupled with a reduction in broad-spectrum antimicrobial use in the NICU.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 6 , June 2020 , pp. 710 - 715
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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