Hostname: page-component-8448b6f56d-dnltx Total loading time: 0 Render date: 2024-04-20T03:40:19.687Z Has data issue: false hasContentIssue false
  • English
  • Français

Use of Adherence Monitors as Part of a Team Approach to Control Clonal Spread of Multidrug-Resistant Acinetobacter baumannii in a Research Hospital

Published online by Cambridge University Press:  02 January 2015

Tara N. Palmore ,
Angela V. Michelin ,
MaryAnn Bordner ,
Robin T. Odom ,
Frida Stock ,
Ninet Sinaii ,
Daniel P. Fedorko ,
Patrick R. Murray  and
David K. Henderson
Tara N. Palmore*
Affiliation:
Clinical Center, National Institutes of Health, Bethesda, Maryland
Angela V. Michelin
Affiliation:
Clinical Center, National Institutes of Health, Bethesda, Maryland
MaryAnn Bordner
Affiliation:
Clinical Center, National Institutes of Health, Bethesda, Maryland
Robin T. Odom
Affiliation:
Clinical Center, National Institutes of Health, Bethesda, Maryland
Frida Stock
Affiliation:
Clinical Center, National Institutes of Health, Bethesda, Maryland
Ninet Sinaii
Affiliation:
Clinical Center, National Institutes of Health, Bethesda, Maryland
Daniel P. Fedorko
Affiliation:
Clinical Center, National Institutes of Health, Bethesda, Maryland
Patrick R. Murray
Affiliation:
Clinical Center, National Institutes of Health, Bethesda, Maryland
David K. Henderson
Affiliation:
Clinical Center, National Institutes of Health, Bethesda, Maryland
*
National Institutes of Health Clinical Center, National Institutes of Health, 10 Center Drive, MSC 1888, Bethesda, MD 20892 (tpalmore@mail.nih.gov)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

Multidrug-resistant Acinetobacter baumannii (MDRAB) is difficult to treat and eradicate. Several reports describe isolation and environmental cleaning strategies that controlled hospital MDRAB outbreaks. Such interventions were insufficient to interrupt MDRAB transmission in 2 intensive care unit-based outbreaks in our hospital. We describe strategies that were associated with termination of MDRAB outbreaks at the National Institutes of Health Clinical Center.

Methods.

In response to MDRAB outbreaks in 2007 and 2009, we implemented multiple interventions, including stakeholder meetings, enhanced isolation precautions, active microbial surveillance, cohorting, and extensive environmental cleaning. We conducted a case-control study to analyze risk factors for acquiring MDRAB. In each outbreak, infection control adherence monitors were placed in MDRAB cohort areas to observe and correct staff infection control behavior.

Results.

Between May 2007 and December 2009, 63 patients acquired nosocomial MDRAB; 57 (90%) acquired 1 or more of 4 outbreak strains. Of 347 environmental cultures, only 2 grew outbreak strains of MDRAB from areas other than MDRAB patient rooms. Adherence monitors recorded 1,330 isolation room entries in 2007, of which 8% required interventions. In 2009, around-the-clock monitors recorded 4,892 staff observations, including 127 (2.6%) instances of nonadherence with precautions, requiring 68 interventions (1.4%). Physicians were responsible for more violations than other staff (58% of hand hygiene violations and 37% of violations relating to gown and glove use). Each outbreak terminated in temporal association with initiation of adherence monitoring.

Conclusions.

Although labor intensive, adherence monitoring may be useful as part of a multifaceted strategy to limit nosocomial transmission of MDRAB.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 12 , December 2011 , pp. 1166 - 1172
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Weber, DJ, Rutala, WA, Miller, MB, Huslage, K, Sickbert-Bennett, E. Role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species. Am J Infect Control 2010;38:S25–S33.Google Scholar
2. Munoz-Price, LS, Weinstein, RA. Acinetobacter infection. N Engl J Med 2008;358:1271–1281.Google Scholar
3. Chan, PC, Huang, LM, Lin, HC, et al. Control of an outbreak of pandrug-resistant Acinetobacter baumannii colonization and infection in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2007;28:423–429.CrossRefGoogle Scholar
4. Fournier, PE, Richet, H. The epidemiology and control of Acinetobacter baumannii in health care facilities. Clin Infect Dis 2006;42:692–699.Google Scholar
5. Villegas, MV, Hartstein, AI. Acinetobacter outbreaks, 1977-2000. Infect Control Hosp Epidemiol 2003;24:284–295.Google Scholar
6. Aygun, G, Demirkiran, O, Utku, T, et al. Environmental contamination during a carbapenem-resistant Acinetobacter baumannii outbreak in an intensive care unit. J Hosp Infect 2002;52:259–262.Google Scholar
7. Harrington, SM, Stock, F, Kominski, AL, et al. Genotypic analysis of invasive Streptococcus pneumoniae from Mali, Africa, by semi-automated repetitive-element PCR and pulsed-field gel electrophoresis. J Clin Microbiol 2007;45:707–714.Google Scholar
8. Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
9. Choi, WS, Kim, SH, Jeon, EG, et al. Nosocomial outbreak of carbapenem-resistant Acinetobacter baumannii in intensive care units and successful outbreak control program. J Korean Med Sei 2010;25:999–1004.Google Scholar
10. Dent, LL, Marshall, DR, Pratap, S, Hulette, RB. Multidrug resistant Acinetobacter baumannii: a descriptive study in a city hospital. BMC Infect Dis 2010;10:196.CrossRefGoogle Scholar
11. La Forgia, C, Franke, J, Hacek, DM, Thomson, RB Jr, Robicsek, A, Peterson, LR. 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.CrossRefGoogle Scholar
12. Ling, ML, Ang, A, Wee, M, Wang, GC. A nosocomial outbreak of multiresistant Acinetobacter baumannii originating from an intensive care unit. Infect Control Hosp Epidemiol 2001;22:48–49.Google Scholar
13. Manian, FA, Ponzillo, JJ. Compliance with routine use of gowns by healthcare workers (HCWs) and non-HCW visitors on entry into the rooms of patients under contact precautions. Infect Control Hosp Epidemiol 2007;28:337–340.Google Scholar
14. Christie, C, Mazon, D, Hierholzer, W Jr, Patterson, JE. Molecular heterogeneity of Acinetobacter baumannii isolates during seasonal increase in prevalence. Infect Control Hosp Epidemiol 1995; 16:590–594.Google Scholar
15. Perencevich, EN, McGregor, JC, Shardell, M, et al. Summer peaks in the incidences of gram-negative bacterial infection among hospitalized patients. Infect Control Hosp Epidemiol 2008;29: 1124-1131.Google Scholar
16. McDonald, LC, Banerjee, SN, Jarvis, WR. Seasonal variation of Acinetobacter infections: 1987-1996. Nosocomial Infections Surveillance System. Clin Infect Dis 1999;29:1133–1137.Google Scholar
17. Retailliau, HF, Hightower, AW, Dixon, RE, Allen, JR. Acinetobacter calcoaceticus: a nosocomial pathogen with an unusual seasonal pattern. J Infect Dis 1979;139:371–375.CrossRefGoogle ScholarPubMed
18. Barnaud, G, Zihoune, N, Ricard, JD, et al. Two sequential outbreaks caused by multidrug-resistant Acinetobacter baumannii isolates producing OXA-58 or OXA-72 oxacillinase in an intensive care unit in France. J Hosp Infect 2010;76:358–360.CrossRefGoogle ScholarPubMed