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Control of an Outbreak of Pandrug-Resistant Acinetobacter baumannii Colonization and Infection in a Neonatal Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Pei-Chun Chan
Affiliation:
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
Li-Min Huang
Affiliation:
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
Hui-Chi Lin
Affiliation:
Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan
Luan-Yin Chang
Affiliation:
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
Mei-Ling Chen
Affiliation:
Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan
Chun-Yi Lu
Affiliation:
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
Ping-Ing Lee
Affiliation:
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
Jung-Min Chen
Affiliation:
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
Chin-Yun Lee
Affiliation:
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
Hui-Jui Pan
Affiliation:
Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan
Jann-Tay Wang
Affiliation:
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Shan-Chwen Chang
Affiliation:
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Yee-Chun Chen*
Affiliation:
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
*
Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, Taiwan10016 (yeechunchen@gmail.com)

Abstract

Objective.

To investigate the potential reservoir and mode of transmission of pandrug-resistant (PDR) Acinetobacter baumannii in a 7-day-old neonate who developed PDR A. baumannii bacteremia that was presumed to be the iceberg of a potential outbreak.

Design.

Outbreak investigation based on a program of prospective hospital-wide surveillance for nosocomial infection.

Setting.

A 24-bed neonatal intensive care unit in a 2,200-bed major teaching hospital in Taiwan that provides care for critically ill neonates born in this hospital and those transferred from other hospitals.

Interventions.

Samples from 33 healthcare workers' hands and 40 samples from the environment were cultured. Surveillance cultures of anal swab specimens and sputum samples were performed for neonates on admission to the neonatal intensive care unit and every 2 weeks until discharge. The PDR A. baumannii isolates, defined as isolates resistant to all currently available systemic antimicrobials except polymyxin B, were analyzed by pulsed-field gel electrophoresis. Control measures consisted of implementing contact isolation, reinforcing hand hygiene adherence, cohorting of nurses, and environmental cleaning.

Results.

One culture of an environmental sample and no cultures of samples from healthcare workers' hands grew PDR A. baumannii. The positive culture result involved a sample obtained from a ventilation tube used by the index patient. During the following 2 months, active surveillance identified PDR A. baumannii in 8 additional neonates, and isolates from 7 had the same electrokaryotype. Of the 9 neonates colonized or infected with PDR A. baumannii, 1 died from an unrelated condition. Reinforcement of infection control measures resulted in 100% adherence to proper hand hygiene protocol. The outbreak was stopped without compromising patient care.

Conclusions.

In the absence of environmental contamination, transient hand carriage by personnel who cared for neonates colonized or infected with PDR A. baumannii was suspected to be the mode of transmission. Vigilance, prompt intervention and strict adherence to hand hygiene protocol were the key factors that led to the successful control of this outbreak. Active surveillance appears to be an effective measure to identify potential transmitters and reservoirs of PDR A. baumannii.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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