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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*
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)

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
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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