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Control of a hospital-wide outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) using the Israeli national carbapenem-resistant Enterobacteriaceae (CRE) guidelines as a model

Published online by Cambridge University Press:  16 June 2020

Danny Alon ,
Hadar Mudrik ,
Michal Chowers  and
Pnina Shitrit Open the ORCID record for Pnina Shitrit [Opens in a new window]
Danny Alon
Affiliation:
Department of Internal Medicine A, Meir Medical Center, Kfar Saba, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Hadar Mudrik
Affiliation:
Department of Internal Medicine A, Meir Medical Center, Kfar Saba, Israel
Michal Chowers
Affiliation:
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Infectious Diseases Unit, Meir Medical Center, Kfar Saba, Israel
Pnina Shitrit*
Affiliation:
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Infection Control Unit, Meir Medical Center, Kfar Saba, Israel
*
Author for correspondence: Pnina Shitrit, E-mail: pninash@clalit.org.il
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Abstract

Objective:

To study the effect of implementing the Israeli national carbapenem-resistant enterobacteriaceae (CRE) guidelines on controlling a hospital-wide outbreak of Acinetobacter baumannii (CRAB).

Design:

A before-and-after study from 2014 to 2018.

Setting:

A 740-bed, secondary-care hospital in central Israel.

Intervention:

Acquisition of CRAB was defined as a positive culture taken at least 48 hours after admission or a positive sample identified upon admission in a patient who had been readmitted within 30 days after discharge from our institution. The intervention included maintaining a case registry of all CRAB patients, cohorting patients under strict contact isolation, using dedicated nursing staff and equipment, rigorous cleaning, education and close monitoring of hospital staff, and involvement of hospital management.

Results:

In total, 210 patients were identified with hospital-acquired CRAB: 141 before the intervention and 69 after the intervention. CRAB acquisition rates decreased by 77%, from 1.3 per 1,000 admissions before the intervention (2014–2015) to 0.3 per 1,000 admissions after the intervention (2016–2018) (P < .001). The decrease in acquisitions was observed hospital-wide, year by year (P for trend, <.001). In 2018, only 7 new acquisitions were detected in internal medicine wards (P = .058) and none in the ICUs (P = .006).

Conclusions:

A structured intervention based on the Israeli CRE management guidelines was successful in controlling a hospital-wide CRAB outbreak.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 8 , August 2020 , pp. 926 - 930
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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