Antimicrobial Resistance and Infection Control (Aug 2021)

A five-component infection control bundle to permanently eliminate a carbapenem-resistant Acinetobacter baumannii spreading in an intensive care unit

  • Marianna Meschiari,
  • José-María Lòpez-Lozano,
  • Vincenzo Di Pilato,
  • Carola Gimenez-Esparza,
  • Elena Vecchi,
  • Erica Bacca,
  • Gabriella Orlando,
  • Erica Franceschini,
  • Mario Sarti,
  • Monica Pecorari,
  • Antonella Grottola,
  • Claudia Venturelli,
  • Stefano Busani,
  • Lucia Serio,
  • Massimo Girardis,
  • Gian Maria Rossolini,
  • Inge C. Gyssens,
  • Dominique L. Monnet,
  • Cristina Mussini

DOI
https://doi.org/10.1186/s13756-021-00990-z
Journal volume & issue
Vol. 10, no. 1
pp. 1 – 13

Abstract

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Abstract Background Carbapenem-resistant Acinetobacter baumannii (CRAB) infection outbreaks are difficult to control and sometimes require cohorting of CRAB-positive patients or temporary ward closure for environmental cleaning. We aimed at controlling the deadly 2018 CRAB outbreak in a 12 bed- intensive care unit (ICU) including 9 beds in a 220 m2 open space. We implemented a new multimodal approach without ward closure, cohorting or temporarily limiting admissions. Methods A five-component bundle was introduced in 2018 including reinforcement of hand hygiene and sample extension of screening, application of contact precautions to all patients, enhanced environmental sampling and the one-time application of a cycling radical environmental cleaning and disinfection procedure of the entire ICU. The ICU-CRAB incidence density (ID), ICU alcohol-based hand rub consumption and antibiotic use were calculated over a period of 6 years and intervention time series analysis was performed. Whole genome sequencing analysis (WGS) was done on clinical and environmental isolates in the study period. Results From January 2013, nosocomial ICU-CRAB ID decreased from 30.4 CRAB cases per 1000 patients-days to zero cases per 1000 patients-days. Our intervention showed a significant impact (-2.9 nosocomial ICU-CRAB cases per 1000 bed-days), while no influence was observed for antibiotic and alcohol-based hand rub (AHR) consumption. WGS demonstrated that CRAB strains were clonally related to an environmental reservoir which confirms the primary role of the environment in CRAB ICU spreading. Conclusion A five-component bundle of continuous hand hygiene improvement, extended sampling at screening including the environment, universal contact precautions and a novel cycling radical environmental cleaning and disinfection procedure proved to be effective for permanently eliminating CRAB spreading within the ICU. Cohorting, admission restriction or ICU closure were avoided.

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