Control of endemic extensively drug-resistant Acinetobacter baumannii with a cohorting policy and cleaning procedures based on the 1 room, 1 wipe approach.

BACKGROUND: Our institution experienced an endemic situation with extensively drug-resistant (XDR) Acinetobacter baumannii in the intensive care units (ICUs). Here, we describe the long-term results of the implementation of a screening and cohorting policy and new cleaning techniques based on a procedure that we call the 1 room, 1 wipe approach. METHODS: We conducted a 4-year quasi-experimental study in the ICUs of an 800-bed teaching hospital. The main actions implemented were active surveillance of XDR A baumannii and cohorting of carriers and introducing new cleaning techniques intended to avoid sharing wipes between rooms. RESULTS: XDR A baumannii significantly decreased from 132 cases in 2011 to 8 cases in 2014 and from 10.78 cases per 1,000 patient days in 2011 to 0.69 cases per 1,000 patient days in 2014. Segmented regression analysis showed that after implementing the measures, the monthly rates presented a sustained negative slope, with a significant change of -0.623 (P = .002). CONCLUSIONS: The prompt identification and isolation of patients and adequate environmental cleaning are effective measures for reducing XDR A baumannii in ICUs. The 1 wipe, 1 room approach should be considered a standard measure for cleaning hospital facilities to avoid cross-transmission as a result of reusable cleaning wipes.

A large sustained endemic outbreak of multiresistant Pseudomonas aeruginosa: a new epidemiological scenario for nosocomial acquisition.

BACKGROUND: Studies of recent hospital outbreaks caused by multiresistant P.aeruginosa (MRPA) have often failed to identify a specific environmental reservoir. We describe an outbreak due to a single clone of multiresistant (MR) Pseudomonas aeruginosa (PA) and evaluate the effectiveness of the surveillance procedures and control measures applied. METHODS: Patients with MRPA isolates were prospectively identified (January 2006-May 2008). A combined surveillance procedure (environmental survey, and active surveillance program in intensive care units [ICUs]) and an infection control strategy (closure of ICU and urology wards for decontamination, strict compliance with cross-transmission prevention protocols, and a program restricting the use of carbapenems in the ICUs) was designed and implemented. RESULTS: Three hundred and ninety patients were identified. ICU patients were the most numerous group (22%) followed by urology patients (18%). Environmental surveillance found that 3/19 (16%) non-ICU environmental samples and 4/63 (6%) ICU samples were positive for the MRPA clonal strain. In addition, active surveillance found that 19% of patients were fecal carriers of MRPA. Significant changes in the trends of incidence rates were noted after intervention 1 (reinforcement of cleaning procedures): -1.16 cases/1,000 patient-days (95%CI -1.86 to -0.46; p = 0.003) and intervention 2 (extensive decontamination): -1.36 cases/1,000 patient-days (95%CI -1.88 to -0.84; p < 0.001) in urology wards. In addition, restricted use of carbapenems was initiated in ICUs (January 2007), and their administration decreased from 190-170 DDD/1,000 patient-days (October-December 2006) to 40-60 DDD/1,000 patient-days (January-April 2007), with a reduction from 3.1 cases/1,000 patient-days in December 2006 to 2.0 cases/1,000 patient-days in May 2007. The level of initial carbapenem use rose again during 2008, and the incidence of MRPA increased progressively once more. CONCLUSIONS: In the setting of sustained MRPA outbreaks, epidemiological findings suggest that patients may be a reservoir for further environmental contamination and cross-transmission. Although our control program was not successful in ending the outbreak, we think that our experience provides useful guidance for future approaches to this problem.

Control measures for Acinetobacter baumannii: a survey of Spanish hospitals.

INTRODUCTION: Control of Acinetobacter baumannii is a challenge. METHODS: A survey was conducted on the control measures introduced against A baumannii in 30 Spanish hospitals. RESULTS: We found significant differences in the application of contact precautions, active surveillance, hygiene of colonised patients, environmental cleaning, and educational activities. Hospitals with a written control program for A. baumannii had a lower incidence of colonisation/infection due to this organism. CONCLUSION: A multidisciplinary consensus document for the control of A. baumannii is needed in Spain.

Control measures for Acinetobacter baumannii: a survey of Spanish hospitals

Introduction Control of Acinetobacter baumannii is a challenge. Methods A survey was conducted on the control measures introduced against A baumannii in 30 Spanish hospitals. Results We found significant differences in the application of contact precautions, active surveillance, hygiene of colonised patients, environmental cleaning, and educational activities. Hospitals with a written control program for A. baumannii had a lower incidence of colonisation/infection due to this organism.ConclusionA multidisciplinary consensus document for the control of A. baumannii is needed in Spain (AU)

Introducción El control de Acinetobacter baumannii es complejo. Métodos Se realizó una encuesta sobre las medidas de control frente a A. baumannii en 30 hospitales españoles. Resultados Se encontraron diferencias en la aplicación de precauciones de contacto, cultivos de cribado, higiene de los pacientes colonizados, limpieza ambiental, y actividades formativas. Los hospitales con un programa escrito de control de A. baumannii tuvieron menor incidencia de este patógeno. Conclusión Es necesario elaborar un documento de consenso multidisciplinar para el control de A. baumannii en España (AU)