394. Management of a multi-year MDR Acinetobacter baumannii outbreak in the ICU setting
Session: Poster Abstract Session: Gram Negative Infection - Epidemiology and Prevention
Friday, October 21, 2011
Room: Poster Hall B1
  • 394_MichelleKaiser.pdf (464.4 kB)
  • Background: Multi-drug resistant Acinetobacter baumannii (MDR AB) can become endemic in the critical care setting, despite traditional infection control interventions. We describe an outbreak of MDR AB in a 651 bed academic medical center associated with three contiguous critical care units. The outbreak ended by combining enhanced infection control interventions, routine point prevalence surveillance, and vaporized hydrogen peroxide (VHP) room decontamination. Methods: Cases were classified as hospital-acquired if the culture was collected >48 hours after admission. Traditional infection control measures were emphasized. Bi-monthly point prevalence cultures (perianal, sputum, wound) began in February, 2008. VHP room decontamination began in January, 2010. Results: In 2005, an increase in MDR AB was identified in three critical care units that have had episodic outbreaks in the past. The incidence rate in these three units rose from 0.44 per 1,000 patient days (PD) in 2004 to 1.12 in 2005. Infection control practices were reinforced, including: hand hygiene, use of contact precautions, and enhanced disinfection of patient equipment and high-touch surfaces. Rates for these units remained above base line levels from 2005 2007 (1.12, 1.98, and 1.64 respectively) despite infection control interventions. In 2008, surveillance culturing began and the incidence rate fell to 0.43 in 2008 and 0.71 in 2009. When VHP was implemented in 2010, patient rooms in the outbreak units were prioritized, 23 (65.71%) were treated in the first month and all rooms in the outbreak units underwent VHP at least once in the first six months of implementation. After implementation of VHP, the rate fell to 0.09 in 2010. Since VHP use began, there has been only one new case of MDR AB in 16 months associated with the affected units. Conclusion: At its conclusion, this outbreak involved 121 patients, 93 (76.86%) were associated with the outbreak units. Traditional infection control interventions alone were not successful. Use of point prevalence surveillance reduced the incidence but the implementation of VHP room decontamination was necessary to resolve the outbreak.

    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    Michelle Kaiser, CIC1, Sarah Elmendorf, MD1, Donna Kent, RN, CIC2, Ann Evans, BS MT (ASCP)3, Susan M. Harrington, PhD3 and Dennis McKenna, MD4, (1)Epidemiology, Albany Medical Center, Albany , NY, (2)Epidemiology, Albany Medical Center, Albany, NY, (3)Microbiology, Albany Medical Center, Albany, NY, (4)Medical Affairs, Albany Medical Center, Albany, NY


    M. Kaiser, None

    S. Elmendorf, None

    D. Kent, None

    A. Evans, None

    S. M. Harrington, CHROMagar Corporation: Collaborator, conference attendance

    D. McKenna, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.