1211. Effectiveness of Advanced Source Control and Environmental Hygiene to Limit Transmission of Extremely-Drug Resistant Acinetobacter baumannii in a Thai Intensive Care Unit: An Analysis Before and After Extensive Flooding
Session: Oral Abstract Session: Identifying and Overcoming Challenges in Preventing Transmission of MDRO GNR Bacterial Infections in Healthcare Settings
Saturday, October 5, 2013: 9:30 AM
Room: The Moscone Center: 250-262
Background: Advanced source control (once daily bathing and 4-times daily oral care with 2% chlorhexidine aqueous solution) and enhanced environmental cleaning were implemented in response to an increased incidence of colonization and infection with extremely-drug resistant (XDR)-Acinetobacter baumannii  in an 8-bed Thai medical intensive care unit (MICU).

Methods: During the 12-month baseline period (P1), universal contact isolation, active surveillance for XDR-A. baumannii, establishment of an XDR-A. baumannii cohort, twice-daily environmental cleaning with detergent-disinfectant, and antibiotic stewardship were implemented.  In the 5.5-month intervention period (P2), P1 measures continued but sodium hypochlorite was substituted for detergent-disinfectant and advanced source control was introduced.  All interventions were continued during the 12.5-month follow-up period (P3), except detergent-disinfectant cleaning was resumed.  Extensive flooding that required a 2-month hospital closure occurred between P2 and P3.  MICU attributable rates of XDR-A. baumanniiclinical and surveillance isolates,  nosocomial infections (NI), and adverse reactions were monitored.

Results: 1,365 patients were studied.  There was no difference in the participants' characteristics in all periods.  Compared to P1 (33 cases; 11.1/1000 patient-days), the rate of XDR-A. baumannii  clinical isolates declined in P2 (3 cases; 1.74/1000 patient-days; P<0.001) and P3 (2 cases; 0.69/1000 patient-days; P<0.001).  A significant reduction in XDR-A. baumannii surveillance isolates was also observed in P2 (2.11/1000 vs. 12.15/1000 patient-days; P<0.001) and P3 (0.98/1000 vs. 12.15/1000 patient-days; P<0.001).  Incidence of NI remained stable.  Six patients developed chlorhexidine-induced rash (1.4/1000 patient-days); 31 patients developed oral mucositis (17.1/1000 patient-days).

Conclusion:  Our study supports advanced source control and enhanced environmental cleaning to limit colonization and infection with XDR-A. baumannii in a Thai MICU.  These simple measure can be readily applied in resource-limited setting.

Anucha Apisarnthanarak, MD1, Uayporn Pinitchai2, David K. Warren, MD, MPH3, Thana Khawcharoenporn, MD1 and Mary Hayden, MD, FSHEA4, (1)Thammasat University, Pathumthani, Thailand, (2)Thammasat University Hospital, Pratumthani, Thailand, (3)Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, (4)Rush University Medical Center, Chicago, IL


A. Apisarnthanarak, None

U. Pinitchai, None

D. K. Warren, None

T. Khawcharoenporn, None

M. Hayden, None

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.