1720. Surveillance of VAP Prevention Bundle Compliance as a Tool for the Rapid Detection and Control of an Outbreak due to Stenotrophomonas maltophilia
Session: Poster Abstract Session: Infection Prevention: Infection Prevention in Resource Limited Environments
Saturday, October 10, 2015
Room: Poster Hall
  • VAP prevention bundle.pdf (356.0 kB)
  • Background:

    Starting in 2014, a bundle-based surveillance method for the prevention and detection of the main hospital-acquired infections was introduced in our hospital. In August 2014 an increase in the number of cases of S. maltophilia VAP in the ICU was noticed. 



    A case-control study was conducted to identify the risk factors related to the outbreak. We performed a measurement of the adherence to the VAP prevention bundle in the ICU. Cleaning and disinfection practices were reviewed also. To increase the sample size and statistical power of our analysis of risk factors, we included all cases of VAP due to S. maltophilia in the last five years.



    We identified 15 cases of S maltophilia VAP in the ICU from 2010 to 2014. All of the isolates were obtained from bronchoalveolar lavage samples and only one was resistant to quinolones and trimethoprim+sulfamethoxazole. We included all the patients (n=154) with VAP due to other etiologies as controls. There was no difference in age, gender or disease severity between the two groups. The variables identified as risk factors were: hemodialysis (OR=12.6, p=<0.001), parenteral nutrition (OR=7.45, p=<0.001), number of days of use of antibiotics prior to the event (17 vs. 8 days, p= <0.01), previous bronchoscopy (OR=5.25, p=0.01) and tracheostomy (OR=3.9, p=0.02). There was no difference in mortality (OR=0.85, p=0.88). Our clinical and epidemiological analysis did not suggest a common source for this outbreak. Adherence to the VAP prevention bundle (especially mouth cleansing with 0.12% chlorhexidine antiseptic solution) had decreased significantly (50%), coinciding with the outbreak. After improving the adherence to the bundle, no new cases have been identified since January 2015.


    This experience allowed us to identify the component of the VAP prevention bundle that needed to be reinforced. Other risk factors for the acquisition of S. maltophilia (such as invasive procedures) were identified but were not modifiable in our ICU. Therefore, our bundle-based surveillance tool allowed us to detect and control the outbreak after the improvement of simple, low-cost preventive measures.


    Figure 1.



    Figure 2.


    Eric Ochoa Hein, M.D.1, Martha Asunción Huertas Jiménez, RN1, Jesús Arturo Ruiz-Quiñones, MD2, Eduardo Rivero Sigarroa, M.D.3, Alfredo Ponce De León, MD4, José Sifuentes-Osornio, MD, FIDSA5 and Arturo Galindo-Fraga, MD, MS1, (1)Hospital Epidemiology and Medical Care Quality Control, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, (2)Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, (3)Intensive Care Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, (4)Microbiology Laboratory, Infectious Diseases Department, Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico, (5)Medicine Direction, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico


    E. Ochoa Hein, None

    M. A. Huertas Jiménez, None

    J. A. Ruiz-Quiñones, None

    E. Rivero Sigarroa, None

    A. Ponce De León, None

    J. Sifuentes-Osornio, None

    A. Galindo-Fraga, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.