Background: There has been a rapid and concerning emergence and spread of MDRAB, which is resistant to most of the available antimicrobial agents. MDRAB is able to grow at various temperatures and pH which facilitates persistence in the environment and concern for spread in the hospital setting. Despite the use of contact isolation for known cases and sporicidal cleaning agents for all patients, UPMC PUH noted an increase in the incidence of MDRAB and possibly an increase in transmission (T).
Methods: MDRAB reduction bundle was implemented that included:
· MDRAB prevalence by location communicated daily
· Active Surveillance testing conducted on high risk areas
· Blue “painter” tape was used to identify MDRAB rooms
· Environmental Services re-educated on the importance of thorough environmental disinfection
· Cohorted MDRAB patients to select units
· An observer was placed at MDRAB rooms:
o Mandatory sign in log
o Re-enforce personal protective equipment and hand hygiene requirement
o Document non-compliance with signature on acknowledgement form
· Disciplinary process for noncompliance
o Non-physician immediate dismissal for that day with wage loss
µ Attending Physicians
· $1,000 fine
· Documented non-compliance in credentialing file and reported to department chair
· Repeat occurrence or failure to pay the fine within one week would result in immediate relinquishment of hospital privileges.
· $250 fine
· Immediate dismissal for that day
· Documented non-compliance in house-staff file and reported to program director
Hospital acquired MDRAB incidence was measured over 3 time periods (TP) and defined as the number of unique patients with MRDAB isolated from a clinical culture or surveillance after hospital day 3 divided by the number of patient days. Rates are reported per 1,000 patient days.
· MDRAB incidence decreased significantly after this MDRAB reduction bundle
· Adding increased focus to ensure compliance of already expected practices and accountability with disciplinary consequences was crucial for continuing compliance and reduction of MDRAB.
K. Posey, None