1412. Management of Extreme Resistant (XDR) Acinetobacter (AB) Cluster in a Medical (M) ICU at the University of Pittsburgh Medical Center (UPMC)
Session: Poster Abstract Session: HAI: Outbreaks
Friday, October 28, 2016
Room: Poster Hall
Posters
  • ACAT Poster Formatted FINAL.pdf (1.1 MB)
  • Background: AB has been associated with outbreaks in healthcare settings, has been shown to persist in healthcare environments and effectively colonizes skin. UPMC is a complex 750 bed tertiary care center with a case-mix index of 2.4.  In Jul 2015, 2 MICU patients were found to harbor XDR AB. The MICU primarily houses lung transplant, acute and chronically ill pulmonary patients. Incidence increased over a 6 month period.   A multidisciplinary investigation ensued to better characterize and terminate the cluster.

    Methods:  Cases were evaluated for commonalties.  An XDR AB reduction bundle was implemented.  XDR AB point prevalence (PP) screening was conducted using modified Leeds AB medium to identify undetected cases.

    Interventions included: 

    Focused/supervised environmental cleaning

    XDR AB rooms were identified with an additional visual cue (blue tape)

    Room observers

    Ensure compliance with hand hygiene (HH) and personal protective equipment (PPE)

    Staff signature required for entrance

    Increased HH and PPE observations

    Dedicated caregivers/equipment

    Discharge ultraviolet disinfection

    PP XDR AB screening

    Pulse field gel electrophoresis (PFGE) molecular typing was performed to assess clonal relatedness 

    After no new clinical culture positivity, a PP study was performed

    Results:

    13 unique MICU patients were identified as incident XDR AB

    8 isolates were available for PFGE typing

    6/8 were highly related based on a grouping level of 90.5%

    2/6 were indistinguishable

    2/8 were unrelated

    No common equipment was identified as a vector for transmission

    PP XDR AB screening

    Oct 2015 – 0/64 + XDR AB

    April 2016 – 0/32 + XDR AB

    Bundle implementation was associated interruption of transmission

                                         

    Conclusion: 

    XDR AB are associated with clusters in healthcare.

    After exposure, patients can develop infections that are difficult to treat and associated with high morbidity and mortality.

    Molecular typing can help characterize clonal clusters and direct appropriate Infection Prevention interventions.

    Focused attention to HH, PPE compliance and enhanced environmental disinfection, to include UV disinfection, were important interventions in stemming this outbreak.

     

    Amy Metzger, BS, MT (ASCP), CIC, CHI1, Ashley Querry, BS, CIC1, Alison Galdys, MD2, Anthony Pasculle, ScD3 and Carlene Muto, MD, MS, FSHEA2, (1)Infection Prevention and Control, University of Pittsburgh Medical Center Presbyterian, Pittsburgh, PA, (2)Infection Prevention & Hospital Epidemiology, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, PA, (3)Microbiology, University of Pittsburgh Medical Center, Pittsburgh, PA

    Disclosures:

    A. Metzger, None

    A. Querry, None

    A. Galdys, None

    A. Pasculle, None

    C. Muto, None

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