510. Detecting Colonized Patients, Training Healthcare Workers and Adequate Disinfection as Effective Strategies for Infections Control by Multidrug-Resistant Microorganisms During the Transfer to a New Hospital Area at a General Hospital in Mexico City
Session: Poster Abstract Session: HAI: The Environment
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • Poster IDWEEK 2017 PDF.pdf (2.5 MB)
  • Background: Emergence and spread of multidrug-resistant organisms (MDROs), in hospitals require interventions for their control; especially when transfer to a new hospital area.

    Methods: We implement a strategy during transfer of our Hospital to a new hospital area in order to reduce the risk of transferring MDROs during 2015; Based on 3 measures: 1. Patients: we obtained rectal swab samples from all patients, in cases colonized by MDROs, we use contact precautions, and wasn't allowed to move to the new area. 2. Healthcare worker (HCW): we develop an “Infections Control Course”, with pre and post test. 3. Environment: biomedical equipment and furniture were evaluated by adenosine triphosphate bioluminescence (ATP method) before and after disinfection with hydrogen peroxide and silver (H2O2) with a whole room fogging system during transfer, if the equipment didn't obtain proper ranges, it wasn't allowed move to new area. These strategies were accompanied by an antimicrobial stewardship program implemented in early 2015

    Results: We analyzed 78 rectal swab samples between September and November 2015, 11.5% of patients were colonized by MDROs (45% Pseudomonas. aeruginosa, 33% Acinetobacter baumannii, 22% Vancomycin Resistant Enterococcus). 1,039 HCW took the course, with pre-test mean score of 63.7, post-test 81.7. We analyzed 454 records of surfaces of biomedical equipment and furniture (227 before, 227 after disinfection), during the transfer, 30 "loads" of room fogging system were recorded, using 6.6 gallons of H2O2 (831ml per load). We obtained before disinfection a mean of 627.4 relative light units (RLU) and after disinfection a mean of 201.4 RLU, we achieved a reduction of 65.4% (p = <0.0001). The antimicrobial stewardship program shows a reduction in defined daily dose compared with previous year (ertapenem 73.6 vs 52.19, vancomycin 55.03 vs 44.08, meropenem 64.75 vs 35.17, caspofungin 6.7 vs 5.53, colistin 23.13 vs 6.33). At July 27th 2016, we reported 288 days without MDROs in the new area, with a reduction of 77.2% of A. baumannii isolates, unfortunately we had an outbreak of Clostridium difficilein new area.

    Conclusion: The combination of strategies that include: detection of colonized patients, training of HCW, high level disinfection and antimicrobial stewardship are effective, and they should be applied, and sustained.

    Bianca Aguilar-Rodea, MD1, Monica Cureño-Diaz, MD2, Ricardo Valdes-Castro, MD3, Rafael Figueroa-Moreno, MD3, Fabiola Alvarez-Montero, MD3, Juan Pablo Ramirez-Hinojosa, MD1, Salvador Medrano-Ahumada, MD1, Patricia Rodriguez-Zulueta, MD1 and Rafael Valdez-Vazquez, MD1, (1)Infectious Diseases, Hospital General Dr. Manuel Gea Gonzalez, Mexico City, Mexico, (2)Hospital Epidemiology, Hospital Juarez de Mexico, Mexico City, Mexico, (3)Hospital Epidemiology, Hospital General Dr. Manuel Gea Gonzalez, Mexico City, Mexico

    Disclosures:

    B. Aguilar-Rodea, None

    M. Cureño-Diaz, None

    R. Valdes-Castro, None

    R. Figueroa-Moreno, None

    F. Alvarez-Montero, None

    J. P. Ramirez-Hinojosa, None

    S. Medrano-Ahumada, None

    P. Rodriguez-Zulueta, None

    R. Valdez-Vazquez, None

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