Multi-drug resistant Acinetobacter baumanii (MDR-AB) has emerged globally as a significant pathogen in hospitals. During 2010, our hospital experienced an increase of MDR-AB in Adult intensive care unit (ICU). Our adult ICU is consists of 10 acute care beds. The hospital is a tertiary institution located in Eastern region of Saudi Arabia. Multidisciplinary team was formed to implement and determine the effect of multifaceted strategies in controlling MDR-AB.
Active surveillance culture (ASC) was initiated to determine the prevalence rate of MDR-AB per 1000 patient days (PD). Using ASC, which was done during admission in ICU, after 48 hours of admission and every week for all patients if there is a positive MDR-AB case, acquisition rate of MDR-AB was calculated per 1000 PD. Average daily colonization pressure was also monitored. In addition, a multifaceted infection control strategies were carried out. These include hand hygiene, contact isolation, cohorting of patients, Chlorhexidine bath, and environmental cleaning and disinfection. Compliance with hand hygiene was observed using direct observation method. We use the Fluorescent Gel Method for evaluating the thoroughness of disinfection and cleaning for environmental surfaces.
Hand hygiene compliance of HCWs initially was 89%, in 2017 was increased to 98%. Daily Chlorhexidine bath was adopted for all patients in ICU. Initially, the compliance for thoroughness of disinfection and cleaning is 84.6% it was increased to 92% in 2013-2017. Prevalence rate of MDR-AB was 20.7/1000 PD in 2010, it was decreased by 50% in 2011-2012. In 2017, declined to 0.9/1000 PD. MDR-AB acquisition rate was 11.8/1000 PD in 2010, it was decreased by 57% in 2011-2012. In 2017, dropped to 0.6/1000 PD. Average daily colonization pressure was 0.21 in 2010. In 2011-2012, it was decreased by 31%. In 2017, it was reduced to 0.02. Death rate among MDR-AB patient in 2010 was 25.7%. It was decreased to 14% in 2011-2012. In 2017, an enormous drop to 0% was achieved.
Implementing these multifaceted strategies help in controlling MDR-AB in our hospital. The commitment and adherence of the HCW to all infection control strategies are essential in sustaining low prevalence rate and acquisition rate of MDR-AB.
A. El Gammal, None