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An outbreak of acinetobacter infection associated with the use of a ventilator spirometer
Abstract:
Although respiratory therapy equipment is a well-known source of nosocomial infection, ventilator spirometers have not been previously implicated. We report 17 Acinetobacter calcoaceticus variety anitratus infections traced to contaminated spirometers. Isolates from infected patients were recovered from urine, sputum, wounds, and blood. A review of attack rates for Acinetobacter was prompted by a dramatic increase in blood culture isolates. Prospective surveillance of intensive care environment, personnel, and patients established that Bennett MA-1 spirometers constituted the major reservoir of infecting organisms. Despite daily sterilization, 30% of spirometers in use were found to be contaminated. The hands of 12% of intensive care nurses and 10% of respiratory therapists cultured were found to be colonized. In addition to the infected patients, 28 other patients on spirometer-equipped ventilators were judged to be colonized by Acinetobacter following examination of sputa and/or mouthwashings. Following discontinuation of spirometer use and following increased emphasis on proper handwashing, the incidence of Acinetobacter infections dropped dramatically. Antibiosis in the intensive care environment and a deterioration in aseptic awareness serve to make Acinetobacter an environmental opportunist of increasing importance.
Insights
Contaminated ventilator spirometers caused 17 Acinetobacter infections in patients. Discontinuation of spirometer use and improved hand hygiene significantly reduced Acinetobacter infections, highlighting a critical environmental risk.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Respiratory therapy equipment is a known source of nosocomial infections.
- Ventilator spirometers had not been previously implicated in healthcare-associated infections.
- A significant increase in Acinetobacter blood culture isolates prompted an investigation.
Purpose of the Study:
- To identify the source of Acinetobacter calcoaceticus variety anitratus infections.
- To determine the role of ventilator spirometers in the transmission of Acinetobacter.
- To assess the effectiveness of interventions in controlling Acinetobacter outbreaks.
Main Methods:
- Prospective surveillance of the intensive care environment, personnel, and patients.
- Microbiological culturing of patient samples (urine, sputum, wounds, blood), spirometers, and healthcare worker hands.
- Review of infection attack rates and patient colonization.
Main Results:
- Seventeen Acinetobacter calcoaceticus variety anitratus infections were traced to contaminated Bennett MA-1 spirometers.
- Despite daily sterilization, 30% of in-use spirometers remained contaminated.
- Healthcare worker hands showed colonization (12% of nurses, 10% of therapists), and 28 additional patients were colonized.
Conclusions:
- Contaminated ventilator spirometers served as a major reservoir for Acinetobacter transmission.
- Discontinuation of spirometer use and enhanced hand hygiene protocols led to a dramatic decrease in infections.
- Acinetobacter poses an increasing opportunistic threat in intensive care settings due to antibiotic use and reduced aseptic awareness.