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Controlling an Outbreak of Multidrug-resistant Acinetobacter baumannii in a Pediatric Intensive Care Unit: a
Joung-Hee Byun1,2, Su Eun Park1,3, Minhae Seo1
1Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea.
Background:
Multidrug-resistant Acinetobacter baumannii (MDRAB) is widespread among intensive care units worldwide, posing a threat to patients and the health system. We describe the successful management of a MDRAB outbreak by implementing an infection-control strategy in a pediatric intensive care unit (PICU).
Methods:
This retrospective study investigated the patients admitted to the PICU in periods 1 (8 months) and 2 (7 months), from the index MDRAB case to intervention implementation, and from intervention implementation to cessation of MDRAB spread. An infection-control strategy was designed following six concepts: 1) cohort isolation of colonized patients, 2) enforcement of hand hygiene, 3) universal contact precautions, 4) environmental management, 5) periodic surveillance culture study, and 6) monitoring and feedback.
Results:
Of the 427 patients, 29 were confirmed to have MDRAB colonization, of which 18 had MDRAB infections. Overall incidence per 1,000 patient days decreased from 7.8 (period 1) to 5.8 (period 2). The MDRAB outbreak was declared terminated after the 6-month follow-up following period 2. MDRAB was detected on the computer keyboard and in condensed water inside the ventilator circuits. The rate of hand hygiene performance was the lowest in the three months before and after index case admission and increased from 84% (period 1) to 95% (period 2). Patients with higher severity, indicated by a higher Pediatric Risk of Mortality III score, were more likely to develop colonization (P = 0.030), because they had invasive devices and required more contact with healthcare workers. MDRAB colonization contributed to an increase in the duration of mechanical ventilation and PICU stay (P < 0.001), but did not affect mortality (P = 0.273).
Conclusion:
The MDRAB outbreak was successfully terminated by the implementation of a comprehensive infection-control strategy focused on the promotion of hand hygiene, universal contact precautions, and environmental management through multidisciplinary teamwork.
Insights
A pediatric intensive care unit successfully managed a multidrug-resistant Acinetobacter baumannii (MDRAB) outbreak using a comprehensive infection control strategy. This approach significantly reduced MDRAB incidence and improved hand hygiene compliance.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Hospital Epidemiology
Background:
- Multidrug-resistant Acinetobacter baumannii (MDRAB) poses a significant threat in intensive care units globally.
- Outbreaks of MDRAB require robust infection control measures to protect vulnerable patients.
Purpose of the Study:
- To describe the successful management of an MDRAB outbreak in a pediatric intensive care unit (PICU).
- To evaluate the effectiveness of a multi-faceted infection-control strategy in controlling MDRAB spread.
Main Methods:
- Retrospective study analyzing patient data from two periods before and after intervention.
- Implementation of a six-concept infection-control strategy: cohort isolation, hand hygiene enforcement, universal contact precautions, environmental management, surveillance cultures, and monitoring.
- Data collection on MDRAB colonization, infection, incidence, hand hygiene rates, and patient outcomes.
Main Results:
- MDRAB incidence per 1,000 patient days decreased from 7.8 to 5.8 after intervention.
- Hand hygiene compliance increased from 84% to 95%.
- MDRAB colonization was associated with increased duration of mechanical ventilation and PICU stay, but not mortality.
Conclusions:
- A comprehensive infection-control strategy, emphasizing hand hygiene, contact precautions, and environmental management, effectively terminated an MDRAB outbreak.
- Multidisciplinary teamwork is crucial for successful implementation and sustained control of hospital-acquired infections.
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