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A five-component infection control bundle to permanently eliminate a carbapenem-resistant Acinetobacter baumannii spreading in an intensive care unit
BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAB) infection outbreaks are difficult to control and sometimes require cohorting of CRAB-positive patients or temporary ward closure for environmental cleaning. We aimed at controlling the deadly 2018 CRAB outbreak in a 12 bed- intensive ca...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8376111/ https://www.ncbi.nlm.nih.gov/pubmed/34412693 http://dx.doi.org/10.1186/s13756-021-00990-z |
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author | Meschiari, Marianna Lòpez-Lozano, José-María Di Pilato, Vincenzo Gimenez-Esparza, Carola Vecchi, Elena Bacca, Erica Orlando, Gabriella Franceschini, Erica Sarti, Mario Pecorari, Monica Grottola, Antonella Venturelli, Claudia Busani, Stefano Serio, Lucia Girardis, Massimo Rossolini, Gian Maria Gyssens, Inge C. Monnet, Dominique L. Mussini, Cristina |
author_facet | Meschiari, Marianna Lòpez-Lozano, José-María Di Pilato, Vincenzo Gimenez-Esparza, Carola Vecchi, Elena Bacca, Erica Orlando, Gabriella Franceschini, Erica Sarti, Mario Pecorari, Monica Grottola, Antonella Venturelli, Claudia Busani, Stefano Serio, Lucia Girardis, Massimo Rossolini, Gian Maria Gyssens, Inge C. Monnet, Dominique L. Mussini, Cristina |
author_sort | Meschiari, Marianna |
collection | PubMed |
description | BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAB) infection outbreaks are difficult to control and sometimes require cohorting of CRAB-positive patients or temporary ward closure for environmental cleaning. We aimed at controlling the deadly 2018 CRAB outbreak in a 12 bed- intensive care unit (ICU) including 9 beds in a 220 m(2) open space. We implemented a new multimodal approach without ward closure, cohorting or temporarily limiting admissions. METHODS: A five-component bundle was introduced in 2018 including reinforcement of hand hygiene and sample extension of screening, application of contact precautions to all patients, enhanced environmental sampling and the one-time application of a cycling radical environmental cleaning and disinfection procedure of the entire ICU. The ICU-CRAB incidence density (ID), ICU alcohol-based hand rub consumption and antibiotic use were calculated over a period of 6 years and intervention time series analysis was performed. Whole genome sequencing analysis (WGS) was done on clinical and environmental isolates in the study period. RESULTS: From January 2013, nosocomial ICU-CRAB ID decreased from 30.4 CRAB cases per 1000 patients-days to zero cases per 1000 patients-days. Our intervention showed a significant impact (-2.9 nosocomial ICU-CRAB cases per 1000 bed-days), while no influence was observed for antibiotic and alcohol-based hand rub (AHR) consumption. WGS demonstrated that CRAB strains were clonally related to an environmental reservoir which confirms the primary role of the environment in CRAB ICU spreading. CONCLUSION: A five-component bundle of continuous hand hygiene improvement, extended sampling at screening including the environment, universal contact precautions and a novel cycling radical environmental cleaning and disinfection procedure proved to be effective for permanently eliminating CRAB spreading within the ICU. Cohorting, admission restriction or ICU closure were avoided. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13756-021-00990-z. |
format | Online Article Text |
id | pubmed-8376111 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-83761112021-08-20 A five-component infection control bundle to permanently eliminate a carbapenem-resistant Acinetobacter baumannii spreading in an intensive care unit Meschiari, Marianna Lòpez-Lozano, José-María Di Pilato, Vincenzo Gimenez-Esparza, Carola Vecchi, Elena Bacca, Erica Orlando, Gabriella Franceschini, Erica Sarti, Mario Pecorari, Monica Grottola, Antonella Venturelli, Claudia Busani, Stefano Serio, Lucia Girardis, Massimo Rossolini, Gian Maria Gyssens, Inge C. Monnet, Dominique L. Mussini, Cristina Antimicrob Resist Infect Control Research BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAB) infection outbreaks are difficult to control and sometimes require cohorting of CRAB-positive patients or temporary ward closure for environmental cleaning. We aimed at controlling the deadly 2018 CRAB outbreak in a 12 bed- intensive care unit (ICU) including 9 beds in a 220 m(2) open space. We implemented a new multimodal approach without ward closure, cohorting or temporarily limiting admissions. METHODS: A five-component bundle was introduced in 2018 including reinforcement of hand hygiene and sample extension of screening, application of contact precautions to all patients, enhanced environmental sampling and the one-time application of a cycling radical environmental cleaning and disinfection procedure of the entire ICU. The ICU-CRAB incidence density (ID), ICU alcohol-based hand rub consumption and antibiotic use were calculated over a period of 6 years and intervention time series analysis was performed. Whole genome sequencing analysis (WGS) was done on clinical and environmental isolates in the study period. RESULTS: From January 2013, nosocomial ICU-CRAB ID decreased from 30.4 CRAB cases per 1000 patients-days to zero cases per 1000 patients-days. Our intervention showed a significant impact (-2.9 nosocomial ICU-CRAB cases per 1000 bed-days), while no influence was observed for antibiotic and alcohol-based hand rub (AHR) consumption. WGS demonstrated that CRAB strains were clonally related to an environmental reservoir which confirms the primary role of the environment in CRAB ICU spreading. CONCLUSION: A five-component bundle of continuous hand hygiene improvement, extended sampling at screening including the environment, universal contact precautions and a novel cycling radical environmental cleaning and disinfection procedure proved to be effective for permanently eliminating CRAB spreading within the ICU. Cohorting, admission restriction or ICU closure were avoided. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13756-021-00990-z. BioMed Central 2021-08-19 /pmc/articles/PMC8376111/ /pubmed/34412693 http://dx.doi.org/10.1186/s13756-021-00990-z Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Meschiari, Marianna Lòpez-Lozano, José-María Di Pilato, Vincenzo Gimenez-Esparza, Carola Vecchi, Elena Bacca, Erica Orlando, Gabriella Franceschini, Erica Sarti, Mario Pecorari, Monica Grottola, Antonella Venturelli, Claudia Busani, Stefano Serio, Lucia Girardis, Massimo Rossolini, Gian Maria Gyssens, Inge C. Monnet, Dominique L. Mussini, Cristina A five-component infection control bundle to permanently eliminate a carbapenem-resistant Acinetobacter baumannii spreading in an intensive care unit |
title | A five-component infection control bundle to permanently eliminate a carbapenem-resistant Acinetobacter baumannii spreading in an intensive care unit |
title_full | A five-component infection control bundle to permanently eliminate a carbapenem-resistant Acinetobacter baumannii spreading in an intensive care unit |
title_fullStr | A five-component infection control bundle to permanently eliminate a carbapenem-resistant Acinetobacter baumannii spreading in an intensive care unit |
title_full_unstemmed | A five-component infection control bundle to permanently eliminate a carbapenem-resistant Acinetobacter baumannii spreading in an intensive care unit |
title_short | A five-component infection control bundle to permanently eliminate a carbapenem-resistant Acinetobacter baumannii spreading in an intensive care unit |
title_sort | five-component infection control bundle to permanently eliminate a carbapenem-resistant acinetobacter baumannii spreading in an intensive care unit |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8376111/ https://www.ncbi.nlm.nih.gov/pubmed/34412693 http://dx.doi.org/10.1186/s13756-021-00990-z |
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