Association of private isolation rooms with ventilator-associated Acinetobacter baumanii pneumonia in a surgical intensive-care unit.
OBJECTIVE
To determine the rates and routes of Acinetobacter baumanii colonization and pneumonia among ventilated patients in a surgical intensive-care unit (SICU) before and after architectural modifications.


METHODS
A nonsequential study comparing two groups of patients. All isolates from systematic and clinical samples were genotyped by pulsed-field gel electrophoresis (PFGE). Records of patients hospitalized during the first and second periods were reviewed and findings were compared. Between the two periods, the SICU was remodeled from enclosed isolation rooms and open rooms to only enclosed isolation rooms with handwashing facilities in each room.


METHODS
All patients hospitalized and mechanically ventilated for more than 48 hours in the 15-bed SICU of the University Hospital of Besançon (France).


RESULTS
For the first and second periods, the rates of colonization were, respectively, 28.1% and 5.0% of patients (P < 10(-7); relative risk [RR], 2.23; 95% confidence interval [CI95], 1.8-2.75) and the specific rates of bronchopulmonary (BP) colonization were, respectively, 9.1 and 0.5 per 1,000 days of mechanical ventilation (P < 10(-5). Seven major PFGE isolate types were identified, 4 of which were isolated from 44 of the 47 colonized or infected patients. Logistic regression analysis showed that colonization was not associated with patient characteristics.


CONCLUSIONS
Conversion from open rooms to isolation rooms may help control nosocomial BP tract acquisition of A baumanii in mechanically ventilated patients hospitalized in an SICU.
Mulin
B
B
Unité d'Hygiène Hospitalière et d'Epidémiologie Moléculaire, Hôpital Jean Minjoz, Faculté de Médecine, Besançon, France.
Rouget
C
C
Clément
C
C
Bailly
P
P
Julliot
M C
MC
Viel
J F
JF
Thouverez
M
M
Vieille
I
I
Barale
F
F
Talon
D
D
D000150:Acinetobacter / Q000302:isolation & purification*; D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D016521:Electrophoresis, Gel, Pulsed-Field; D004866:Equipment Contamination; D005602:France; D006749:Hospital Design and Construction; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D010356:Patient Isolation; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D013514:Surgical Procedures, Operative; D012122:Ventilators, Mechanical