Use of vaporized hydrogen peroxide decontamination during an outbreak of multidrug-resistant Acinetobacter baumannii infection at a long-term acute care hospital.
OBJECTIVE
To describe vaporized hydrogen peroxide (VHP) as an adjuvant in the control of multidrug-resistant (MDR) Acinetobacter baumannii infection in a long-term acute care hospital (LTACH) and to describe the risk factors for acquisition of MDR A. baumannii infection in the LTACH population.


METHODS
Outbreak investigation, case-control study, and before-after intervention trial.


METHODS
A 54-bed LTACH affiliated with a tertiary care center in northeastern Ohio.


METHODS
Investigation of outbreak with clinical and environmental cultures, antimicrobial susceptibility testing, polymerase chain reaction assay of repetitive chromosomal elements to type strains, and case-control study; and intervention consisting of comprehensive infection control measures and VHP environmental decontamination.


RESULTS
Thirteen patients infected or colonized with MDR A. baumannii were identified from January 2008 through June 2008. By susceptibility testing, 10 (77%) of the 13 isolates were carbapenem-resistant. MDR A. baumannii was found in wound samples, blood, sputum, and urine. Wounds were identified as a risk factor for MDR A. baumannii colonization. Ventilator-associated pneumonia was the most common clinical syndrome caused by the pathogen, and the associated mortality was 14% (2 of the 13 case patients died). MDR A. baumannii was found in 8 of 93 environmental samples, including patient rooms and a wound care cart; environmental and clinical cultures were genetically related. Environmental cultures were negative immediately after VHP decontamination and both 24 hours and 1 week after VHP decontamination. Nosocomial acquisition of the pathogen in the LTACH ceased after VHP intervention. When patients colonized with MDR A. baumannii reoccupied rooms, environmental contamination recurred.


CONCLUSIONS
Environmental decontamination using VHP combined with comprehensive infection control measures interrupted nosocomial transmission of MDR A. baumannii in an LTACH. The application of this novel approach to halt the transmission of MDR A. baumannii warrants further investigation.
Ray
Amy
A
Division of Infectious Diseases and HIV Medicine, University Hospitals Case Medical Center, Cleveland, Ohio 44106-5083, USA. Amy.Ray@uhhospitals.org
Perez
Federico
F
Beltramini
Amanda M
AM
Jakubowycz
Marta
M
Dimick
Patricia
P
Jacobs
Michael R
MR
Roman
Kathy
K
Bonomo
Robert A
RA
Salata
Robert A
RA
D000151:Acinetobacter Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D040981:Acinetobacter baumannii / Q000235:genetics / Q000302:isolation & purification*; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D003666:Decontamination / Q000379:methods*; D004196:Disease Outbreaks / Q000517:prevention & control; D024901:Drug Resistance, Multiple, Bacterial; D006761:Hospitals; D006801:Humans; D006861:Hydrogen Peroxide / Q000008:administration & dosage*; D017053:Infection Control / Q000379:methods*; D008134:Long-Term Care; D009820:Ohio / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D014835:Volatilization
D006861:Hydrogen Peroxide